A new study led by researchers at McLean Hospital and Harvard Medical School, in collaboration with researchers from Massachusetts General Hospital and Cambridge Health Alliance, has uncovered concerning disparities in boarding rates of children and adolescents with severe mental health symptoms in emergency departments. When reviewing more than 4,900 boarding episodes of youth under 17 years old in Massachusetts over an 18-month period, the researchers found there were numerous racial and gender disparities: Black youth were less likely to be admitted to inpatient psychiatric care than White youth. Additionally, transgender and nonbinary youth experienced longer boarding times in the Emergency Department and lower admission rates to inpatient units compared to cisgender females.
Nearly half of the boarding episodes did not result in inpatient admission. Youth who must board in the emergency department for days or weeks at a time without transitioning to inpatient care typically receive less mental health care than they would have received in an inpatient setting, which potentially puts them at risk of even worse outcomes, according to the authors. Our study found that several non-clinical factors, including statewide demand for inpatient care, appear to play a role in the admission decision, and that racial and gender disparities permeate the process.
Boarding is a culmination of problems and lack of access throughout the mental health care system, not just inpatient care. S.
