MH/BH- Hundreds of thousands of Medicaid patients seek mental health care in emergency rooms

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[MM Curator Summary]: A new study begins to quantify how much ED is used for mental health in multiple states.



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A study by Oregon Health & Science University found that patients in Iowa, Nevada and Ohio had the highest rates of use, while Oregon was in the middle


Emergency rooms, like the one at Oregon Health & Science University, end up boarding mental health patients who have no where else to go. (Christine Torres Hicks/OHSU)

A new study shows that hundreds of thousands of low-income patients seek mental health care every year in emergency departments across the country rather than in clinics designed to treat them.

Those patients include thousands of Oregonians, the study’s lead author told the Capital Chronicle.

John McConnell, a health economist at Oregon Health & Science University, led the study, which he said was one of the first of its kind to use newly available Medicaid data to chart emergency department visits for mental illness. 

“Mental health is very important to the Medicaid program,” McConnell said. “Medicaid covers a disproportionate number of people with mental health conditions. It’s hard to really measure access to mental health care, so you can consider this a proxy for access to care.”

Published in the journal Health Affairs, the study looked at 12 million adults in 2018 on Medicaid, which covers one in four in Oregon and nearly as many nationwide. The researchers found that these patients in some states – Iowa, Nevada and Ohio – had the highest number of per-capita emergency department visits for mental health care, while patients in other states – Colorado, West Virginia and Arizona – sought emergency care for a mental health issues at the lowest rates nationwide.

Oregon fell in the middle.

McConnell said that probably reflects an emphasis in Oregon on keeping people on Medicaid out of emergency departments. Regionally based insurers, called coordinated care organizations, manage care for Oregon’s Medicaid patients. The state has pressured them to reduce the rate of ER visits for mental health care, especially among patients with severe and persistent conditions.

McConnell estimated that Medicaid patients in Oregon sought emergency mental health care up to 12,000 times in 2018.

“In a perfect world, we don’t want a lot of people to go to the ER to get their mental health care,” McConnell said. “It’s a place that takes all comers. It’s really designed for acute care. A lot of mental health treatment requires something more than an hour-long visit.”

Mental health treatment can take time and sometimes requires medication. Residential facilities and clinics are designed to treat these patients – and can do so successfully, experts say.

Although Oregon falls in the middle in the study, nationwide surveys have shown a high prevalence of mental illness in Oregon and a low access to treatment. This session, the Legislature is looking again at boosting funding to expand residential treatment capacity and attract more workers to the field.

The study did not analyze why the patients sought help in emergency departments rather than clinics or other facilities. But researchers said this is something for states to look at. 

“Do high rates of utilization for both ambulatory and emergency mental health care suggest a region under duress, or are they an indicator of high capacity and low quality? Or do they reflect idiosyncratic patient preference and provider coding practice?” the study asked.

Researchers found little correlation between visits for anxiety and schizophrenia or between visits for depression and suicide.

“These findings suggest that a ‘one-size-fits-all’ solution to improving mental health may be less effective than programs likely tailored to the local population’s needs,” the study said.