Trends in Psychiatric Care in Emergency Settings During the Pandemic

​The COVID-19 pandemic had a profound impact on mental health care and access to emergency medical services by vulnerable populations, which manifested in various ways, depending on the patient population and type of malady.

In the June 2025 issue of The Journal of Emergency Medicine, researchers at the University of California, San Diego Medical Center explored psychiatric emergencies. In the article “Acute Health Care Utilization Among Schizophrenia or Related Conditions and Bipolar Disorder Before, During, and After COVID-19,” the authors characterize providing mental health (MH) resources as a “pervasive challenge” in many American communities.

With diagnoses of severe mental illness (SMI) on the rise, emergency departments (EDs) often bear the brunt of the responsibility of caring for patients with acute mental health issues. The assistance and care they provide help address severe psychological distress and acute crises.

The authors of the four-year multicenter retrospective analysis of California emergency departments note that, before the pandemic, cases of mental illness-related ED visits were on a consistent uptrend. A National Hospital Ambulatory Medical Care Survey spanning 2016 to 2018 found 43.9 ED visits per 1000 adults related to mental illnesses. Another study documented a 39.7 rise in severe MH ED visits in California between the years 2005 and 2015.

As a coordinated pandemic response evolved, the COVID-19 protocol resulted in a 4.3 percent decrease in overall ED visits (prior to the initial emergency shutdown). This reversed an upward trend: ED hospital visits rose from 11.8 million in 2018 to 12 million the following year. They decreased to a nadir of 10.2 million in 2020 before partially recovering in 2021 to 10.9 million ED visits.

While SMI-related ED visits also decreased, in line with the overall trend, they continued to represent a substantial number of ED visits, with patients with mental issues still seeking care. Indeed, the authors found that SMI-related ED visits (per 100,000 visits) rose between 2019 and 2020 and remained elevated the following year. Those with the highest utilization rates for SMI-related ED visits included Medicaid beneficiaries, those aged 25 to 44, and African Americans. Across California, Los Angeles County had a consistently high representation. The authors conclude that the ED played an even more vital role in addressing mental health issues during the pandemic than before; the number of schizophrenia and bipolar disorder patients rose as a proportion of total ED visits.

Another study, “The Impact of COVID-19 Pandemic on Psychiatric Emergencies in Two Different Settings: Emergency Room and Community Mental Health Service” (Frontiers in Psychiatry, May 2022), collected data in a northern Italian town from 2020 to 2021. The monocentric observational study revealed a 24 percent decrease in urgent psychiatric consultations (UPCs) within an ED setting. At the same time, UPCs increased by four percent in community mental health service (CMHS) settings.

Interestingly, while UPC visits to ED decreased among the general population, they increased among those who had disability pensions or resided in psychiatric facilities. Within the CMHS setting, the uptick reflected more older people and those living in other institutions requiring UPC. Most frequently, UPC visits to the ED reflected issues such as socio-environmental maladjustment and aggressiveness, as well as the psychiatric symptoms of existing mental disorders. By contrast, UPC visits to CMHS tended to reflect patients’ mixed affective/manic states, as well as issues related to psychopharmacology therapies.

These findings also point to a proportional increase in vulnerable people requiring more frequent mental health care and attention throughout the pandemic. As the authors put it, the pandemic “disrupted individuals’ ability to adapt and induced many stressful reactive symptoms.”

Eugene Saltzberg MD

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