Study highlights nationwide reliance on emergency departments for mental health care

Oregon Health & Science University researchers measured wide differences among U.S. states in the number of people who turn to hospital emergency departments for treatment of mental health conditions through Medicaid, highlighting the lack of suitable care in many states.

The findings published today in the February edition of the journal Health Affairs.

The study is the first to examine mental health access through emergency departments for patients enrolled in Medicaid, which provides health care coverage to 90 million Americans. The disparate reliance on emergency departments among states comes amid a national mental health crisis identified by the Biden administration.

“We know that access to mental health care is a problem,” said lead author John McConnell, Ph.D., director of the OHSU Center for Health Systems Effectiveness and a professor of emergency medicine in the OHSU School of Medicine. “This study confirms that it’s more of a problem in some areas than in others. If I were a federal policymaker, I’d be pretty concerned about states at the top and want to know what’s happening there.”

Researchers tracked Medicaid data from 2018. They found that Ohio, Nevada and Iowa had the largest number of per-capita visits to emergency departments for mental health conditions among Medicaid beneficiaries while Colorado, West Virginia and Arizona had the least.

Hospital emergency departments will always be a resource for people who need timely care for mental health conditions. However, McConnell said heavy reliance on emergency departments for behavioral health is problematic.

“If lots and lots of people are going to the emergency department for mental health care, it may be that they’re not finding access to care in a less-acute setting,” he said. “Emergency departments are trained in handling urgent and acute health needs, but they’re not necessarily a good fit for the long-term well-being of people in need of mental health treatment.”

The study marks the first extensive use of a newly available set of Medicaid claims data known as the Transformed Medicaid Statistical Information System Analytic Files, or TAF.

McConnell said he expects the database will be a burgeoning source of research going forward.

“There will be a lot more coming,” he said. “Medicaid is a huge, huge program that has really not received a lot of attention.”

In addition to McConnell, co-authors on the study included Kelsey Watson, M.P.H., biostatistician in the OHSU Center for Health Systems Effectiveness; Esther Choo, M.D., M.P.H., professor of emergency medicine; and Jane Zhu, M.D., assistant professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine.

The research was supported by the Silver Family Foundation; National Institute of Mental Health award R01MH123416; the National Institute on Drug Abuse award R01DA044284; and the National Institute of Mental Health award K08MH123624. McConnell is supported by grants from the Robert Wood Johnson Foundation; the Commonwealth Fund, Arnold Ventures; the National Institute on Minority Health and Health Disparities; the National Institute on Drug Abuse; and the National Institute on Aging.