Across the United States, a growing crisis is unfolding for children experiencing mental health emergencies. Instead of receiving prompt, specialized care, many young patients are spending days—sometimes nearly a week—waiting in hospital emergency rooms, caught in a holding pattern that leaves families desperate and hospital staff stretched thin. This troubling reality, revealed in a recent study published in JAMA Health Forum and reported by NPR and The Oregonian, points to a deep gap in the nation’s pediatric mental health care system.
The study, led by researchers at Oregon Health & Science University (OHSU), analyzed Medicaid claims data from 44 states, reviewing more than 255,000 pediatric emergency department visits for mental health conditions in 2022. The findings were stark: about 12% of these visits—over 30,000 cases—involved children being “boarded” in emergency rooms for three to seven days while waiting for placement in appropriate treatment programs. As Dr. John McConnell, director of OHSU’s Center for Health Systems Effectiveness and lead author of the study, put it, “So a child shows up at an emergency department with a mental health condition, about one in ten times, they’re staying for three days or longer.”
The most common crises leading to these extended ER stays were depressive disorders and suicidal thoughts or attempts. The surge in such cases is not just a statistical blip. According to data from the Centers for Disease Control and Prevention, the number of suicides among U.S. children and young adults rose by 62% from 2007 to 2021. These numbers translate into real children and families facing the unthinkable, often at their most vulnerable moments.
Geographically, the problem is uneven but widespread. Boarding rates varied dramatically across states, with 2.7% of mental health ER visits leading to extended stays in Arkansas, but a staggering 27.3% in Iowa. In states like North Carolina, Florida, and Maine, as many as 25% of such visits resulted in children boarding in emergency departments for three to seven days. Oregon’s rate was just above the national average, despite targeted efforts to address the problem.
The Joint Commission, which sets benchmarks for healthcare quality, recommends that pediatric patients in mental distress be stabilized and moved out of the ER within four hours. Extended stays, the Commission notes, can jeopardize patient safety, delay the start of critical treatment, and divert resources from other urgent cases. Yet, as Dr. McConnell observed, “It points to a big gap in getting timely, appropriate care.”
Behind these numbers are stories of children and families navigating a system ill-equipped for the current demand. Dr. Rebecca Marshall, who leads the pediatric psychiatry consult service at OHSU Doernbecher Children’s Hospital, described the situation vividly: “These aren’t just numbers. They represent real kids, real families and the hospital staff trying to help them in a space that was never meant for this.”
Marshall noted that psychiatric visits to her hospital’s pediatric ER nearly tripled from 150 in 2016 to 453 in 2024. The patients are evenly split between those on Medicaid and those with private insurance, highlighting that the crisis extends far beyond those covered by public insurance. Often, children arrive after confiding in a parent or guardian about suicidal thoughts or severe depression, only to be told there’s no psychiatric bed available. “It’s often disorienting and disappointing for youth and families,” Marshall said. “They’re in limbo, in a place that’s not designed to be therapeutic, and sometimes it can make things worse.”
The ER environment is hardly conducive to recovery. Children boarding there often stay in small, sometimes windowless rooms, with little to no access to exercise, fresh air, or therapeutic activities. “They’re not able to leave the room. They can’t exercise. They’re not able to interact with other kids, which is a really important part of development,” Marshall explained to NPR. The result? Some children become more agitated, depressed, or even attempt to leave, placing themselves at further risk.
Most emergency departments lack child and adolescent psychiatrists—a gap that has persisted for decades. Dr. Jennifer Havens, chair of Child and Adolescent Psychiatry at NYU Grossman School of Medicine, told NPR, “There’s an enormous problem across the country with a lack of access to mental health services, both on the inpatient and outpatient side.” Without adequate outpatient care, more children reach a crisis point and end up in the ER, where immediate help is often unavailable. “Most ERs don’t even have a child and adolescent psychiatrist, because we’ve just never invested in the resources to have this kind of service for kids,” Havens added.
In Oregon, the shortage is especially acute. The state has only 38 inpatient psychiatric beds for the highest-need pediatric cases and fewer than 200 residential beds, according to NPR. Efforts to expand capacity have included a $130 million investment in 2021 to increase community-based residential facilities for people with severe mental illness. But as Marshall explained to The Oregonian, “The challenge has been scaling it up quickly enough.” The state’s much-touted parity law, which required insurers to cover mental health on par with physical health, has failed to deliver, and stricter reporting requirements passed in 2021 remain largely unenforced.
A fragmented healthcare system fuels the crisis. There is, as McConnell noted, “no single source of accountability for Medicaid patients having a mental health crisis. When these kids show up in the emergency department, it’s not clear who’s responsible for making sure they get timely care.” Even when states add beds or resources, the lack of clear responsibility and measurable outcomes—such as boarding rates or patient well-being—means that systemic change is slow to materialize.
Meanwhile, the toll on families is profound. “I’m not sure what the right words are, but, it’s a really challenging, heartbreaking situation for families that have a child and they’re trying to kind of find a place to stabilize them, and they’re stuck in the emergency department,” McConnell told NPR. Marshall echoed this sentiment, emphasizing the emotional strain on both families and staff. “You can train staff and add activities, but you can’t turn an ER into a therapeutic psychiatric space,” she said. “If we want kids to get better, we have to put them in the right environment.”
As the children’s behavioral health crisis continues to escalate, the gap between need and available services grows wider. The study’s findings confirm what many clinicians and families have experienced for years: the current system is simply not keeping up. Until there is a coordinated, accountable approach to pediatric mental health—one that treats mental health with the same urgency and resources as physical health—children in crisis will remain at risk of falling through the cracks, forced to wait for help that should be immediate.
