Behavioral health urgent care clinics are growing in popularity in the last five years as a way to provide mental health care outside of EDs.
Over the past decade, the number of adult and pediatric emergency department visits involving mental health concerns has increased. More than half of adults report they or a family member have experienced a severe mental health crisis, KFF survey data from 2022 shows. From 2018 to 2020, the average rate of mental health-related ED visits among adults was 53 per 1,000 adults, according to CDC data. Among children, the rate was 14 per 100,000.
"The changes in the prevalence and acuity of mental health in the population will require a new approach to addressing these emerging issues," Erick Messias, MD, PhD, chair of psychiatry at Saint Louis University and chief medical officer for behavioral health at SSM Health Saint Louis, told Becker's.
About 20% to 25% of children presenting in the ED with psychiatric emergencies need critical and life-saving care, the other 80% are in the ED unnecessarily, Michael Scharf, MD, chief psychiatrist at University of Rochester (N.Y.) told Becker's.
"Many families and children recognize an urgent need for help but don't require interventions like restraints or locked units," Dr. Scharf said.
The first mental health urgent care center was opened by Edison, N.J.-based Hackensack Meridian Health in 2019. In about two years, at least 77 more behavioral urgent care sites were opened across the nation, with about 20 of those opening in 2024. Systems praise the model for freeing up ED beds and lowering patient costs.
It appears that behavioral health urgent cares are most common in states with Medicaid expansions, Tracey Kaly, director of clinical operations at Tampa-based BayCare's Behavioral Health Urgent Care, told Becker's. BayCare will be opening the first behavioral health urgent care in Florida thanks to $3.5 million in opioid settlement funds.
How it works
Every behavioral health urgent care works differently depending on the system, however they all hold to the same tenets — provide walk-in mental healthcare to people in crisis.
"Behavioral health urgent care addresses the 'middle zone' between routine outpatient care and emergency or crisis-level care," Ms. Kaly said.
Saint Louis University Hospital's behavioral urgent care has helped 200 people in the first two months. A third of those were recommended for inpatient admission, but the rest received follow-up care through the outpatient network.
"A significant number of people are coming for urgent assessment, most for anxiety and depression, with another large number of people needing medication refills and adjustment," Dr. Messias said.
The University of Rochester's urgent care aims to fill gaps in immediate and follow-up care by providing walk-in services, short-term care and community connections to coordinate care for patients.
"Because we're part of a large health system, we can provide ongoing care for most patients who don't already have a provider," Dr. Scharf said. "This integration ensures our urgent care isn't just a one-time solution but part of a larger continuum of care."
BayCare's facility will only be open to adults, with plans to expand to adolescent care in the future. The facility is placed between the inpatient services and outpatient services to allow for a "seamless continuum of care," Ms. Kaly said.
The pros
Part of the appeal of behavioral health urgent care is the immediate access and early intervention opportunities. Patients can receive care when they need it and systems have an opportunity to connect them with the right level of care depending on their need.
The formula can also help follow-up care by connecting patients with the appropriate people.
"Patients leave knowing exactly where to go for their next step in care," Ms. Kaly said. "This design mitigates the common issue of patients receiving urgent care but lacking access to ongoing treatment."
In New York, Project TEACH is a child psychiatric access program that allows primary care providers to consult with child psychiatrists during follow-up visits, Dr. Scharf said. This can improve collaboration and care.
The cons
Leaders have found a few challenges with the urgent care model.
First, it can be difficult for patients to find transportation to an urgent care clinic, and Medicaid and ride-share programs do not always cover the cost of transportation. Involuntary transports for mental health conditions, especially among children being transported through law enforcement actions, also raises concerns about where to take these children.
"A local car dealership donated a van to us, which we hope will help us provide transportation for children who are calm and cooperative but don't have access to a ride," Dr. Scharf said. "Currently, the average wait time for an ambulance in our region is four hours. We want to reduce that time and offer a less intimidating experience for families."
Another con is the expense to maintain the care centers with unpredictable utilization patterns, Dr. Messias said, and "there is also a risk of becoming the de facto outpatient network, which "is not the intention."
Staffing concerns and managing volume at the centers is also a challenge, Ms. Kaly said.
"Urgent care is just one of the possible answers to [the behavioral health care] challenge," Dr. Messias said. "The role of virtual mental healthcare and social and community-based care are some of the opportunities on the horizon."