Mental Patients Flood ERs; Where To Go Instead

Know the location of an urgent care center near  you

| ERs are flooded with mentally ill patients with no place else to turn

CNN – A “huge and largely unreported problem” is happening in ERs across the nation, one expert says.

“The extent to which ERs are now flooded with patients with mental illness is unprecedented,” said Dr. David R. Rubinow, chairman of the Department of Psychiatry at the School of Medicine at University of North Carolina, Chapel Hill.

*** Headline Health Tip – Instead of going to an emergency room, just say Hey Siri, urgent care center near me.”

And this overflow is “having a really destructive effect on health care delivery in general,” he added.

“There are ERs now that are repeatedly on diversion — which means they can’t see any more patients — because there are so many patients with mental illness or behavioral problems that are populating the ER.”

A 2017 government report found that the overall number of emergency department visits increased nearly 15% from 2006 to 2014, yet ER visits by patients with mental or substance use disorders increased about 44% in the same period.

This supports Rubinow’s belief that ERs are a major provider of mental health care for a “very, very sizable percentage of patients” these days.

Dr. Catherine A. Marco, from her vantage point as an emergency physician professor at Wright State University in Dayton, Ohio, said, “we commonly see depression, anxiety, substance-related conditions and suicidal behavior.”

Firsthand experience suggests to Dr. Mark Pearlmutter, an emergency physician in Boston, that the most common mental health problems in emergency rooms are dual diagnoses, such as “substance abuse and depression, for example.” He’s also seen cases combining acute psychosis, bipolar disorder, suicidality, aggression and (mal) adjustment disorders.

“We’re the safety net,” he said.

On the opposite coast, Dr. Renee Y. Hsia, an attending physician at Zuckerberg San Francisco General Hospital and Trauma Center, also finds that the most prevalent psychiatric diagnoses among adults in the ER are alcohol-related disorders, anxiety disorders and suicide or intentional self-harmRead more. 

What are urgent care centers? Are they less expensive? Do I need a referral?

NH HealthCost – An urgent care center is a walk-in clinic that focuses on caring for patients who need care right away but are not having a life-threatening emergency.

If it’s an emergency, call 911 or go to the emergency room right away!

If your problem is less serious, you may be better off going to an urgent care center. You may get care more quickly and less expensively than you would in the emergency room.

Why go to an urgent care center?

  • You don’t need an appointment
  • They open earlier and close later than most doctors’ offices or clinics
  • Usually, you will pay much less than if you go to the emergency room
  • Typically, you will have a shorter wait than at the emergency room (at the emergency room, the heart attack or car accident victims will go to the front of the line and your ear infection will have to wait)

Some examples of urgent conditions include:

  • Accidents and falls
  • Sprains and strains
  • Moderate back problems
  • Bleeding/cuts — not bleeding a lot but requiring stitches
  • Diagnostic services, including X-rays and laboratory tests
  • Eye irritation and redness
  • Fever or flu
  • Vomiting, diarrhea or dehydration
  • Sore throat or cough
  • Minor broken bones and fractures (i.e. fingers, toes)
  • Skin rashes and infections
  • Urinary tract infections

The costs and type of clinicians at urgent care centers vary, but urgent care sites will usually be less expensive than using an emergency room when the care you need is not an emergency.  Among others, clinical staff may include emergency physicians, general or family physician practitioners, nurse practitioners, and physician assistants.

  • Check your insurance card or summary of benefits and coverage to see how much your copay or other cost sharing will be to visit an urgent care facility.

Not all Urgent Care Centers are the same!

Some urgent care sites are essentially run as offsite emergency departments, and your costs will be similar to that of an emergency department.  Others are described as an “urgent care center,” but are still treated as part of a hospital.  In those cases, while your cost sharing may be less than at an emergency department, you may pay substantially more than at an urgent care site setup as physician practice.

  • NH HealthCost provides estimates of the rates at different sites, and can be used for comparative purposes.
  • You can also call ahead to an urgent care site to ask how you will be billed for services.
  • Ask if you are just billed a copay like a visit to a physician’s office, or if you will be responsible for something more.
  • Ask if there is a facility bill as well as a cost for the professional service.  If so, your overall cost obligation will most likely be higher.
  • You can also call ahead and ask if the condition you need treatment for is appropriate for an urgent care visit.

Other options

  • Call your primary care provider if the office is open; some offices offer same-day appointments.
  • Call your plan’s 24-hour nurse line (if they offer one) for advice.
  • Visit a retail health clinic. Often found in a major pharmacy or retail stores, they have physician assistants and nurse practitioners onsite.
  • “See” a health care provider through a virtual office visit either online or by phone, if your plan offers that service.


Source: This information was provided by the New Hampshire Insurance Department and the University of New Hampshire Mobile Development. To find comparable information for your state, search for — urgent care [state name]


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