The past decade has seen a dramatic increase in the number of Americans arriving at emergency rooms with mental health concerns. A report by the Healthcare Cost and Utilization Project found that ER visits for depression, anxiety and stress jumped 55 percent between 2006 and 2013. Visits by people with psychosis and bipolar disorder increased 52 percent.
Why the rise in ER visits for mental health?
While some research has indicated that the overall rates of mental illness in the United States may have increased, some patients just may not know where else to go when they are feeling depressed or anxious—and they often don’t start treatment until a crisis sends them to the ER, says Amy Faith Ho, MD, an emergency medicine doctor and assistant medical director at John Peter Smith Hospital in Fort Worth, Texas.
“A lot of resources—such as therapy, community psychiatrists and mental health clinics—are simply not available in a lot of places, and as a result there is not a lot of prevention for mental health issues,” Dr. Ho explains. “Instead, we end up having to wait until the patients act out in a way that puts them into acute harm, and only then is the health community able to intervene.”
When the ER is ill-equipped to help mental health patients
The problem with this “wait until it gets really bad” strategy, according to Ho, is that many ERs don’t have the resources to handle mental health emergencies.
“At my hospital, we are fortunate to have a psychiatric ER, but that is not typical,” she says. “In hospitals without a psych ER or psychiatry department, it’s not uncommon for patients who come in with mental health concerns to spend hours or even days in the ER waiting for placement in a facility that can better help them, especially if they don’t have insurance.”
What’s more, Ho explains, the ER may not have the resources to start the patient on a proper plan of treatment. In cases like these, she says, “the ER is not doing much for them, except making sure they’re not hurting themselves and getting them somewhere else that can help.”
In fact, a 2014 survey by the National Alliance on Mental Illness found that 2 out of 5 patients who had visited ERs for mental-health emergencies rated their experience as “bad” or “very bad,” with the main complaints being poor staff communication, limited access to extra resources and long wait times.
Challenges to obtaining regular mental health care
Even when patients don’t seek out the ER to begin with, many aggravating factors can disrupt a patient’s ability to find non-urgent mental health care, says Russell L. Margolis, MD, a psychiatrist and clinical director of the Johns Hopkins Schizophrenia Center in Baltimore, Maryland.
“There are a lot of situations where an ER visit is not necessary, but in many cases, people are dealing not just with mental illness but with substance abuse and a family or financial crisis, so that multiple supports are pulled away from an individual who is vulnerable,” he explains.
For example, studies have shown that rates of unemployment increase with the severity of mental illness, and many of those with mental illness who do not seek care say that lack of money or insurance is the main reason.
The result is that the ER—which typically should be a last resort—often becomes the first.
Where to turn in a mental health crisis
Dr. Margolis says that if you are already undergoing treatment with a psychiatrist or therapist, it’s always best to contact them first in a crisis.
“It makes sense for that person, or their family, to contact their current treatment team, because there may already be a specific plan in place for an emergency and the patient may be able to avoid an ER visit or hospital admission,” he says.
By sticking with someone who knows your history of symptoms and treatment, you will also receive better continuity of care, which is crucial in mental health treatment, says Ho.
When to head to ER
Of course, there are cases where a visit to the ER is not only appropriate but is potentially life-saving.
If a patient is having thoughts of harming themselves or anyone else, and their treatment team is not immediately available or the situation is immediately dangerous, an ER visit is essential right away, says Margolis. The same goes for if you are experiencing acute hallucinations or psychosis, adds Ho. It such cases, you may need to have someone take you to the ER.
If you or a loved one is in crisis and you need help right away, you can also call the National Suicide Prevention Lifeline at 1-800-273-8255 or call, text, or chat 988.
If you have a choice, Ho suggests you choose an ER in a hospital that has a psychiatric unit or department; they are more likely to have the staff and resources in place to get you the help you need.
How to seek help for mental health
When it comes to mental health, the best strategy is always to find help before you reach that moment when you need to dial 911 or walk into an ER. Here are some options to explore:
- Talk to your primary care physician. She can refer you to a mental health professional, or in some cases provide appropriate care herelf. “Much psychiatric care is provided by primary care physicians because there is not enough expert psychiatric care to go around,” points out Margolis.
- Call your insurance company and ask about referrals to mental health clinics and providers. They will let you know what you are covered for and can provide a list of in-network doctors.
- Go to the Substance Abuse and Mental Health Services Administration (SAMHSA) website, where you can input your address to find mental-health treatment centers in your area. You can also call their toll-free helpline at 1-800-662-4357 for referrals. The National Institute of Mental Health also has online resources to help you find treatment.
- Contact your local university or medical school to see if they have a psychiatry or psychology program that provides mental health care.
- Search online for providers using tools like Sharecare’s Find a Doctor directory.
- Consider telemedicine. Many telemedicine apps now provide face-to-face therapy via your computer or smartphone. “This is the one disease where you don’t really need to physically examine the patient, you really need to talk to them,” says Ho.
Telemedicine for mental health—online therapy sometimes known as “telemental health”—is also growing among health-care facilities, particularly those in rural areas. A study published in 2017 in the journal Health Affairs found that telemental health visits increased on average 45 percent annually between 2004 and 2014.
