Pediatric Emergency Department Boarding

There is a crisis affecting the delivery of behavioral health care to children in Massachusetts, and research shows that children and teens are likely to wait for longer periods of time than adults.

Boarding occurs when a person presents in the Emergency Department (ED) requiring inpatient psychiatric care, but there are no appropriate psychiatric placements available. Patients are often stuck waiting for weeks, even months, in hospital EDs, in non-psychiatric medical units, or at home. There are many reasons children may experience boarding, but one of the most important is that the pediatric behavioral health system is overwhelmed by demand, resulting in delayed and inconsistent treatment.

Read our 2017 report: Pediatric Psychiatric Boarding: Using Data to Develop Policy Solutions

COVID-19 and “Boarding”

The COVID-19 pandemic and resulting mental health impacts have put significant stress on an already overburdened system. From July-October 2020, Boston Children’s Hospital reported 277 youth patients boarding in the ED having suicidal thoughts or attempting suicide – a 47% increase over the same time period in 2019. In October 2021, Massachusetts acute care hospitals saw 173 pediatric patients boarding while awaiting psychiatric evaluation.

With a lack of community-based urgent care options, the Emergency Department is the most accessible place to go for a family in need, however there continues to be a severe shortage of psychiatric beds. 

Watch the CMHC & Boston Children’s Hospital Special Webinar on Behavioral Health Boarding
Read the Q&A responses from the panel.

How are we addressing the problem?

CMHC is addressing the escalating boarding crisis through public awareness campaigns and legislative & budget advocacy. We have hosted legislative briefings and and partnered with legislators on several bills that expand behavioral health urgent care services, create a system of data collection, and establish expedited protocols for admitting patients under the age of 22. We’re also advocating for resources in the state budget dedicated to meeting the needs of children and families and sure they can return home.

Learn more about our work on behalf of children at home.

Recent news

-WCVB-TV Boston: Why children are waiting days, even weeks for critical mental health care

“Some patients say boarding makes their anxiety, depression and other mental health problems worse. Lisa Lambert, executive director at the Parent/Professional Advocacy League, says adding data to the stories about patients languishing in ERs will illustrate the scope of the problem and help push needed changes.”

-WBUR: 716 psych patients are stuck in emergency rooms waiting for care, Mass. report shows

“The problem stems partly from difficulties accessing mental health treatment due to long waits for appointments and providers who do not accept insurance. There is also a scarcity of inpatient psychiatric beds, particularly for children.”

-Commonwealth Magazine: Lack of mental health beds means long ER waits

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