A new study published in JAMA Health Forum finds that children experiencing mental health crises in emergency departments often board for extended periods while waiting for inpatient psychiatric beds. Roughly one in ten mental health emergency visits for children enrolled in Medicaid resulted in stays of three days or longer. In some states including North Carolina, Florida, and Maine, as many as 25% of mental health visits led to children boarding in the emergency department for 3 to 7 days. The most common crises requiring hospitalization were depressive disorders and suicidal thoughts and attempts, according to the study led by John McConnell, director of the Center for Health Systems Effectiveness at Oregon Health and Science University.
Systemic Capacity Shortages
The crisis reflects a broader failure to build adequate pediatric psychiatric capacity. Oregon has only 38 beds for highest-need pediatric psychiatric cases and less than 200 residential beds for lower-acuity treatment. States have not kept pace with the rising behavioral health crisis in children. Most emergency departments do not have a child and adolescent psychiatrist on staff. According to Dr. Rebecca Marshall, an associate professor of child and adolescent psychiatry at Oregon Health and Science University, “we’ve just never invested in the resources to have this kind of service for kids.” Without adequate outpatient services to prevent crisis escalation and without sufficient inpatient beds, families take children to emergency rooms where no immediate care is available.
Harm to Children’s Development and Health
Children boarding in emergency departments spend extended periods in confined spaces, often windowless rooms, unable to leave, exercise, or interact with other children—experiences that can worsen symptoms. Adequate outpatient services are critical to preventing children from reaching crisis points, yet according to Dr. Jennifer Havens, chair of the department of Child and Adolescent Psychiatry at NYU Grossman School of Medicine, “there’s an enormous problem across the country with a lack of access to mental health services, both on the inpatient and outpatient side.” When children do end up boarding in emergency departments, they miss therapeutic activities available in inpatient psychiatric units, delaying needed treatment and potentially exacerbating their conditions.
The study analyzed only Medicaid claims, but the problem extends to children with private health insurance as well.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.npr.org/sections/shots-health-news/2025/08/15/nx-s1-5502689/pediatric-mental-health-er-boarding-jama-health-forum