US had ‘psychiatric boarding crisis’ during COVID-19 pandemic
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Key takeaways:
- Pediatric mental health services were not prepared for the number of youths needing care during the COVD-19 pandemic.
- A lack of beds and staff may have contributed to the hardship.
There was a “psychiatric boarding crisis” in the United States during the COVID-19 pandemic, as psychiatric services were not prepared to support the number of youths needing care, researchers reported in JAMA Network Open.
It has been almost 2 years since the AAP declared a national emergency over youth mental health in the U.S. Researchers have been investigating the COVID-19 pandemic’s role in the crisis.
For the new study, researchers cataloged 7,625 psychiatric emergency services encounters of patients aged 4 to 20 years who attended one of five mobile clinics operated by the Boston Emergency Services Team in Massachusetts.
From those encounters, the researchers found that the average monthly rate of boarding — when admission to a psychiatric facility is delayed — increased from 37.4% to 62.7% during the COVID-19 pandemic. The number of publicly insured youths who boarded also increased compared with pre-pandemic levels.
They also found that compared with the pre-pandemic period, patients who boarded during the pandemic were less likely to have a diagnosis or stress or adjustment disorder, but were more likely to have an eating disorder or a developmental delay diagnosis. Following adjustment, the researchers determined that the odds of an encounter resulting in boarding doubled during the pandemic (adjusted OR = 2.03; 95% CI, 1.82-2.26; P<.001).
“These findings suggested that during the pandemic, publicly insured youths in our study were more likely to board and less likely to be discharged to the standard of care for which they were boarding,” they wrote. “High boarding rates coupled with lower discharge rates to [inpatient and community-based treatment facilities] suggested an insufficient number of IPU and CBAT beds were available during the pandemic.”
In a related editorial, Abigail L. Donovan, MD, a researcher in the department of psychiatry at Massachusetts General Hospital and Harvard Medical School, called the issue of pediatric mental health “the other pandemic.”
“Although increases in boarding during the pandemic are well established, the Herrera et al 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,” Donovan wrote.
“Perhaps even more importantly, while youths were stable at the time of discharge, for some, this stability was short lived; they subsequently had more readmissions within 30-days after discharge and more repeat encounters overall. For these youths, boarding was a temporizing measure, not a definitive treatment.”
Ignoring this warning, Donovan continued, has “potentially devastating consequences” for the future.
“These findings serve as both warning and a call to action,” Donovan wrote. “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.”
References:
Donovan AL, et al. JAMA Netw Open. 2023;doi: 10.1001/jamanetworkopen.2023.21754.
Herrera C, et al. JAMA Netw Open. 2023;doi: 10.1001/jamanetworkopen.2023.21798.
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