PRINCETON – Patients with mental health and substance use disorder needs account for nearly half of the growth in hospital emergency room cases in New Jersey hospitals and are far outpacing the overall growth in emergency department use.

Emergency department visits in New Jersey hospitals increased overall by more than 117,000 patients from 2014 to 2015, and nearly 54,000, or 45.7 percent, of these new ED cases included a mental health or substance use disorder diagnosis, according to the annual Mental Health and Substance Use Disorder Volume Report from the New Jersey Hospital Association. Overall emergency department visits increased 3.8 percent from 2014 to 2015; ED visits with a mental health or substance use diagnosis increased 10.1 percent in the same period.

“We know that treating people in a mental health crisis in the emergency department can place stress on the patient; it’s simply not the right setting to handle their complex needs,” said Betsy Ryan, president and CEO of NJHA. “At the same time, it places increased strain within the emergency department, adding to overcrowding, long waits and increased healthcare costs.”

The report uses billing codes to identify cases with a mental health condition or substance use disorder as a primary or secondary diagnosis. Key findings in the report include:

• The percentage of emergency department cases with a mental illness or substance use disorder has increased from 15 percent of all ED visits in 2011 to 18.4 percent in 2015.
• Longer term, total visits to the ED increased by 216,794 patients from 2011 to 2015, of which 140,744 included a mental health or substance use billing code. These diagnostic codes represent 64.9 percent of the increase in total ED visits.
• In 2011, 14.9 percent of all mental health and substance use disorder patients arriving in the ED were covered by Medicaid; in 2015, that percentage increased to 28.8.

Often the ED has been the only option to get guaranteed care for the uninsured and underinsured, but despite increased levels of health insurance coverage, a growing number of patients use hospital EDs for treatment.

“One positive takeaway from this new data is that more of these individuals in need of care are covered by health insurance, thanks largely to Medicaid expansion in our state,” said Ryan. “It’s great that these New Jerseyans are covered by insurance, but we also need to make sure they have access to appropriate behavioral health services, in the right setting – and that setting should not be the emergency department.”

The Mental Health and Substance Use Disorder Volume Report is part of NJHA’s ongoing advocacy to strengthen the state’s system of care. Increasing access to care in appropriate settings will result in better outcomes for patients, reduced demands on emergency personnel and a reduction in the cost of care to the system.

A copy of the full report, including information broken down by county, payer and age, is available on the NJHA web site at /quality-patient-safety/behavioral-health/.