Nearly one in five American adults struggles with some form of mental illness, and ED visits for children who attempted suicide or had suicidal thoughts are increasing. The current health care system is failing too many of these patients, making it difficult for them to find appropriate care. Emergency departments are often their only option, although many emergency departments aren’t optimized to provide psychiatric care. Patients with mental health concerns often remain in emergency departments for hours, sometimes days, as follow-up transfers or community care options are secured.

ACEP has prioritized these issues, advocating for legislative and regulatory changes that would help reduce barriers to treatment and provide more tools and resources for physicians to help meet their patients’ needs. At the same time, we’ve been developing clinical tools and resources to help emergency physicians manage mental health patients in the emergency department. Like many other public health concerns, patient access to mental health care in the emergency department is a complicated problem that requires multipronged solutions.

Advocating for Change

As ACEP advocates for comprehensive mental health care reform, we have seen many ACEP-supported provisions included in House and Senate legislative efforts to enact mental health care reforms in the past few years, including:

• Creating an Assistant Secretary for Mental Health and Substance Use and the National Mental Health and Substance Use Policy Lab
• Extending the Assisted Outpatient Treatment grants and instituting grants for assertive community treatment
• Establishing liability protections for health professional volunteers at community health centers
• Extending suicide prevention programs
• Reauthorizing grants to help train emergency medical personnel to recognize individuals with mental health issues and how to intervene
• Encouraging the Centers for Disease Control and Prevention to improve its National Violent Death Reporting System
• Expanding the mental health workforce
• Clarifying HIPAA privacy rules for patients with mental illness and their caregivers
• Eliminating the Medicaid same-day exclusion
• Seeking additional information about Medicaid managed care plan provision of services for adults at an institution for mental diseases
• Studying participation in the Medicaid Emergency Psychiatric Demonstration project
• Enhancing compliance with mental health and substance use disorder insurance coverage

During the 2019 ACEP Leadership & Advocacy Conference, 500 ACEP members asked their legislators to support H.R. 2519, Improving Mental Health Access from the Emergency Department Act. This important piece of legislation, developed by ACEP, would:

• Expedite transition to post-emergency care through expanded coordination with regional service providers, assessment, peer navigators, bed availability tracking and management, transfer protocol development, networking infrastructure development, and transportation services;
• Increase the supply of inpatient psychiatric beds and alternative care settings such as regional emergency psychiatric units; and
• Expand approaches to providing psychiatric care in the emergency department, including tele-psychiatric support and other remote psychiatric consultations, peak period crisis clinics, or creating dedicated psychiatric emergency service units.

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On June 26, the U.S. House Committee on Ways and Means unanimously approved a bill, H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act, to provide patient improvements for rural services provided by Medicare. This bill incorporated a provision based on the ACEP-supported Mental Health Telemedicine Expansion Act that would improve treatment of mental health by providing telehealth services to individuals at home.