An increasing number of patients are getting stuck in Massachusetts emergency rooms as they wait for appropriate treatment for behavioral health issues, according to new research from the Massachusetts Health Policy Commission.
Patients are considered to be “boarding” in emergency departments if they stay longer than 12 hours.
The report says the percentage of behavioral health patients boarding in Massachusetts emergency rooms jumped from 31.3% in 2020 to 38.8% in the period between January and May of 2024.
That figure includes patients seeking care for issues of substance abuse. When the researchers looked at patients admitted to emergency departments specifically for mental health related issues, they found that nearly half of them in May 2024 stayed for more than 12 hours.
Although fewer patients are being admitted to Massachusetts hospitals now than there were several years ago, occupancy rates are increasing, because patients are staying longer.
In 2016, 3.8% of all hospital stays in the state were over 30 days. By 2023, that increased to 8.6%. Four of the top 10 diagnoses among those long-stayers were mental health conditions, with schizophrenia being the most common reason.
“This growing trend of behavioral health ED boarding is not only harmful for these patients and their families, but also impacts hospital staff, non-[behavioral health] patients, and emergency medical services across the Commonwealth,” Health Policy Commission executive director David Seltz said in a written statement.
The percentage of boarding in emergency departments has been a longstanding problem in Massachusetts. The study points to a number of causes.
“Boarding occurs for variety of reasons,” said Laura Nasuti, director of research and analytics at the Massachusetts Health Policy Commission. “A patient gets to the emergency department, and they either need an inpatient placement and a bed is not yet available or they need to be referred to care in the community and that care plan or community resource is not yet available. Or they’re just waiting in the ED for certain medical clearance in order to get placed in the next setting of care.”
Last year, the problem was compounded by the closure of Nashoba and Carney Hospitals , resulting in a loss of 129 beds, according to the report.
The report breaks down the demographics of behavioral health patients who were “boarded” in Massachusetts emergency departments in 2023. A third of those patients were Black, Hispanic or some race other than white. Fifty-six percent were male, and 11% aged 17 or younger. Nearly half of them had health insurance through MassHealth, the state’s insurance program that includes Medicaid and the Children’s Health Insurance Program.
