Wednesday, July 12, 2023

Psychiatric ‘Boarding’ Found More Likely During Pandemic for Youth With Public Insurance

Youth who were insured by Medicaid or other public programs and experienced a psychiatric emergency in Massachusetts during the COVID-19 pandemic were more likely to be held in the emergency department (“boarded”) than those who experienced such emergencies before the pandemic. Moreover, youth who were boarded during the pandemic were more likely to have readmissions to the emergency department within 30 days compared with prior to the pandemic. These findings were published in JAMA Network Open.

“Psychiatric boarding occurs when patients who accessed psychiatric emergency services … require treatment in an inpatient psychiatric unit … or community-based acute treatment … facility but experience administrative delays in their transfer and remain under clinical supervision in suboptimal care,” wrote Carolina Nicole Herrera, M.A., Rachel Oblath, Ph.D., and Alison Duncan, M.D., of Boston University.

Herrera and colleagues evaluated data from 7,625 encounters with publicly insured patients aged 4 to 20 years who were evaluated by a mobile crisis team between January 2018 and August 2021. Specifically, the researchers examined what happened after the initial evaluation by the mobile crisis teams—comparing such outcomes as the youth’s psychiatric boarding and repeat hospital visits—before the pandemic (January 2018 to March 2020) with what happened during the pandemic (March 2020 to August 2021). The authors considered the youth to have been psychiatrically boarded if they required 24-hour psychiatric care and an inpatient psychiatric unit or community-based acute treatment bed was unavailable within six hours of the disposition decision.

The average age of youth who were evaluated by the mobile crisis teams was 13.6 years; 48% identified as male; 36%, Black; 36%, Hispanic; and 91% spoke English. During the pandemic, the youth were twice as likely to be boarded in the emergency department as they were before the pandemic. These youth were also 64% less likely to be admitted to the hospital. Additionally, youth who were boarded during the pandemic had 2.2 times the rate of 30-day readmissions compared with those who were boarded before the pandemic.

In an accompanying editorial, Abigail Donovan, M.D., of Massachusetts General Hospital said the report paints a stark picture of psychiatric emergency services for youth insured by public programs during the pandemic: “[This] article is the first to demonstrate that compared with pre-pandemic, during the pandemic, publicly insured youths evaluated by a [mobile crisis team] who were boarding for a higher level of care were less likely ever to receive the treatment for which they were waiting,” she wrote. “Perhaps even more importantly, while youths were stable at the time of discharge, for some, this stability was short-lived … .”

Donovan concluded, “We must establish long-term plans for overhauling the mental health care system, implement immediate clinical innovations to prevent harm to vulnerable populations, and conduct additional research to delineate the current crisis further and evaluate future solutions. Only by taking these steps can we hope to repair our mental health care system before it collapses.”

For related information, see the Psychiatric News article “Congress Hears Testimony on Need for Robust MH Crisis Services.”

(Image: iStock/pablohart)

Nominations Now Open for APA Components and Board of Trustees

APA’s success hinges on the expertise, knowledge, and input of its members. Learn more about APA leadership opportunities and nominate yourself or a colleague by Tuesday, August 15, for component service and Friday, September 1, for the Board of Trustees.



The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.