America’s mental health crisis among youth has escalated to alarming levels, with new research revealing a troubling pattern of extended stays for children in hospital emergency departments. According to the latest study conducted by Oregon Health & Science University (OHSU), a significant number of young patients suffering primarily from suicide-related behaviors and depression are forced to linger in emergency rooms for three days or longer, unable to access the inpatient care they urgently need. This emerging trend highlights a growing gap between the demand for behavioral health services and the capacity of healthcare systems to deliver timely, appropriate care.
The pivotal study, recently published in the esteemed medical journal JAMA Health Forum, leverages data from Medicaid claims in 2022 to scrutinize patterns of psychiatric emergency department (ED) utilization among youths. Analysis of more than 255,000 emergency visits for mental health conditions among Medicaid-enrolled children revealed that over 10 percent of these encounters culminated in “boarding” — where patients remain in the emergency department because no suitable inpatient psychiatric beds are available. Disturbingly, these children often remain in the chaotic, non-therapeutic environment of the ED for between three to seven days.
This prolonged boarding is far from ideal and has profound implications for the wellbeing of these vulnerable patients. Lead author John McConnell, Ph.D., director of the OHSU Center for Health Systems Effectiveness, emphasizes that in a well-functioning healthcare system, boarding would rarely, if ever, occur. The reality is starkly different: for many young patients in psychiatric crisis, the absence of available acute care beds or appropriate residential behavioral health facilities leaves EDs as a last resort, despite their limitations as treatment environments.
Young patients experiencing a mental health crisis typically require immediate and specialized intervention, yet the scarcity of dedicated psychiatric beds forces hospitals to use emergency departments as holding areas. This is a stopgap that can exacerbate distress and delay recovery. As McConnell explains, families often arrive at the emergency department hoping for prompt admission to suitable care, but frequently encounter bottlenecks that lead to prolonged stays in a setting ill-equipped to provide focused mental health treatment.
The escalating demand for pediatric psychiatric services has outpaced system capacity over recent years, a trend visible even within a single institution like OHSU Doernbecher Children’s Hospital. Rebecca Marshall, M.D., associate professor of psychiatry and director of the pediatric psychiatry consult service at OHSU, reports that the need for psychiatric evaluations in the emergency department at Doernbecher has nearly tripled—from 150 consultations in 2016 to 453 in the past year alone. This surge reflects a nationwide trend of increasing mental health emergencies among young people and underscores critical systemic shortcomings.
The impact of boarding on children, families, and hospital staff is profound. Dr. Marshall notes that pediatric healthcare professionals enter the field motivated by a desire to improve the lives of children, yet witnessing patients languish in emergency settings without appropriate care can be deeply demoralizing. The prolonged stays not only fail to meet the complex therapeutic needs of these patients but may also lead to deterioration in their condition. Moreover, staff face the challenge of balancing care for multiple sick patients simultaneously, intensifying workplace strain and burnout.
From a clinical perspective, emergency departments are designed primarily for acute stabilization and triage rather than sustained psychiatric care. Children languishing within these units experience an environment that typically lacks the structured therapies and specialized support integral to effective mental health treatment. This mismatch between patient needs and care environment can prolong recovery and increases the risk of adverse outcomes, including worsening symptoms and heightened risk of self-harm or suicide.
The findings highlight an urgent need for structural reforms and investment in the continuum of care for young patients experiencing psychiatric crises. McConnell points out that no single institution or payer bears sole responsibility for managing mental health among Medicaid-enrolled populations. Addressing this complex challenge requires coordinated efforts across healthcare delivery systems, insurers, policymakers, and community resources to develop a network capable of providing timely, effective inpatient and outpatient services.
To mitigate the boarding crisis, systemic enhancements must focus on expanding inpatient psychiatric capacity, improving transition pathways from emergency departments to specialized care settings, and fortifying community-based behavioral health services that may prevent crisis escalation. Additionally, innovations in care delivery models—such as telepsychiatry, mobile crisis teams, and integrated care programs—hold promise in addressing gaps and reducing the strain on emergency facilities.
The research team at OHSU includes not only Dr. McConnell but also co-authors Thomas Meath, M.P.H., and Lindsay Overhage, B.A., with Overhage currently pursuing an M.D./Ph.D. at Harvard Medical School. Their meticulous analysis stands as a clarion call emphasizing the critical shortage of adequate psychiatric resources for the most vulnerable demographic: Medicaid-enrolled youth in crisis.
This study was funded by the National Institute of Mental Health, a division of the National Institutes of Health, underscoring the national priority of addressing mental health care disparities and system inefficiencies. While the research provides stark evidence of the boarding crisis, it also serves as a foundational piece for policy discussions and reforms aiming to enhance mental health infrastructures across the country.
Broader societal factors, including the increased pressures of modern adolescence, socioeconomic disparities, and systemic deficiencies in early intervention, contribute to the rising incidence of mental health crises among youth. The resultant strain on emergency departments reflects a failure to build preventative and therapeutic systems capable of absorbing growing demand before crises reach emergency thresholds.
In summary, the prolonged psychiatric emergency department boarding of Medicaid-enrolled youths signals a deeply entrenched challenge in pediatric mental health care. Confronting this crisis calls for immediate attention from clinical leaders, health administrators, and policymakers committed to crafting an integrated, responsive system that can deliver timely, effective care for children facing mental health emergencies. Without such concerted action, thousands of young lives remain at risk, caught in an emergency care limbo that undermines recovery and burdens an already strained healthcare infrastructure.
Subject of Research: People
Article Title: Variations in Psychiatric Emergency Department Boarding for Medicaid-Enrolled Youths
News Publication Date: 15-Aug-2025
Web References: http://dx.doi.org/10.1001/jamahealthforum.2025.3177
References: Oregon Health & Science University Center for Health Systems Effectiveness; JAMA Health Forum; NIH/National Institute of Mental Health
Keywords: Clinical psychology, Emergency rooms, Age groups, Adolescents, Human behavior
