Why Emergency Rooms Now Include 24 Hour Psychiatric Support

You’ve probably been there-sitting in an emergency room at 2 AM, waiting for someone to look at a sprained ankle or a weird rash. The fluorescent lights buzz overhead. A TV plays infomercials nobody’s watching. And somewhere nearby, someone’s having the worst night of their life.

Not because of a broken bone. Because their mind is breaking.

For decades, emergency rooms treated mental health crises as an afterthought. Patients in psychiatric distress would wait for hours-sometimes 12, 24, even 48 hours-before seeing anyone qualified to help. They’d sit in hallways, handcuffed to gurneys, surrounded by the chaos of a busy ER.

That’s changing - fast.

The Quiet Revolution in Emergency Mental Health

Hospitals across the country are now staffing psychiatrists, psychiatric nurses, and mental health crisis counselors around the clock. Not as an occasional luxury - as standard practice.

Why the shift? Numbers tell part of the story. Mental health-related ER visits jumped 44% between 2006 and 2014. Then the pandemic hit, and those numbers exploded. Pediatric psychiatric emergencies alone surged by over 30% between 2019 and 2021.

But here’s what the statistics don’t capture: the human cost of making someone in suicidal crisis wait half a day in a noisy, overstimulating environment designed for physical emergencies.

“We used to basically warehouse people,” admits Dr. Sarah Chen, an emergency physician at a major urban hospital who asked me not to name her institution. “Someone comes in after a suicide attempt, and we’d put them in a room with a security guard. That was our mental health intervention. It was barbaric.

What 24-Hour Psychiatric Support Actually Looks Like

So what’s different now?

Walk into an ER with dedicated psychiatric services, and you’ll notice a few things. First, there’s usually a separate space-quieter, calmer, with dimmer lighting. Some hospitals call these “psychiatric emergency services” or “behavioral health units. " The vibe matters more than you’d think. Reducing sensory overload can prevent a crisis from escalating.

Then there’s the staff. A psychiatric nurse practitioner or crisis counselor can often see you within an hour of arrival. They’re trained specifically for this - they know how to de-escalate. They know when someone needs medication, when they need a bed in an inpatient unit, and-crucially-when they just need someone to listen.

Dr. Marcus Webb, a psychiatrist who helped launch his hospital’s 24-hour program in 2019, puts it simply: “Most people in psychiatric crisis don’t need to be admitted. They need intervention, stabilization, and a good discharge plan. Having specialists available means we can actually provide that instead of defaulting to ‘hold them until Monday.

The data backs this up. Hospitals with dedicated psychiatric emergency services report shorter wait times, fewer patients leaving against medical advice, and better follow-up compliance after discharge.

Why This Matters for Everyone-Not Just Psych Patients

Here’s something people don’t always consider. When psychiatric patients wait for hours or days in the general ER, it affects everyone.

ER beds are limited. Every bed occupied by someone waiting for a psychiatric evaluation is a bed unavailable for the person having a heart attack, the kid with appendicitis, the car accident victim. “Psychiatric boarding”-the practice of holding psych patients in the ER because there’s nowhere else to put them-costs hospitals millions annually and contributes to staff burnout.

And the staff - they’re stretched impossibly thin. ER nurses aren’t typically trained in psychiatric care. Asking them to manage a patient in acute psychosis while also handling trauma cases and medication administration? That’s a recipe for exhaustion, errors, and people leaving the profession entirely.

24. Hour psychiatric support is more than humane. It’s practical. It keeps ERs functioning the way they’re supposed to.

The Crisis Intervention Team Model

Some hospitals have gone further, partnering with local police departments to create crisis intervention teams. Here’s how it works: when cops encounter someone having a mental health emergency, they can bring them directly to the hospital’s psychiatric unit instead of arresting them or dropping them in the general ER.

Officer Terrence Brooks, who’s worked on a crisis team in the Midwest for three years, describes a typical call: “Guy’s standing on a bridge, talking about ending it. Old model? We’d tackle him, cuff him, take him to county lockup or the ER. New model? I talk to him, we walk to my car together, I drive him straight to the crisis center. He’s seeing a psychiatrist within 20 minutes. No handcuffs - no trauma.

These partnerships work because they recognize something obvious that took us way too long to figure out: mental health emergencies aren’t crimes. Treating them like crimes makes everything worse.

What Still Needs to Change

Look, I’m not going to pretend everything’s fixed. It’s not.

Rural hospitals often can’t afford dedicated psychiatric staff. They rely on telepsychiatry-video consultations with off-site psychiatrists-which helps but isn’t the same as having someone physically present.

Insurance remains a nightmare. Reimbursement rates for psychiatric services are lower than for other specialties, making it harder for hospitals to justify the cost of 24-hour coverage.

And there simply aren’t enough psychiatrists. The U - s. faces a shortage of over 8,000 psychiatrists, according to the Health Resources and Services Administration. That gap is wider in some regions than others. Mississippi has about 5 psychiatrists per 100,000 people. Massachusetts has nearly 30.

Staffing a 24-hour psychiatric service requires people. And the people aren’t there.

What You Can Do Right Now

If you or someone you care about ends up in a mental health crisis, knowing your options matters.

First: find out which ERs in your area have dedicated psychiatric services. This information isn’t always easy to find, but your primary care doctor, therapist, or local NAMI chapter might know.

Second: if you’re in crisis and not in immediate danger, consider calling the 988 Suicide and Crisis Lifeline before going to the ER. The counselors there can sometimes help you stabilize at home or connect you with crisis services that don’t involve a chaotic emergency room.

Third: advocate. Hospital boards respond to community pressure. Insurance companies respond to public scrutiny. Legislators respond to constituents. If you think your local hospital needs better psychiatric emergency services, say so. Write letters - show up to meetings. Make noise.

The shift toward 24-hour psychiatric support didn’t happen because hospital administrators suddenly developed empathy. It happened because patients, families, and advocates demanded better. Because doctors and nurses burned out from an impossible system started speaking up. Because the costs-human and financial-became impossible to ignore.

The Bigger Picture

We’re in the middle of a mental health crisis that’s been building for decades. The pandemic accelerated it, but the foundations were crumbling long before.

24. Hour psychiatric support in emergency rooms isn’t a solution to that crisis. It’s a bandage on a wound. Goes much deeper-into our housing systems, our schools, our workplaces, our communities, our entire approach to what it means to care for each other.

But bandages matter. When someone’s bleeding out, you apply pressure. You stop the immediate harm. Then you work on the underlying causes.

Every person who walks into an emergency room at 3 AM, terrified and desperate, deserves to find help waiting for them. Real help. Not a security guard and a hallway gurney.

We’re getting closer to that - not everywhere. Not perfectly - but the direction is right.

And that’s something.