Behavioral health drives rise in ER visits in New Jersey

A new report from the New Jersey Hospital Association found that patients with behavioral health diagnoses, especially those with substance abuse problems, were responsible for a disproportionate share of the increase in emergency department visits in the state over the last five years.

The state report comes on the heels of a survey and several studies released recently by the American College of Emergency Physicians (ACEP) that found that emergency departments are often clogged with psychiatric patients who are waiting for inpatient care. Nationally, about half of emergency physicians said mental health care in their communities was worse this year than last. That percentage was 49 percent in Pennsylvania and 38 percent in New Jersey.

The New Jersey report found that total visits to emergency departments increased by 7 percent between 2011 and 2015, from 2,988,786 to  3,205,580.  Behavioral health visits, though, increased by 31 percent, from 447,561 to 588,305.  Substance abuse, which is considered a behavioral health diagnosis,  was up even more: 36.8 percent.  The number of ED patients with that diagnosis rose from 251,366 in 2011 to 343,882 last year.   Some patients may have both a mental illness and substance use disorder.

Officials from both the hospital and emergency physicians group said that emergency departments are often not the best place for people with mental health problems because the setting can be loud and chaotic. ACEP leaders  said their departments had become "dumping grounds" for the mentally ill and addicted because of inadequate inpatient and outpatient services elsewhere in their communities.

"The emergency department becomes the safety net for folks that otherwise are not receiving care, for whatever reason, that might be more appropriate," said  Mary Ditri, director of professional practice for the New Jersey Hospital Association.

"I think you can safely say that, if there were better access to care, it would help folks avoid crisis care in the emergency department."

The New Jersey report found that patients with behavioral health emergencies accounted for 14.9 percent of ED visits in 2011 compared to 18.35 percent last year.  People with substance use diagnoses were 8.4 percent of ED patients in 2011 and 10.7 percent in 2015.

The number of behavioral health patients without insurance fell from 143,511 in 2011 to 83, 943, a decline the association attributed to expansion of the state's Medicaid program.