In a deeply concerning trend, a new study has found that thousands of children in mental health crises are being left in hospital emergency rooms for days, sometimes for nearly a week, because there's nowhere else for them to go. A report published in JAMA Health Forum by researchers at Oregon Health & Science University (OHSU) sheds light on this growing crisis.
The Scope of the Crisis
Using 2022 Medicaid data from 44 states, the study analyzed over 255,000 pediatric mental health ER visits. It found that about 12% of those visits—over 30,000 children—resulted in "boarding" in the ER for three to seven days while they waited for a proper placement.
This practice stands in stark contrast to healthcare standards set by The Joint Commission, which recommends that pediatric mental health patients be stabilized and moved out of the ER within four hours. Extended stays can put patient safety at risk, delay the start of necessary treatment, and strain hospital resources.
According to Dr. John McConnell, the lead author of the study, the findings confirm what many have long suspected. "It points to a big gap in getting timely, appropriate care," he said, noting his surprise at the frequency of such long stays. The issue is especially pronounced for children with suicidal thoughts or severe depression, conditions that have become more common in recent years, with youth suicides rising by 62% between 2007 and 2021.
The Lack of Resources and Accountability
McConnell emphasizes that the core problem is a significant shortage of both inpatient beds and outpatient services for children. This lack of available treatment options has turned emergency departments—traditionally built for physical injuries—into a default solution for mental health crises.
Dr. Rebecca Marshall, who was not involved in the study but leads the pediatric psychiatry consult service at OHSU Doernbecher Children’s Hospital, sees this firsthand. She says her hospital's pediatric psychiatric visits have nearly tripled since 2016. Marshall points out that this is not just a Medicaid problem; it affects children with private insurance as well.
The ER is not a therapeutic environment. Marshall says that kids can feel "disoriented and disappointed" while in limbo, and the confined, stressful atmosphere can make their conditions worse, sometimes leading to agitation or lashing out. At times, she notes, as many as half of her hospital's pediatric ER beds are occupied by children waiting for behavioral health placement, forcing staff to improvise space for other emergencies.
"These aren't just numbers," Marshall stated. "They represent real kids, real families, and the hospital staff trying to help them in a space that was never meant for this." She believes that while staff can be trained and activities can be added, you can't turn an ER into a therapeutic space. "If we want kids to get better, we have to put them in the right environment," she said.
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