This study addressed delays to involuntary mental health examinations experienced by individuals in emergency departments (EDs). Florida statute specifies that involuntary mental health examinations shall take place only at state-designated facilities “without unnecessary delay”—no longer than 12 h until transfer—for individuals in hospital EDs. Individuals in EDs needing involuntary mental health examinations sometimes wait for admission to inpatient units because of unavailability of mental health services. Data collectors at two hospitals reviewed the records of 170 randomly selected ED patients requiring involuntary mental health examinations. Nearly one-half (48.8%) of participants waited longer than the 12-h maximum allowed by Florida law for transfer to an authorized facility. Factors that associated with prolonged waits were being male, increased age, being a Medicare beneficiary, and being intoxicated. State agencies responsible for the regulation of hospitals and mental health facilities should use this data and engage front-line caregivers to identify statutory remedies.
AlakesonV.PandeN.LudwigM. (2010) A plan to reduce emergency room ‘boarding’ of psychiatric patients. Health Affairs29(9): 1637–1642. doi:10.1377/hlthaff.2009.0336.
2.
American College of Emergency Physicians (2008) Psychiatric and substance abuse survey, Irving, TX: American College of Emergency Physicians.
3.
AppelbaumP. S. (1992) Civil commitment from a systems perspective. Law and Human Behavior16(1): 61–74. doi:10.1007/BF02351049.
4.
BenderD.PandeN.LudwigM. (2009) Psychiatric boarding interview summary. (Contract # No. HHS-100-03-0027), Washington, DC: U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy.
5.
BloomJ. D. (2006) Civil commitment is disappearing in Oregon. The Journal of the American Academy of Psychiatry and the Law34(4): 534–537.
CatalanoR.McConnellW.ForsterP.McFarlandB.ThorntonD. (2003) Psychiatric emergency services and the system of care. Psychiatric Services54(3): 351–355. doi:10.1176/appi.ps.54.3.351.
8.
ChangG.WeissA. P.OravE. J.JonesJ. A.FinnC. T.GitlinD. F.RauchS. L. (2011) Hospital variability in emergency department length of stay for adult patients receiving psychiatric consultation: A prospective study. Annals of Emergency Medicine58(2): 127–136. doi:10.1016/j.annemergmed.2010.12.003.
9.
ChangG.WeissA.KosowskyJ. M.OravE. J.SmallwoodJ. A.RauchS. L. (2012a) Characteristics of adult psychiatric patients with stays of 24 hours or more in the emergency department. Psychiatric Services (Washington, D.C.)63(3): 283–286. doi:10.1176/appi.ps.201000563.
10.
ChangG.WeissA. P.OravE. J.SmallwoodJ. A.GonzalezS.KosowskyJ. M.RauchS. L. (2012b) Bottlenecks in the emergency department: The psychiatric clinicians’ perspective. General Hospital Psychiatry34(4): 403–409. doi:10.1016/j.genhosppsych.2012.03.005.
11.
ChristyA. (2008) The Florida mental health act (Baker act). (Annual Report No. 2007), Tampa, FL: University of South Florida, Louis de La Parte Florida Mental Health Institute.
ChristyA. (2014) Report of 2013 Baker act data, Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute.
14.
ClaassenC. A.WiseB.KrakoverB. A. (2006) Involuntary treatment in the emergency department: What is the cost?Emergency Medicine & Critical Care Review2(1): 1–4.
15.
Conditions of Participation: Patient’s rights. C.F.R. 482.13 (2006).
16.
CunninghamP.McKenzieK.TaylorE. F. (2006) The struggle to provide community-based care to low-income people with serious mental illnesses. Health Affairs25: 694–705. doi:10.1377/hltha£f.25.3.694.
17.
Department of Children and Families, Florida Department of State (2015) Licensing procedure. (Florida Administration Code 65E-12.104), Tallahassee, FL: Author.
18.
DingR.McCarthyM. L.DesmondJ. S.LeeJ. S.AronskyD.ZegerS. L. (2010) Characterizing waiting room time, treatment time, and boarding time in the emergency department using quantile regression. Academic Emergency Medicine17(8): 813–823. doi:10.1111/j.1553-2712.2010.00812.x.
19.
Emergency Medical Treatment and Active Labor Act. 42 CFR. § 489.24 (2013).
Florida Center for Health Information and Policy Analysis (2013) Emergency department patient data: Public data file. (Data file and code book), Tallahassee, FL: Agency for Health Care Administration.
23.
Florida Mental Health Act. Fla. Stat. § 394.463 (2014).
24.
Florida Mental Health Act. Fla. Stat. § 394.453 (2015).
25.
HazlettS. B.McCarthyM. L.LondnerM. S.OnyikeC. U. (2004) Epidemiology of adult psychiatric visits to U.S. emergency departments. Academic Emergency Medicine11(2): 193–195. doi:10.1197/j.aem.2003.09.014.
26.
HowardP. (2006) Psychiatric care in the emergency department: Chaos or crisis?Emergency Medicine & Critical Care Review4(1): 41–42. Retrieved from http://www.touchbriefings.com/pdf/2459/Howard.pdf.
27.
IBM Corp (2010) IBM SPSS statistics for windows, Version 19.0 ed. Armonk, NY: Author.
28.
JayaramG.TriplettP. (2008) Quality improvement of psychiatric care: Challenges of emergency psychiatry. The American Journal of Psychiatry165(10): 1256–1260. doi:10.1176/appi.ajp.2008.08040556.
29.
KellyM.DunbarS.GrayJ. E.O’ReillyR. L. (2002) Treatment delays for involuntary psychiatric patients associated with reviews of treatment capacity. The Canadian Journal of Psychiatry47(2): 181–185.
30.
KishiY.MellerW. H.KatholR. G.SwigartS. E. (2004) Factors affecting the relationship between the timing of psychiatric consultation and general hospital length of stay. Psychosomatics: Journal of Consultation Liaison Psychiatry45(6): 470–476. doi:10.1176/appi.psy.45.6.470.
31.
LexisNexis 50 state comparative legislation/regulations: Mental health. (2011). New York, NY: Reed Elsevier.
32.
MansbachJ. M.WharffE.AustinS. B.GinnisK.WoodsE. R. (2003) Which psychiatric patients board on the medical service?Pediatrics111(6): e693–e698. doi:10.1542/peds.111.6.e693.
McKennaM. (2011) The growing strain of mental health care on emergency departments few solutions offer promise. Annals of Emergency Medicine57(6): 18A–20A. doi:10.1016/j.annemergmed.2011.04.013.
35.
Md. Mental Health Law. Md. Health General Code Ann. § 10–624 (2014).
36.
Mental Health Program Office & Department of Mental Health Law & Policy (2014) 2014 Baker Act user reference guide: The Florida Mental Health Act, Tampa, FL: Department of Children and Families, Mental Health Program Office, University of South Florida, Louis de la Parte Florida Mental Health Institute.
37.
Mich. Mental Health Code. Mich. Comp. Laws. § 330.1428 (2015).
38.
MisekR. K.DeBarbaA. E.BrillA. (2015) Predictors of psychiatric boarding in the emergency department. Western Journal of Emergency Medicine16. (1). doi:10.5811/westjem.2014.10.23011. Retrieved from: https://escholarship.org/uc/item/3tc8h6m4.
39.
National Alliance of Mental Illness (2014) State mental health legislation 2014: Trends, themes, & effective practices. (No. December), Arlington, VA: Author.
40.
N.C. Mental health, developmental disabilities, and substance abuse act of 1985. N.C. Gen. Stat. § 122C–263 (2014).
41.
N.H. Public Health. N.H. Rev. Stat. Ann. RSA 135–C: 28 (2015).
42.
NicksB. A.MantheyD. M. (2012) The impact of psychiatric patient boarding in emergency departments. Emergency Medicine International2012: 360308. doi:10.1155/2012/360308.
43.
Nolan, J. M. (2011). Emergency department boarding practices in the United States (PhD). Retrieved from ProQuest Dissertations & Theses A&I. (899258184).
44.
NolanJ. M.FeeC.CooperB. A.RankinS. H.BlegenM. A. (2015) Psychiatric boarding incidence, duration, and associated factors in United States emergency departments. Journal of Emergency Nursing41(1): 57–64. doi:10.1016/j.jen.2014.05.004.
45.
Oh. Public Welfare. Oh. Rev. Code Ann. § 5122.10 (2014).
46.
Okl. Mental Health. Okla. Stat. Ann. 43A Okl. St. § 5–208 (2014).
47.
Okla. Mental Health Law of 1986. La. Rev. Stat. § 28:53 (2014).
48.
Ore. Mental Health and Developmental Disabilities. Ore. Ann. Stat. § 426.231 (2015).
49.
OwensP.MutterR.StocksC. (2010) Mental health and substance abuse-related emergency department visits among adults, 2007. (Statistical brief No. 92), Rockville, MC: Agency for Healthcare Research and QualityRetrieved from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb92.pdf.
50.
ParkJ. M.ParkL. T.SiefertC. J.AbrahamM. E.FryC. R.SilvertM. S. (2009) Factors associated with extended length of stay for patients presenting to an urban psychiatric emergency service: A case-control study. The Journal of Behavioral Health Services & Research36(3): 300–308. doi:10.1007/s11414-008-9160-0.
51.
Penn. Mental Health Procedures. Penn. Stat. Ann. 50 P.S. § 7302 (2014).
52.
PetrilaJ. (1992) Redefining mental health law: Thoughts on a new agenda. Law and Human Behavior16(1): 89–106. doi:10.1007/BF02351051.
Schwartzman, P., Helderman, R. S., & Johnson, J. (2013, November 20). Virginia’s deeds stabbed in home. Washingtonpost.Com, pp. A01.
55.
SladeM. (2009) The contribution of mental health services to recovery. Journal of Mental Health18(5): 367–371.
56.
SladeE. P.DixonL. B.SemmelS. (2010) Trends in the duration of emergency department visits, 2001–2006. Psychiatric Services61(9): 878–884. doi:10.1176/appi.ps.61.9.878.
57.
StoneA.RogersD.KruckenbergS.LieserA. (2012) Impact of the mental healthcare delivery system on California emergency departments. The Western Journal of Emergency Medicine13(1): 51–56. doi:10.5811/westjem.2011.6.6732.
58.
TestaM.WestS. G. (2010) Civil commitment in the United States. Psychiatry7(10): 30–40.
59.
The Secretary’s Advisory Committee on Human Research Protections (2011) Terms and recommendations on informed consent and research use of biospecimens, Washington, DC: U.S. Department of health and human services.
60.
TorreyE. F.FullerD. A.GellerJ.JacobsC.RagostaK. (2012) No room at the inn: Trends and consequences of closing public psychiatric hospitals, Arlington, VA: The Treatment Advocacy Center.
61.
TuttleG. A. (2008) Access to psychiatric beds and impact on emergency medicine. (CMS Report No. 2-A-08), Chicago, IL: American Medical AssociationRetrieved from http://www.ama-assn.org/resources/doc/cms/a-08cms2.pdf.
Va. Acute Psychiatric Bed Registry. Va. Code Ann. § 37.2–308.1 (2014).
65.
WeissA. P.ChangG.RauchS. L.SmallwoodJ. A.SchechterM.KosowskyJ.OravE. J. (2012) Patient- and practice-related determinants of emergency department length of stay for patients with psychiatric illness. Annals of Emergency Medicine60(2): 162–171.e5. doi:10.1016/j.annemergmed.2012.01.037.
66.
WharffE. A.GinnisK. B.RossA. M.BloodE. A. (2011) Predictors of psychiatric boarding in the pediatric emergency department, implications for emergency care. Pediatric Emergency Care27(6): 483–489. doi:10.1097/PEC.0b013e31821d8571.
67.
WilsonM. P.BrennanJ. J.ModestiL.DeenJ.AndersonL.VilkeG. M.CastilloE. M. (2015) Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use. The American Journal of Emergency Medicine33(4): 527–530. Retrieved from http://dx.doi.org.ezproxylocal.library.nova.edu/10.1016/j.ajem.2015.01.017.
68.
YoreM.BrunellM. L. (2014) Florida’s advanced practice nurse supply 2012–2013. (No. July 2014), Orlando, FL: Florida Center for Nursing.
