Hospitals: Where Full Integration Begins

The U.S. health care system has historically treated mental and physical health conditions separately, fragmenting whole-person care into different components. But nearly half of adults will experience a mental health disorder in their lifetime. Hospitals — as centralized units of care that may encompass emergency departments, short-term psychiatric treatment facilities, and other units — are critical for integration. If policy better supports integration of mental health care throughout hospitals, they can become another entry point for whole-person care.

One-third of hospital stays are now related to mental health diagnoses, and these admissions cost approximately twice as much.1“Pain in the Nation Update” (Trust for America’s Health and Well Being Trust, March 2019).

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Young people in psychiatric crisis in the ED who reported they had not previously sought outpatient care.2P. J. Gill et al., “Emergency Department as a First Contact for Mental Health Problems in Children and Youth,” J Am Acad Child Adolesc Psychiatry 56, no. 6 (June 2017): 475-482.e4, https://doi.org/10.1016/j.jaac.2017.03.012.

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Hospitals can be a good point to identify people who have fallen through the cracks and who might not intersect with health care outside of showing up in the Emergency Department.
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Solutions for Better Mental Health

Identification and Intervention Across Specialties

While mental health is a common comorbidity with other physical health or medical conditions, it frequently goes undiagnosed — increasing costs and worsening outcomes. Hospitalization provides another opportunity to identify needs; this is especially true in suicide prevention, where hospital contacts have been found to be an effective intervention point.

View Action Items:

  • The federal government should ensure that hospital payment models and quality programs incentivize assessing mental health at every interaction as a vital sign, and not only during well visits. This should include integrating screening and treatment into episode-based payment models for health conditions for which there are frequent mental health comorbidities, such as cardiovascular diseases, cancers, and pulmonary diseases.
  • The federal government should increase incentives for reducing readmissions for mental health problems over ninety days and provide seed funds for safety net hospitals to have the necessary resources to perform well on these new incentives.
  • Suicide and mental health crises should be included as part of hospital safety initiatives and evidence-based strategies should be integrated into federally funded hospital quality improvement programs. Examples include the Zero Suicide program.

Integrating Care in Emergency Departments

Mental health crises can lead patients to the Emergency Department, but many EDs are not well equipped to provide the right care. Integration is key to improving quality of care: integrating mental and physical care within the ED; integrating care between Emergency Medical Services and EDs; and integrating ED care with community-based treatment.

View Action Items:

  • The federal government should invest in piloting and scaling innovative information technology solutions to improving the successful triage and coordination of care for individuals with mental health conditions that present to EMS or the ED,2Z. F. Meisel et al., “Optimizing the Patient Handoff between Emergency Medical Services and the Emergency Department,” Ann Emerg Med 65, no. 3 (March 2015): 310-317.e1, https://doi.org/10.1016/j.annemergmed.2014.07.003., 3Kutscher, “Bedding, Not Boarding. (Cover Story)”; M. Moore et al., “The Role of Social Work in Providing Mental Health Services and Care Coordination in an Urban Trauma Center Emergency Department,” Psychiatr Serv 67, no. 12 (December 1, 2016): 1348–54, https://doi.org/10.1176/appi.ps.201500469. including connections with social services.4Moore et al., “The Role of Social Work in Providing Mental Health Services and Care Coordination in an Urban Trauma Center Emergency Department.”
  • The federal government should provide funding or centralized administration to expand the availability of online “bed boards” that allow clinicians to find available psychiatric beds in other hospitals and transfer patients to those facilities with the caveat that these beds are not geographically prohibitive from a person having access to their family or caregiver.5Crisis Bed Registries to Assist People with Urgent Mental Health Needs. https://www.samhsa.gov/newsroom/press-announcements/201901240130
  • The federal government should fund the development and dissemination of evidence-based training and continuing education materials on mental health for ED staff.
  • The federal government should establish a three-digit suicide prevention lifeline number. The FCC has recommended that 9-8-8 be designated as the new lifeline number, and dollars should be appropriated to allow for local call centers to support ongoing services from the call line.

Tailored Policies for Unique Needs

To be effective, mental health solutions need to address individuals' range of identities based on race, ethnicity, language, gender, or gender identity, sexual orientation, disability, veteran's status, or life circumstances. We recommend meaningful policies to combat a harmful legacy of one-size-fits-all solutions.

Explore our recommended policies for focus populations

Explore our Fact Sheets

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Hospitals: Where Full Integration Begins

One-third of hospital stays are related to mental health diagnoses. Read our proposed policy solutions to improve care.

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