Decreasing mental health services drives up ED utilization

Decreasing mental health services leads to higher and more costly utilization of emergency departments, according to a recent study. Reductions in inpatient and outpatient psychiatric services in Sacramento County, Calif., have led to more than triple the amount of emergency psychiatric consults and a 55 percent increase in lengths of stay for psychiatric patients in local emergency departments.

"The emergency department catches everyone who falls through the cracks in the healthcare system," said lead author Arica Nesper, MD, MAS, University of California Davis School of Medicine Sacramento, in a press statement. "People with mental illness did not stop needing care simply because the resources dried up. Potentially serious complaints increased after reductions in mental health services, likely representing not only worse care of patients' psychiatric issues but also the medical issues of patients with psychiatric problems."

Sacramento County decreased its inpatient psychiatric beds from 100 to 50 and closed its outpatient unit, and between 2009 and 2011, $587 million was cut from mental health services in the state. The study authors found the average number of daily psychiatry consults in the emergency department increased from 1.3 to 4.4, and the average length of stay for patients requiring psychiatric consults in the emergency department increased by 55 percent. 

"These budget cuts affect individual patients as well as communities and facilities like emergency departments that step in to care for patients who have nowhere else to turn,” Nesper added. “They ultimately led to a five-fold increase in daily emergency department bed hours for psychiatric patients. That additional burden has ripple effects for all other patients and the community."

The study authors concluded that the findings have policy implications for addressing the challenges of psychiatric needs in communities.