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In a recent Healthcare Construction and Activation Community (HCAC) webinar, clinical and design leaders ( Dr. Ben Maxwell, a child and adolescent psychiatrist from Rady Children’s Hospital; Dr. David Seigler, Medical Director at Vituity; Andrea Ruelas, Principal-in-Charge at HMC Architects; and Daniel Perschbacher, Healthcare Practice Leader at HMC Architects) shared what they’re seeing on the ground and how systems are responding with new crisis care models that improve flow, safety, and patient experience.
Emergency behavioral health volumes, acuity, and safety risks are rising fast, and hospitals across the country are feeling it first in the Emergency Department (ED). But the ED was never designed to be the long-term “front door” for psychiatric crisis care, especially when patients end up boarding for hours (or longer) while teams scramble for downstream placement.
One of the clearest themes from the conversation: the growth in demand isn’t incremental, it’s exponential.
At Rady Children’s Hospital in San Diego, pediatric psychiatric emergencies grew from roughly 160 cases per year in 2010 to over 4,700 cases last fiscal year. That kind of increase doesn’t just strain a behavioral health team; it reshapes the entire emergency department’s operations and capacity.
And the math in the ED becomes unforgiving.
Behavioral health patients often stay far longer than medical patients. In the discussion, the median length of stay for behavioral health patients was approximately 800 minutes, compared with about 120 minutes for typical medical ED patients. From a throughput perspective, a single behavioral health patient can consume the same bed-time as multiple medical patients, creating a system-wide backlog that expansion alone can’t solve.
Hospitals can invest in more ED beds, but if a high percentage of those beds are occupied by patients boarding for behavioral health placement, the bottleneck simply shifts. The underlying issue is a mismatch between: