• Posted August 18, 2025

Children in Crisis Languishing in ERs For Days

Thousands of children at risk for suicide or in the throes of depression spend days languishing in hospital ERs, awaiting treatment, a new study says.

More than 1 in 10 children sent to a hospital for a mental health condition wound up waiting in the ER for three to seven days before a bed became available, researchers reported Aug. 15 in JAMA Health Forum.

The practice, known as “boarding,” has become increasingly common as hospitals’ capacity for inpatient treatment has failed to keep up with the growing number of kids in crisis, researchers said.

“In a perfect world, boarding wouldn’t happen at all,” said lead researcher John McConnell, director of the Oregon Health & Science University Center for Health Systems Effectiveness in Portland.

For the new study, researchers analyzed Medicaid claims data from 2022 involving 255,000 ER visits for mental health conditions among children ages 5 to 17 in 44 U.S. states.

Overall, more than 1 in 10 mental health-related ER visits wound up lasting three or more days, as children awaited care.

In five states, such boarding occurred in more than 1 in 5 such visits, researchers said. Those states were Montana, North Carolina, Maine, Florida and Iowa.

Unfortunately, it often isn’t possible to discharge a child in crisis either to their home or to a residential behavioral health facility, researchers said.

“If you’re a parent and your child is having a crisis, you may go to the emergency department and then ideally find a more suitable place to get care after that,” McConnell said in a news release. “Unfortunately, this study reveals that there is often no place to send them.”

At OHSU’s Doernbecher Children’s Hospital alone, the number of kids requiring a psychiatric consult in the ER has tripled, rising to 453 last year from 150 in 2016, said Dr. Rebecca Marshall, an OHSU associate professor of psychiatry.

“Nurses and doctors who go into pediatric care do so because they like kids and want to see them doing better,” said Marshall, who wasn’t involved in the study.

“When you have a child languishing in the emergency department not able to get the care they need, their condition can get worse,” she said in a news release. “It’s demoralizing and overwhelming, especially when you’re trying to juggle a lot of other kids who also need care.”

U.S. hospitals overall are facing a crisis regarding boarding patients in the ER, earlier studies have said.

For example, 25% to 35% of all ER patients requiring hospitalizations wind up waiting four or more hours for a bed to open, according to a report issued earlier this month in the journal Health Affairs.

Worse, nearly 5% of patients admitted during the peak winter months waited a full day for a bed, and nearly 3% waited that long during off-peak months, results in Health Affairs showed.

The new results show the special problems associated with the shortage of appropriate mental health care for children, McConnell said.

If you or someone you know is suicidal, call the Suicide and Crisis Lifeline at 988 or go to 988lifeline.org.

More information

The American College of Emergency Physicians has more on ER boarding and crowding.

SOURCES: Oregon Health & Science University, news release, Aug. 15, 2025; JAMA Health Forum, Aug. 15, 2025