Decreased Funding For Mental Health Services Results in Crowded, Strained Emergency Rooms

Dr. Arica Nesper

Dr. Nesper Interview with:
Arica Nesper, MD, MAS
Resident Physician
Stanford/Kaiser Emergency Medicine Residency
Stanford University Medical Center
Department of Emergency Medicine

Medical Research: What is the background for this study? What are the main findings?
Dr. Nesper: Patients with severe mental illness are a distinct demographic in the emergency department. Unfortunately, resources to help these vulnerable patients are frequently the target of funding cuts. We aimed to describe the effect of these cuts on our emergency department and the care provided to our patients. In this study we evaluated data from before our county mental health facility cut its inpatient capacity by half and closed its outpatient unit, and compared this data with data collected after this closure. We found that the mean number of daily psychiatric consultations in our emergency department more than tripled and that the average length of stay for these patients increased by nearly eight hours. These two data combined demonstrate a five-fold increase in daily emergency department bed hours for psychiatric patients, placing a significant strain on the emergency department and demonstrating a delay in definitive care provided to these vulnerable patients.

Medical Research: What should clinicians and patients take away from your report?

Dr. Nesper: Clinicians and patients should understand the importance of high quality and accessible mental health services in our communities. A lack of available mental health resources has a profound impact on clinicians and staff working in the emergency department as well as patients, both those with and without mental health needs, seeking care in our emergency departments. This is a need that we as a society must acknowledge and address as a priority in policy and practice moving forward.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Nesper: This study demonstrates the impact of decreased mental health services on the flow in the emergency department and the care provided to patients with mental health needs, highlighting the importance of high quality and appropriately available mental health care in our communities. Future research is needed to better understand how best to improve the care provided to this vulnerable patient population and how to make it more readily accessible.


Arica C. Nesper, Beth A. Morris, Lorin M. Scher, James F. Holmes
Effect of Decreasing County Mental Health Services on the Emergency Department. Annals of Emergency Medicine, 2015

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Arica Nesper, MD, MAS (2015). Decreased Funding For Mental Health Services Results in Crowded, Strained Emergency Rooms 

Last Updated on November 22, 2015 by Marie Benz MD FAAD