Cutbacks in capacity at state and county mental hospitals have forced more and more psychiatric patients to seek treatment . But a new study led by the Perelman School of Medicine at the University of Pennsylvania, found that people who visit emergency rooms for mental health care were transferred to another facility at six times the rate of people who visit ERs for non-psychiatric conditions, and could wait almost two hours longer. The study is published today in the September issue of Health Affairs and highlights a persisting shortfall in emergency psychiatric services in the country.

“Previous research shows that patients in the ER often experience lengthy wait times, but our new study shows that psychiatric patients wait disproportionately longer than other patients – sometimes for several hours – only to ultimately be discharged or transferred elsewhere,” said lead author Jane M. Zhu, MD, MPP, a National Clinician Scholar in the department of General Internal Medicine at the Perelman School of Medicine at the University of Pennsylvania, and a fellow at Penn’s Leonard Davis Institute of Health Economics. “Overall, the study highlights the degree to which emergency departments struggle to meet the needs of mental health patients.”

The study examined length-of-stay data for more than 200,000 psychiatric and non-psychiatric ER visits during 2002-2011. Length-of-stay is a standard measure of ER crowding and access to services. The dataset came from the National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual survey by the Centers for Disease Control and Prevention that derives national estimates of various measures of health care provision based on visits to sample hospitals.

The analysis showed that for the vast majority of psychiatric patients, the average length-of-stay was significantly longer than for non-psychiatric patients: 355 versus 279 minutes for patients admitted for observation, 312 versus 195 minutes for patients who were transferred to other facilities, and 189 versus 144 minutes for patients who were discharged.

For patients who were eventually admitted to the hospital, the average length-of-stay for psychiatric patients wasn’t significantly different than for their non-psychiatric counterparts, but fewer than one-fifth (18 percent) of psychiatric patients fell into this category.