By Erin Nelson, Director of Strategy, and Meredith Letendre, Healthcare Strategist

Providing adequate care for patients with behavioral health issues is a growing challenge for healthcare providers. Behavioral health spans a range of conditions from eating disorders to substance abuse and touches all demographics.

Unfortunately, the number of dedicated behavioral health beds in the United States has been declining, dropping 13% between 2010 and 2016. It’s estimated that an additional 123,300 psychiatric beds are needed to alleviate the shortage.[i] This shortage is largely attributed to low reimbursement rates for these patients, and consequently it is financially challenging for hospitals to sustain behavioral health programs.

As a first line of care, behavioral health patients often present in the emergency department. EDs aren’t conducive to caring for the majority of patients in this population: They can be loud and chaotic and don’t offer the calm environment necessary for patients struggling with certain behavioral health conditions. Additionally, depending on the condition, sometimes these patients can also be disruptive to other patients.

Treating behavioral health patients in the ED also drives up costs. These patients are often considered a lower priority in the ED,  and they are likely boarded until an inpatient bed opens up, or they are eventually discharged or transferred to another facility. Given the high cost of ED care, boarding patients in this setting leads to longer length of stays, driving up costs for the hospital.

On top of high costs and reduced capacity, the field is also struggling with provider recruitment. Caring for behavioral health patients can be draining for providers, and they are typically reimbursed less than other specialists. The number of providers retiring is higher than the number of people enter the field, so it’s estimated that by 2025 there could be a 12% to 25% deficit in the workforce.[ii]

Moving Care out of the ED

Patients with behavioral health issues are largely misunderstood and stigmatized. They often feel ashamed, although control of their condition is out of their hands. A lot of work has been done to raise awareness and remove the stigma, but more understanding is needed. There are a few solutions that could improve care and remove the burden from overstressed EDs and start to shift treatment into the outpatient setting

  • Primary care: PCPs can address behavioral health proactively to catch symptoms early and redirect the patient to appropriate treatment before a visit to the ED becomes necessary.
  • Crisis centers attached to EDs: Crisis centers allow for the easy transfer of a patient from the ED to an alternative model of care right on campus. These centers are equipped with staff trained in behavioral health and infrastructural resources to manage and treat patients appropriately and efficiently.
  • Telehealth: Telehealth is vital for rural hospitals and medical facilities that may not have the on-site expertise for a particular behavioral health diagnosis. Combined with its lower costs, telehealth helps increase access in rural communities.
  • Collaborative community efforts: Behavioral health treatment should not be isolated to one particular provider type; instead, resources across the community, when working together, can treat the whole person in the most efficient way possible. A community effort involves a continuum of care, from the school district to primary care to hospitals to the state. The sum of the parts is greater than the whole. 

Proper Care Takes a Village

Given the challenges in behavioral health care, it is becoming increasingly important to leverage collaborative models of care by pooling community resources. A wide range of providers and services need to come together to assess the current state of behavioral health resources in the community and determine the service area’s future direction in the space, including:

  • Hospital systems
  • County government
  • Mental health centers, including substance abuse and community crisis centers
  • County jail
  • Police department
  • Transitional housing facilities
  • Local chapters of national mental health associations
  • Department of Health
  • Department of Aging
  • School district

Currently, each group is trying to solve behavioral health in its own silo. Coming together to tackle this health issue as a community allows each to bring its unique perspective and experience on what may or may not work and, ultimately, will improve the quality of care that these patients receive.


[i] “Amid shortage, number of psychiatric beds in US down 13% from 2010. Becker’s Hospital Review. Aug 2 2016. https://www.beckershospitalreview.com/patient-flow/amid-shortage-number-of-psychiatric-beds-in-us-down-13-from-2010.html

[ii] “The Psychiatric Shortage: Causes and Solutions.” National Council Medical Director Institute. Mar 28 2017. https://www.thenationalcouncil.org/wp-content/uploads/2017/03/Psychiatric-Shortage_National-Council-.pdf