Black adults more likely to seek mental health treatment at EDs, pre-pandemic data show

Non-Hispanic Black adults were almost twice as likely to visit an emergency department for a mental health disorder than non-Hispanic white adults and nearly three times more likely than Hispanic adults during the years leading up to the pandemic, according to new National Center for Health Statistics data released this week.

The rates of emergency mental health care for Black Americans were also higher for each specific disorder studied by the federal researchers, including anxiety-related disorder, mood disorder, schizophrenia and several different types of substance use disorder.  

Whereas mental health ED visits were split similarly between men and women among white patients, men made up a greater portion of the visits for both Black and Hispanic adults, the researchers found. Further, visits by Black patients were less likely to lead into a hospital admission or transfer than they were for white patients.

The findings add to a body of research outlining different routine and emergency mental health treatment patterns by race and ethnicity. These conditions affected 1 in 5 U.S. adults as of 2020, though more recent data suggest that incidence has increased through the pandemic.

“Research has shown that Hispanic and non-Hispanic Black adults are less likely to receive routine treatment for mental health disorders,” they wrote in a report published on the Centers for Disease Control and Prevention’s website (PDF).

“In the absence of routine care, patients with mental health disorders often receive care related to a mental health disorder in emergency departments,” they continued. According to prior research, “the percentage of ED visits with a mental health diagnosis increased from 6.6% in 2007 to 2008 to 10.9% in 2015 to 2016, and in 2019, mental health disorders were the seventh most common primary diagnosis at ED visits,” they wrote.

Data used in the most recent analysis was submitted by hospitals that participated in the 2018, 2019 and 2020 National Hospital Ambulatory Medical Care Survey, an annual survey of ED visits that is weighted to be nationally representative. Researchers included visits that had diagnosis codes associated with mental health-related ED visits. Due to small sample sizes, they refrained from making estimates regarding patients who identified as races and ethnicities such as Asian or American Indian.

During those three years, mental health ED visits accounted for 12.3% of all ED visits among adults, translating to an average incidence rate of 53 mental health ED visits per 1,000 U.S. adults per year, according to the study. Broken down by race and ethnicity, 96.8 mental health ED visits occurred per 1,000 Black adults, 53.4 per 1,000 white adults and 36 per 1,000 Hispanic adults.

Medicaid was the most common (41.5%) primary payment source for all mental health ED visits, followed by Medicare (23.2%), private insurance (21.2%) and no insurance (11.3%). A greater portion of Hispanic and Black mental health ED patients were on Medicaid than white patients, researchers found, while private insurance was more frequent among white patients.

Fourteen percent of all mental health ED patients were made to wait an hour or more before being seen, though Black patients had significantly longer wait times than white patients. This finding was consistent with prior research, the researchers noted, although those studies found that the differences decreased when adjusting for factors such as location and visit volume of the ED.

Though Hispanic patients also had longer wait times than white patients, the difference wasn’t strong enough to be statistically significant—potentially a limit of the smaller sample size of those patients in the analysis, researchers wrote.

The increased ED utilization by Black Americans spotted in the study precedes the widespread capacity and boarding issues that have been reported over the past year. A recent study reviewing pediatric ED mental health visits also noted increased incidence and lengthy stays during much of the pandemic.

To combat their backlogged ED departments, hospital and provider groups have requested—among other things—greater investment in behavioral health inpatient capacity.