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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, available here.
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Elizabeth Sinclair Hancq
Director of Research
Treatment Advocacy Center
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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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