Emergency departments are seeing more behavioral health cases, and those visits often last longer —impacting patient flow, staffing, and overall department performance. As these cases become a consistent part of ED volume, they shape throughput, capacity, and the ability to deliver timely care. 

Emergency departments are increasingly serving as the default entry point for behavioral health care often without the resources, environment, or downstream capacity to support it. 

For hospital leaders, this shift is impacting throughput, length of stay, and staff sustainability in ways that extend far beyond the ED. 

Inside the Reality Clinicians are Managing Every Day

By the time Kylie Little starts her shift at one of the busiest emergency departments outside Atlanta, several behavioral health cases are already there. 

Some are waiting for lab results. Others have been medically cleared and are waiting for placement. Some arrived overnight and are still there. More are already coming through the door. 

“I used to only see maybe one or two patients a shift that had mental health issues,” said Little, a physician assistant at Wellstar Kennestone Regional Medical Center, just northwest of Atlanta. “Now we see so many more.” 

This increase has been building for years. Emergency Departments have become a consistent point of care when other options are not available. Especially during moments of crisis.  

For hospital leaders, this shift is not just clinical; it directly affects patient flow, staffing, and overall department performance. Behavioral health patients in the ED shape capacity, throughput, and the ability to care for every patient who comes through the door. 

What Clinicians See First 

Often, the visit does not start with a clear reason. Behavioral health concerns do not always show up in obvious ways. Some people say what is wrong. Others cannot. 

“They just don’t seem to make sense,” Little said. “They seem really scattered. They don’t always present with a clear complaint.” 

A nurse flags the concern. From there, a clinician steps in and starts piecing things together. 

“I have very little information about the patient,” said Kaitlyn Schaefer, a physician assistant who works nights. “It’s kind of a fine balance of determining is this medical, is this psychiatric, is this potentially related to substance use.” 

 These early decisions shape the entire visit. They often determine: 

• How long a patient will remain in the department  

• What resources are required  

• How the rest of the shift unfolds  

 For hospital leaders, this is where behavioral health begins to intersect directly with throughput, staffing, and operational flow. 

Where the Environment Falls Short 

Emergency departments are built to stabilize urgent health problems and move on. Behavioral health does not follow that pace, and that gap shapes much of what clinicians are managing. What patients need and what the ED is designed to provide are often not the same. 

“The ER really is not the best place for that,” Schaefer said. “A lot of times these patients need maybe a more therapeutic environment with lower lights, quieter environments.” 

Even in a dedicated unit, the mix can be hard. 

“It can be a really scary environment for some patients,” Little said. “In that same unit there might be a sweet 18-year-old girl, and in that same unit there will be a person who is high on methamphetamines, who is aggressive to staff.” 

 This dynamic creates challenges around: 

• Patient safety  

• Staff workload  

• Space and bed utilization  

 And ultimately, it affects the experience for all patients in the department. 

When Length of Stay Changes the Entire System 

Most emergency visits move quickly. Behavioral health often does not. 

“Most patients are there for at least 24 hours, if not longer,” Schaefer said. 

“Oftentimes, they might stay in our department for days, weeks, even,” Little said. 

Extended stays like these don’t just affect individual patients. They reshape how the entire department operates. 

• Reduced bed availability  

• Increased boarding  

• Delays in seeing new patients  

• Added strain on clinical teams 

 As hours turn into days, the work changes. Clinicians move beyond initial assessment into ongoing monitoring, reassessment, and safety management, all while coordinating next steps that are often dependent on resources outside the hospital.  

At the same time, new patients continue to arrive.  

The result is a compounding effect on patient flow and capacity. Beds remain occupied longer, wait times increase, and pressure builds across the department. What begins as an individual patient need quickly becomes a broader operational challenge. 

Many of the most complex decisions happen early. The “He Said, She Said” cases can be some of the most difficult, Little said, when family members report concerns but the person appears stable in the ED. In these situations, clinicians work to interpret sometimes conflicting information and coordinate next steps with the care team, balancing patient needs and department resources.  

For hospital leaders, these moments are part of a larger pattern influencing throughput, staffing, and overall department performance. 

What Holds the Shift Together 

Across the shift, safety remains a constant priority. Clinicians work closely with nurses and security. They watch for small changes and respond quickly. When things go well, patents are stabilized and trust is built; when challenges arise, delays or limited resources can extend stays and increase stress for both patients and staff. 

“Sometimes these patients sit in the ER for a very prolonged time, which is not the best for the patient,” Schaefer said. 

Some return again and again. 

“We have a lot of chronically ill mental patients, and we are not going to fix it in the emergency department,” Little said. 

The emergency department becomes part of an ongoing cycle of care. The next step often depends on resources outside the ED. In many communities, those resources are limited. 

“I always try to have a conversation with them and explain to the patients the process of what’s going to happen,” Schaefer said. 

“I think just patience with these patients is such a huge thing,” Little said. “And having a little bit of empathy as well.” 

For clinicians, this is what they are managing each shift. For hospital leaders, it highlights a growing operational challenge — one that affects patient flow, staff capacity, and the ability to deliver timely care across the entire department. 

What This Means for Hospital Leaders 

Behavioral health is now embedded in daily emergency department operations, and its impact extends well beyond the ED. 

• Improving ED performance now requires addressing behavioral health flow as part of the broader system. 

• Longer stays reduce bed availability, increase boarding, and slow overall patient throughput. 

• Care teams are managing complex needs that extend beyond the ED’s intended to support. 

• These challenges are impacting staffing, operational efficiency, and patient experience across the hospital. 

Kylie Little, PA-C, is a physician assistant in the emergency department at Wellstar Kennestone Regional Medical Center, has been with ApolloMD since 2008 in the emergency department and says: “I am so grateful to work in a place where people can show up, regardless of who they are, and receive the medical care that they need. And I think that’s why I stay in the emergency department.” 

Kaitlyn Schaefer, PA-C, is a physician assistant who also works in emergency medicine at Wellstar Kennestone, primarily on night shifts. “With some of the behavioral health patients, you do really see that we have the ability to make a difference in their lives,” she says. “You can almost see on their face the fear and the worry go away.” 

Continuing the Conversation

Behavioral health in the ED is a growing operational challenge that requires coordination across care teams, departments, and community resources. ApolloMD works alongside hospital leaders to better understand these dynamics and support strategies that improve patient flow, care delivery, and overall performance.