Transfer and discharge delays continue to plague Minnesota mental health, substance use disorder patients

New study highlights underlying reasons for delays, opportunities for improvement

The Minnesota Department of Health (MDH) released a new study today detailing reasons for the prolonged transfer and discharge delays experienced by mental health and substance use disorder patients who seek hospital care in Minnesota.

Findings from this study conducted by Wilder Research and MDH’s Health Economics Program provide insights into the anguish that being held in hospital settings – a practice called boarding – can cause for patients, families, caregivers and hospital staff by pointing to specific factors such as the lack of next-setting care for mental health and addiction services. The study also sheds light on characteristics of patients most affected by transfer and discharge delays.

The 14-day study of 33 emergency departments and 13 inpatient units at Minnesota hospitals observed that though emergency departments and inpatient units are a critical access point for life-saving stabilization and treatment, gaps in the chain of behavioral health care have led to an over-reliance on these settings. The study showed that 17% of people being treated for mental health or substance use disorders experienced a discharge delay from inpatient care and that the delays averaged eight days per patient. The most common reason for discharge delays was a lack of available beds in a safe setting like inpatient psychiatric units and intensive residential treatment service facilities for adult and pediatric patients.

“We know that people being treated in the hospital or emergency department for behavioral health disorders have more delays in their discharge than Minnesotans who do not have these conditions. This reality is particularly acute for Black Minnesotans,” said Minnesota Commissioner of Health Dr. Brooke Cunningham. “Discharge delays also contribute to the shortage of hospital beds. This study suggests that more community-based services such as intensive residential treatment services for mental health or chemical dependency treatment for addiction recovery are two strategies among many that are needed to help reduce time to discharge.”

Whether a patient had state public insurance program coverage was the leading predictor for experiencing delays. According to the study, 75% of patients who experienced a discharge delay from inpatient care were covered by Medicaid or MinnesotaCare, despite accounting for just 46% of patients admitted with behavioral health diagnoses. The study also found a disproportionate percentage of inpatient delays impacting Minnesotans of color and specifically those who identify as African American or African-born.

“The results of the study are important but also don’t come as a surprise,” noted Sue Abderholden, executive director of NAMI (National Alliance on Mental Illness) Minnesota. “We know all too well that youths and adults with mental illnesses languish in our ERs without treatment and comfort. They face long wait times for every level of care in our mental health system and stay in the highest level of care longer than needed due to lack of community options. We believe it is critical that solutions include improving access by increasing reimbursement rates, addressing the workforce shortage and increasing the diversity of the workforce.”

The emotional cost to patients and families of boarding is significant, as is the economic cost to hospitals when accommodating patients who are ready to be transferred to an inpatient bed or discharged to community-based services.

“There is a strong consensus that patients waiting in a hospital setting when they can be discharged is harmful to patients, caregivers, hospital staff and the health care system,” noted Kristin Dillon from Wilder Research, a lead author on the study and similar previous studies in Minnesota and Maryland. “However, we cannot take steps to effectively address these discharge delays without understanding the underlying reasons behind the delays and which parts of the behavioral health system can have the greatest impact on reducing these delays.”

The study indicates that creating additional post-hospital infrastructure is a key element of reversing Minnesota’s stubborn boarding issue. At the same time, the data show that streamlining the transfer and discharge processes could have significant benefits and should be an important policy goal.

“The issue is not just how frequently delays occur, because boarding and decompression are not new,” MDH Researcher Nate Hierlmaier added. “This study points to concrete steps such as increasing residential treatment capacity and addressing administrative barriers that could make a real difference for patients boarding in emergency departments and hospital beds. Additionally, recommendations from a recent study by the Minnesota Department of Human Services (DHS) point to the importance of adequate payment rates as an additional component in addressing capacity challenges.”

An approach aimed at helping youth has been the Mental Health Collaboration Hub, funded by MDH. The hub is a statewide virtual networking center aimed at helping children and youth who are boarding in hospitals and emergency departments get connected to mental health treatment settings. To date, this program has helped hundreds of children. Preliminary data collected from October 2023 to January 2024 through the hub showed a 55% reduction in days children or youth boarded, or 24 fewer days. Approximately 80% of youth entered in the hub’s virtual community were able to discharge in less than 45 days.

During the 2024 session, the Minnesota Legislature passed additional budget and policies designed to assist in expediting hospital discharges and increasing access to behavioral health services. The legislature added additional mental health beds to the state’s direct care and treatment system, funded rate increases for some outpatient mental health services and residential substance use disorder services paid for through Medicaid, and made policy changes to improve access to supports in the community.

The Minnesota Study of Behavioral Health Discharge Delays included a study sample of 182 inpatients and 537 emergency department patients experiencing delays at Minnesota hospitals during a 14-day period between Sept. 5 and Oct. 20, 2023. More findings from the study are available on the MDH Health Economics Program website.

-MDH-

Media inquiries:
Garry Bowman  
MDH Communications
651-529-5164
[email protected]