ED Boarding Crisis Overview: Past Present Future

by Aden Huang, written under the auspices of Winchester's Network for Social Justice

What do you do when there are no more beds in the Emergency Department (ED) to accommodate patients? For many years, hospitals nationwide have been faced with this pressing question, as a series of hospital closures and policy changes have led to an influx of people struggling with their mental health to seek help by going to the ED, and it is a question that I have wondered about. As a Leader for an Equitable Tomorrow (LET) intern this summer, I decided to dedicate some time and space toward exploring this question. The LET program is a partnership between the Network for Social Justice and Social Capital Inc. that is funded by Winchester Hospital Community Benefits with a mission to engage students to find ways to explore and address topics pertaining to youth mental health. I specifically decided to explore ED capacity because of how close it hits to home at Winchester Hospital, but also how broad the crisis is affecting the entire country. 

When EDs are at their limit, the only thing individuals in crisis can do is sit in the waiting room, or even the hallways of the hospital, to wait their turn for an open room. This unfortunate phenomenon is known as the Emergency Department (ED) Boarding Crisis and involves everyone of all ages, including a concerning number of teenagers. 

What makes the ED Boarding Crisis so difficult to resolve is the finite amount of mental health resources available. Whether it be bed and staffing shortages, or even just financial constraints, the crisis intertwines many aspects of the healthcare system, which operate as a system of gears. Each part is necessary for the entire system to run smoothly, so when one is compromised, the other parts are severely affected as well.

The COVID-19 pandemic especially exacerbated the crisis as people were more prone to experience mental health issues while isolated at home, especially youth who value peer interactions and connections as a core part of growing up. According to a CDC press release published in March 2022, researchers surveyed high school students and “more than a third (37%) of high school students reported they experienced poor mental health during the COVID-19 pandemic.” 

Not only was there an increase of people struggling with their mental health, but the ED was inundated with COVID-19 patients, limiting the ED’s capacity and dissuading folks in need of mental health services from seeking ED help due to fears of contracting COVID-19. 

Although the acute hospital crisis caused by the pandemic relatively subsided in 2022, the ED boarding crisis has not. This raised serious concerns from ED employees who sounded the alarm to state legislatures. To aid the crisis, State Senator Cindy Friedman (Fourth Middlesex District) and State Senator Julian Cyr (Cape and Islands) co-sponsored a bill dubbed the “ABC” bill which stood for “Addressing Barriers to Care.” The bill was signed into law in August 2022 by Former Governor Charlie Baker and included the creation of a streamlined online portal that would provide real-time data about open ED beds, boarding numbers, and much more.

Former Massachusetts Attorney General Maura Healey, now Governor of Massachusetts, announced in October 2022 that a $2.9 million grant program would be created to mitigate the ED Boarding Crisis. The money would go to funding diversionary alternatives and services for mental health patients waiting for hospital beds. The hope was that it would alleviate the pressure of having people go to the ED and instead receive treatment elsewhere, like at home via telehealth services.

Although these two notable efforts to address the ED Boarding Crisis make tremendous ground on the path of ending the issue, the crisis still affects EDs today. Both merely laid the foundation of more to come as State Senator Friedman explains how “[The ‘ABC’ bill] is just a start and we will be continuously monitoring the mental health care landscape in the Commonwealth and around the country to look for ways that we can improve care here.” 

In April 2023, Senator Shelley Moore Capito (R-WV) and Senator Maggie Hassan (D-NH) reintroduced the “Improving Mental Health Access from the Emergency Department Act” bill, which directly addresses the crisis on a national level. The bill includes better coordination between providers and hospitals, a grant funding program for EDs, funding for alternative care locations like regional emergency psychiatric units, and much more.

While it might seem that everyday individuals do not have the power to affect the ED Boarding Crisis, that is certainly not the case. Without awareness, issues like the ED Boarding Crisis too often go under the radar of the public eye. Supporting family and friends who might be struggling with their mental health can go a long way. Not only that, reaching out to legislators and urging them to pass future bills can further alleviate the issue. It is imperative to stay informed and raise awareness about the crisis. It is my hope that you as a reader pass on some things you have learned through this article and continue to spread awareness about the crisis.