Psychiatric Boarding in Emergency Departments: A Treatable Crisis
A treatment-first approach can reduce prolonged emergency department stays, avoid unnecessary psychiatric admissions, and provide more humane care for people experiencing behavioral health emergencies.
By Scott Zeller, MD • Published March 1, 2026
Key Takeaways
- Behavioral health emergencies make up roughly one in eight emergency department visits.
- Traditional boarding can worsen symptoms, increase agitation, contribute to crowding, and raise staffing and security costs.
- Many psychiatric emergencies can be stabilized within 24 hours when assessment and treatment begin promptly.
- EmPATH units provide hospital-based, trauma-informed treatment in a therapeutic environment rather than functioning as holding areas.
- Reported outcomes include shorter emergency department stays, fewer inpatient admissions, improved follow-up, and reduced revisits.
Psychiatric boarding occurs when patients experiencing behavioral health emergencies remain in hospital emergency departments while waiting for an inpatient psychiatric bed. Instead of receiving care in an appropriate therapeutic setting, patients may spend hours or days in hallways or small rooms with limited access to psychiatric treatment.
The Scope and Consequences of Boarding
Growing demand for emergency behavioral health care has collided with limited inpatient capacity. The result is longer stays for psychiatric patients, reduced emergency department throughput, increased walkouts, delayed care, and added pressure on clinicians and hospital operations.
1 in 8
Emergency department visits involve behavioral health emergencies.
~70%
Reduction in psychiatric ED length of stay reported by one EmPATH program.
70–80%
Patients in many EmPATH programs stabilized without inpatient admission.
Why Traditional Diversion Efforts Fall Short
Mobile crisis teams and community crisis centers are important parts of the behavioral health system, but many cannot accept patients with severe agitation, psychosis, intoxication, withdrawal, involuntary holds, or significant medical needs. Emergency departments therefore remain the primary point of access for many of the highest-acuity cases.
A Treatment-First Model
The article argues that psychiatric emergencies should be approached like other medical emergencies: with rapid evaluation, immediate intervention, treatment in the least restrictive appropriate setting, and a disposition decision based on the patient’s response to care.
Psychiatric crises deserve the same urgency, active treatment, and dignity as every other emergency medical condition.
How EmPATH Units Work
Emergency Psychiatric Assessment, Treatment, and Healing units are hospital-based extensions of the emergency department. After basic medical clearance, patients receive active psychiatric care from multidisciplinary teams that may include psychiatrists, psychiatric nurses, social workers, and peer-support specialists.
The environment is intentionally therapeutic, using open spaces, natural light, calming design, recliners, private calming areas, and layouts that support safety and visibility. Care emphasizes trauma-informed treatment, de-escalation, autonomy, and recovery.
Clinical and Operational Results
Published findings cited in the original article associate EmPATH programs with substantially shorter emergency department stays, fewer inpatient admissions, stronger outpatient follow-up, fewer 30-day returns, reduced restraint use, and improved hospital capacity. Some organizations have implemented the model by repurposing existing hospital space.
Implications for Health System Leaders
Psychiatric boarding does not have to be accepted as an unavoidable consequence of rising demand. Hospital and psychiatric leaders can support treatment-first emergency care models that align patient dignity and clinical outcomes with operational and financial sustainability.
About the Author
Scott Zeller, MD, is a psychiatrist and a leader in emergency psychiatric care and the development of the EmPATH model.
Read the Original
View the complete article, supporting references, and source material on Psychiatric Times.