A recent nationwide study uncovers a pressing crisis in pediatric mental health: among Medicaid-enrolled children, more than one in ten visits to emergency departments (EDs) for mental health reasons resulted in prolonged stays—commonly known as “boarding”—lasting three to seven days.
The Scope of the Problem
Researchers analyzed Medicaid claims data from 2022 covering approximately 255,000 pediatric ED visits for mental health concerns. Alarmingly, over 10% of these visits ended with the child remaining in the emergency department for three days or more, due to a shortage of inpatient psychiatric beds. These extended stays place children in environments neither designed nor equipped for ongoing mental health care.
Behind the Findings
Dr. John McConnell, the study’s lead author and a systems effectiveness expert, emphasizes that emergency departments are being transformed into holding areas—not healing spaces—for young patients experiencing mental health crises. At OHSU’s Doernbecher Children’s Hospital alone, psychiatric consultations in the ED have nearly tripled, highlighting a surge in demand against mounting systemic bottlenecks.
A Strain on Children, Families & Staff
These prolonged stays take a heavy emotional toll. As Dr. Rebecca Marshall, director of pediatric psychiatry at OHSU, notes, healthcare professionals enter their field aimed at helping children—but watching young patients languish in inappropriate, stressful settings can be deeply demoralizing. The ED environment—optimized for medical emergencies and stabilization—is ill-suited for treating complex mental health needs. This mismatch not only delays recovery but may also worsen conditions and increase risks, including self-harm.
What’s Driving the Crisis?
The study and expert observers point to several critical factors:
- A dearth of inpatient psychiatric beds and step-down services.
- Gaps in community-based crisis care, leaving EDs as default safety nets.
- A fragmented system of responsibility—with no single organization accountable for managing mental health needs among Medicaid-enrolled youth.
- A rising influx of pediatric mental health emergencies, particularly since the pandemic.
Paths to Improvement
Experts believe that reducing pediatric ED boarding requires systemic and coordinated responses:
- Expanding inpatient psychiatric capacity and community-based crisis resources.
- Creating specialized crisis units—such as EmPATH centers—where patients receive focused, calming care outside the chaotic ED setting.
- Implementing telepsychiatry and mobile crisis teams to support rapid assessment and relieve pressure on emergency departments.
- Strengthening coordination across insurers, hospitals, policymakers, and community providers to create an integrated continuum of mental health services.
A Call to Action
The study, supported by the National Institute of Mental Health, serves as a clarion call. Without timely interventions, thousands of vulnerable children will remain caught in an emergency care limbo—unable to access the treatment they urgently need.
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