Emergency departments across the country are caught in a familiar bind: behavioral health patient boarding for hours or days, medical beds occupied, staff stretched thin and a laundry list of resources often complicating the patients care journey.
Four health systems are attacking the problem from different angles: mobile crisis response, telehealth-enabled treatment, flexible physician infrastructure and dedicated psychiatric stabilization units — with no one-size-fits-all approach.
The most effective boarding strategy may be interception before a patient enters the hospital.
Novant Health Presbyterian Medical Center in Charlotte partnered with North Carolina’s MORES program — mobile outreach, response, engagement and stabilization — which launched in 2023 and serves individuals ages 3 to 21 experiencing non-life-threatening emotional or behavioral health crises. Teams of clinicians trained in adolescent care paired with a family peer support specialist, respond within an hour and can provide follow-up support in the home for up to eight weeks.
The impact on the ED has been stark. Behavioral health patients previously occupied 50% to 70% of pediatric emergency department rooms, with at least half classified as “unpreventable social holds,” according to Courtney Cortes, MSN, RN, director of nursing for emergency services. Since the partnership’s inception, those patients account for fewer than 10% of pediatric rooms on any given day.
Length of stay for those pediatric behavioral health patients dropped from an average of four to six weeks to an average of 2.11 days, excluding four outliers.
Between June 2023 and Dec. 31, 2025, program teams engaged with 645 children and families, following up an average of 1.6 times per week during the eight-week post-contact window. Satisfaction was high: 96% of caregivers and 94% of adolescents said the service was appropriate for their needs. The program now operates across 20 North Carolina counties.
At St. Louis-based SSM Health, the system carries the highest capacity of psychiatric beds in Missouri, which means EMS providers frequently bypass other hospitals to bring behavioral health patients directly to their facilities. That volume creates its own pressure.
“There are days where we can have 10 to 15 patients sitting in the ED waiting on an inpatient psych bed,” said Becky Dvorak, MSN, RN, regional vice president of behavioral health.
SSM’s response: Do not wait. Nurse practitioners and psychiatrists are assigned to evaluate boarding patients via telehealth and initiate medication before a bed becomes available. Although psychiatric medications do not offer instant relief, early administration can improve outcomes along the boarding continuum. At DePaul Hospital, SSM’s 124-bed flagship behavioral health facility, the telehealth team conducted roughly 3,700 consults last year alone.
A centralized intake team handles next-step decision-making, connecting patients deemed appropriate for outpatient care directly to appointments through the EMR while also linking them with food banks, homeless shelters and transportation resources.
“Sometimes a patient will come to the emergency department with a diagnosis of a psych problem,” Ms. Dvorak said. “But a lot of times what they need is not necessarily any type of psychiatrist help. They need a lot of psychosocial services. They need help just getting set up on ‘Where am I going to sleep tonight?’ Or, ‘How am I going to pay for food? How am I going to get my transportation?’”
SSM also established a behavioral health urgent care — separate from the ED, staffed by psychiatric nurse practitioners, nurses and social workers — to catch patients who have run out of medication or could not secure a timely psychiatrist appointment. A grant now enables EMS providers to be reimbursed for transporting appropriate patients there directly, bypassing the ED entirely.
Through a separate grant, SSM created an ED evaluation program targeting high utilizers.
“Ninety-five percent of the time they don’t need to be admitted,” Ms. Dvorak said. “They’re just trying to get a need met.”
For WellSpan’s Good Samaritan Hospital in Lebanon, Pa., the constraint was physical. The hospital has five designated behavioral health beds in its emergency department — and behavioral health volume has grown 100% over three years.
“We’re having to hold people outside of those rooms on a daily basis,” said hospital President Tina Citro, DNP, RN. “There are more patients than there are safe rooms.”
The hospital’s solution was to redesign a set of ED rooms to serve either medical or behavioral health patients, converting between uses in seconds. Staff with programmed badges can lock two wooden doors that conceal medical equipment and supplies and reinforced steel doors prevent unauthorized exits. When a patient arrives, clinical staff can complete the required medical screening exam with full equipment access, then seal off that equipment once the patient is cleared medically and awaiting behavioral health placement — eliminating the ligature risks that make standard medical rooms unsafe for psychiatric patients.
The hospital now has nine potential behavioral health beds. During peak respiratory virus season, the flex rooms shift back toward medical use, giving the department elasticity it did not previously have.
“We really need flex rooms because more behavioral health rooms are great,” Dr. Citro said. “But it’s that patient coming in and we’re doing the medical exam, where do we put them? They’re still at risk.”
The project used a multidisciplinary development team spanning behavioral health, clinicians, nursing, security and patient safety, with staff safety as an explicit design priority. The $1 million renovation was funded by a Pennsylvania Department of Human Services grant.
At the Medical University of South Carolina in Charleston, the strategy is structural separation. Rather than managing behavioral health patients within the general ED, the system opened EmPATH units — emergency psychiatric assessment, treatment and healing — designed to move patients out of the medical emergency department and into a dedicated therapeutic environment before a clinician even sees them.
“If we can move them into a safe space, like an EmPATH unit, then before the clinician comes and sees them, the therapeutic environment that they are in should help in calming them down, and hopefully will help them stabilize better,” said Lalithkumar Solai, MD, chief of mental health at MUSC.
The units are equipped for therapeutic activities including music, relaxation and group therapy, staffed by licensed counselors, nurses and a psychiatric provider. Patients can remain for up to 72 hours — long enough for a crisis to resolve without requiring inpatient admission.
The goal is diversion. A patient who arrives suicidal after a breakup, under traditional ED flow, would likely be admitted. In an EmPATH unit, a therapist can work with that patient on coping skills, help them reframe the crisis and reconnect them with outpatient resources — avoiding hospitalization entirely.
Sustainability hinges on reimbursement. In South Carolina, Medicaid does reimburse for the EmPATH model — a prerequisite, Dr. Solai said, for long-term viability.
“We can do all of these things, but if the payers don’t pay, then it’s not going to be a sustainable model five years from now,” said Dr. Solai.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.