By many measures, the nation's mental health crisis is growing and with a lack of access to appropriate care, hospital emergency departments are often where patients seeking behavioral care show up.
Over the past decade, the number of adult and pediatric emergency department visits involving mental health concerns has increased. From 2018 to 2020, the average rate of mental health-related ED visits among adults was 53.0 per 1,000 adults, according to CDC data. Among children, the rate was 14.0 per 100,000. More than half of adults report they or a family member have experienced a severe mental health crisis, KFF survey data shows.
At Edison, N.J.-based Hackensack Meridian Health, expanding access to behavioral healthcare to prevent mental health crises and ease pressure on emergency departments is a top priority. The health system handles around 120,000 behavioral health visits per year across its emergency departments and in outpatient settings — figures that are more than double pre-pandemic levels.
"It's heartbreaking," Robert Garrett, CEO of Hackensack Meridian Health, told Becker's. "I never thought I'd see this in my lifetime or my career, but we're actually seeing children who are 4 and 5 years old attempting suicide. We never saw that before. This is a huge crisis at every age group, every demographic group and every geographic area of the country."
Over the past few years, the organization has taken an innovative approach to create more care access points for behavioral health patients. In 2019, Hackensack Meridian was the first system in the nation to open an urgent care behavioral health center. From 2022 to 2023, around 3,000 patients were seen — patients who otherwise may have ended up in the emergency department.
"Depending on that initial urgent care visit and on the advice of the professional seeing the patient, if they are in crisis, they can then be referred to one of our hospitals for care," Mr. Garrett said. "Some really can be treated on an outpatient basis, but the beauty of being seen quickly in the urgent care center is if additional intervention is necessary, they can make that referral right there."
In addition, telepsychiatry hubs have gone live across all of the system's emergency departments over the past year, allowing patients to connect with a psychiatric provider through telehealth.
Early identification of behavioral health needs and care coordination are a core part of this work, Mr. Garrett said. For instance, Hackensack Meridian has opened clinics where social workers can check in with patients between mental health visits, as appointments can often be two to three months apart.
"Sometimes that intervention can significantly reduce crisis," he said.
Screening is also proving successful in connecting patients with critical resources such as housing and transportation, which ultimately can affect the state of their mental health. Of more than 1.5 million patients screened for social determinants of health, the health system has made more than 3 million referrals, more than half of which were for behavioral health services.
And leaders are often looking at data to determine services for which there is an increasing need by region. That led to a decision to open 52 additional pediatric and adolescent inpatient beds at Hackensack Meridian Health Carrier Clinic, a project set to be completed in 2025.
While speaking at Politico's 2024 Health Care Summit in March, Mr. Garrett called for a national effort to address the nation's behavioral health crisis akin to the commitments the country has put forward through the Cancer Moonshot.
"We really need an all-out effort to involve the government, providers, patients and researchers all getting together and addressing this," and reduce the rate of mental illness and mortality, he said.