New Study Details Reasons for Delays in Mental Health Boarding

July 25, 2024

A new study released on July 22 shows that 17% of people being treated for mental health or substance use disorders in Minnesota experienced a discharge delay from inpatient care and that the delays averaged eight days per patient. 

The Minnesota Study of Behavioral Health Discharge Delays included a study sample of 182 inpatients and 537 emergency department patients experiencing delays at Minnesota hospitals during a 14-day period between September 5 and October 20, 2023. More findings from the study are available on the MDH Health Economics Program website. 

The most common reason for discharge delays was a lack of available beds in a safe setting like inpatient psychiatric units and intensive residential treatment service facilities for adult and pediatric patients. 

The study was conducted by Wilder Research and the Minnesota Department of Health’s (MDH) Health Economics Program to examine reasons for the prolonged transfer and discharge delays experienced by mental health and substance use disorder patients who seek hospital care in Minnesota. 

Whether a patient had state public insurance program coverage was the leading predictor for experiencing delays. According to the study, 75% of patients who experienced a discharge delay from inpatient care were covered by Medicaid or MinnesotaCare, despite accounting for just 46% of patients admitted with behavioral health diagnoses. The study also found a disproportionate percentage of inpatient delays impacting Minnesotans of color and specifically those who identify as African American or African-born. 

The emotional cost to patients and families of boarding is significant, as is the economic cost to hospitals when accommodating patients who are ready to be transferred to an inpatient bed or discharged to community-based services. 

The study indicates that creating additional post-hospital infrastructure is a key element of reversing Minnesota’s stubborn boarding issue. At the same time, the data show that streamlining the transfer and discharge processes could have significant benefits and should be an important policy goal. 

An approach aimed at helping youth has been the Mental Health Collaboration Hub, funded by MDH. The hub is a statewide virtual networking center aimed at helping children and youth who are boarding in hospitals and emergency departments get connected to mental health treatment settings. To date, this program has helped hundreds of children. Preliminary data collected from October 2023 to January 2024 through the hub showed a 55% reduction in days children or youth were boarded, or 24 fewer days. Approximately 80% of youth entered in the hub’s virtual community were able to discharge in less than 45 days. 

During the 2024 legislative session, the Minnesota Legislature passed additional budget and policies designed to assist in expediting hospital discharges and increasing access to behavioral health services. The Legislature added additional mental health beds to the state’s direct care and treatment system, funded rate increases for some outpatient mental health services and residential substance use disorder services paid for through Medicaid, and made policy changes to improve access to supports in the community. 

The MMA welcomes the study as it continues its advocacy related to mental health boarding. In May of 2023, the MMA and the Minnesota Chapter of the American College of Emergency Physicians (MNACEP) released a 44-page report on mental health boarding, complete with recommendations on how to address it.  

Since then, the MMA has developed a “Mental Health Resource Guide for Physicians,” with the goal of empowering physicians with tools to better connect patients with mental health services before patients’ symptoms drive them to emergency rooms. The MMA is also pursuing a stronger, more regular data collection system to better monitor the mental health boarding situation in Minnesota and to evaluate the efficacy of proposed solutions.  

If you have any questions, please contact Adrian Uphoff, health policy analyst.