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RESEARCH WEEKLY: How Does Adding More Beds Affect Emergency Department Visits for
Mental Illness?
(November 21, 2019) Emergency department visits for mental health treatment have
been steadily increasing in recent years, far outpacing population growth and emergency
visits for other health concerns. Solutions differ from one community to the next
and have had varied results in helping to reduce demand on emergency departments
and improve outcomes for people with mental illness.

One of the more common solutions implemented, in part to its relatively low cost
compared to other options like increasing numbers of inpatient beds, is to expand
the psychiatric emergency department. New research published this month in Psychiatric
Services suggests that this is a narrow resolution and may not actually produce
the effect that is intended.
Although north of the US border, Toronto, Canada has many similarities to large
urban centers in America. The city has seen a large increase in mental health emergency
department visits and a growth in demand for inpatient beds, but the government
or hospital systems have not met that demand by opening more beds. Instead, one
hospital doubled the size of their psychiatric emergency department to address the
overcrowding.
Researchers from Toronto evaluated the effect of this expansion looking at administrative
health records over time at all seven hospitals in the area. By including data from
all hospitals in the region, the study authors hoped to capture the effect of this
emergency department expansion beyond just the individual hospital, but the system
overall.
The authors found that the rate of emergency department visits for mental health
concerns continued to increase after the expansion of the hospital. Therefore,
as a system, the rate of mental health visits for emergency department visits did
not decrease by the expansion of the hospital emergency department. However, the
opening of more psychiatric emergency capacity in one hospital in the region significantly
shifted traffic in the emergency departments to the one that had more space.
The authors warn that this narrow view on service capacity decisions for mental
health can have detrimental effects. The growth of system wide mental health emergency
visits they observed was coupled with no change in inpatient bed numbers. The authors
argue that this suggests that there is a decreasing proportion of emergency department
visits resulting in admission to the hospital. A growing pressure on acute care
without the subsequent increases in bed numbers can have negative impacts on the
hospitals and overall system, such as reducing length of stay or increasing the
thresholds for admission. These policies are associated with "less safe treatment
environments, poorer patient outcomes, and systematic neglect of a significant proportion
of the population in need of care," according to the authors.
Service expansion decisions should consider the whole system, according to the authors,
as well as look to the full continuum of psychiatric care for people with mental
illness. Without this systems and whole person approach, the increase in demand
for acute mental health care may have detrimental effects on quality of care for
individuals.
To learn more about boarding of people with serious mental illness in emergency
departments and the how the availability of psychiatric beds plays a role in our
latest evidence brief, Delayed and Deteriorating [[link removed]],
[[link removed]]
available [[link removed]]
here [[link removed]].
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Elizabeth Sinclair Hancq
Director of Research
Treatment Advocacy Center
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References:

*
Reid, N., et al. (2019, November). Effect of a psychiatric emergency department
expansion on acute mental health and addiction service use trends in a large urban
center. [[link removed]]
Psychiatric Services.
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Questions? Contact us at [email protected] [mailto:[email protected]]
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Research Weekly is a summary published as a public service of the Treatment Advocacy
Center and does not necessarily reflect the findings or positions of the organization
or its staff. Full access to research summarized may require a fee or paid subscription
to the publications.
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The Treatment Advocacy Center does not solicit or accept funds from pharmaceutical
companies.
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