MMA, MNACEP Offer Recommendations on Emergency Department Boarding of Patients with Psychiatric Diagnoses

May 31, 2023

After years of deliberating, a task force formed by the Minnesota Medical Association and the Minnesota Chapter of the American College of Emergency Physicians (MNACEP) has released a list of recommendations designed to reduce the incidence, and improve the quality, of emergency department boarding of patients with psychiatric diagnoses (EDBPPD) in Minnesota.

The recommendations are part of a 44-page report produced by the task force, which met for nine, two-hour meetings over four years to research, discuss, and develop recommendations on EDBPPD. The task force took a one-year break during the height of the COVID-19 pandemic.

"This is a critical issue. Many Minnesotans have to spend days, and sometimes weeks, in emergency departments waiting for available hospital or residential treatment beds," says task force co-chair Dionne Hart, MD. “Taking action is long past due.”

"The recommendations that our task force developed offer up a game plan on addressing this complex issue," says task force co-chair Drew Zinkel, MD. "It's a big lift but desperately needed."

The task force’s recommendations include:  

1. Recommendations spanning the ED boarding continuum.

• Publicize and circulate the report to inform and empower leaders
• Support the creation of a Minnesota ED boarding database
• Collaborate to improve the usefulness of mental healthcare search tools in Minnesota
• Strategize to improve the size, distribution, and diversity of the mental healthcare workforce in Minnesota
• Protect and expand the use of telehealth for mental health services

2. Recommendations for inflow factors (that lead to high ED utilization by patients in mental health crises).

• Support the financial sustainability of 988 Call Centers in Minnesota
• Explore emergency transport diversion to EDs in hospitals with patient-appropriate inpatient mental health beds
• Leverage healthcare workers and facilities to educate the public about mental health resources
• Support legislation to require Minnesota health plans to reimburse for collaborative care model services

3. Recommendations for stalling factors (that potentially worsen the mental and physical health of boarding patients).

• Support the development and evaluation of alternative emergency facilities for patients with psychiatric diagnoses who await disposition
• Advocate for an increase in ED-designated mental healthcare workers

4. Recommendations for outflow factors (why mental health patients get stuck boarding in EDs).

• Advocate for more inpatient mental health hospital beds in Minnesota
• Advocate for more residential treatment beds in Minnesota
• Monitor and engage in the development of locked Intensive Residential Treatment Services (IRTS) facilities in Minnesota
• Support legislation to require Minnesota health plans to cover Psychiatric Residential Treatment Facilities (PRTF) and IRTS
• Collaborate to reduce the burdens of corporate foster care on ED boarding.

Task force members:  

• Co-Chair Dionne Hart, MD, director, Care from the Hart; psychiatry, Hennepin Healthcare; MMA Board of Trustees Member  
• Co-Chair Drew Zinkel, MD, senior medical director of emergency medicine, University of Minnesota; past president, Minnesota Chapter of the American College of Emergency Physicians
• Sue Abderholden, MPH, executive director, NAMI Minnesota (National Alliance on Mental Illness)
• Kathleen Heaney, MD, psychiatry, Hennepin Healthcare
• Sara Hevesi, MD, senior associate consultant (Emergency Medicine), Mayo Clinic
• Larry Hook, MD, psychiatry, CentraCare Hospital St. Cloud
• Matt Kruse, MD, psychiatry, Anoka Metro Regional Treatment Center (AMRTC)
• Dave Lee, MA, LP, LMFT, LICSW, director, Carlton County Public Health & Human Services
• Marc Martel, MD, emergency medicine, Hennepin Healthcare
• Lisa Mattson, MD, national medical director, Optum
• Jinny Palen, executive director, Minnesota Association of Community Mental Health Programs
• Kristin Peterson, MSN, RN, CEN vice president of acute care and clinical operations, Children’s Minnesota
• Michael Reese, MD, psychiatry, Mayo Clinic
• Adam Riutta, MD, emergency medicine, Essentia Health
• Michael Schwemm, MD, medical director, Allina Health, Mercy Hospital
• Shamala Tamirisa, MD, medical director, PrairieCare
• Amitabh Tipnis, MD, psychiatry, Allina Health, Cambridge Medical Center

Former task force members:

• Casey Clements, MD, PhD, emergency medicine, Mayo Clinic, clinical practice chair
• Carolyn McLain, MD, medical director, The Urgency Room, Twin Cities