Cutler Institute for Health and Social Policy

Maine Rural Health Research Center, Population Health and Health Policy

Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms


Background: National data demonstrate that mental health visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture this issue. Purpose: This study investigates the use of Critical Access Hospital (CAH) ERs by patients with mental health problems to understand the role these facilities play in rural mental health needs, and the challenges they face. Methods: We collected primary data through the combination of a telephone survey and ER visit logs. Our sampling frame was the universe of CAHs at the time the survey was fielded.

Key Findings: 43% of CAHs surveyed operate in communities with no mental health services, while 9.4% of all logged visits were by patients identified as having some type of mental health problem. The most common problems identified were substance abuse, anxiety and psychotic disorders. Only 32% of CAHs have access to onsite detoxification and 2% have inpatient psychiatric services, meaning that patients in need of these services typically must leave their communities to gain treatment. Conclusions: The lack of community resources may impact CAHs ability to assist patients with mental health problems. Among those with a primary mental health condition 21% left the ER with no or unknown treatment, as did 51% of patients whose mental health condition was secondary to their emergent problem. Patients in need of detoxification or inpatient psychiatric services often must travel over an hour to obtain these services, potentially creating significant issues for themselves and their families.

Suggested Citation: Hartley D, Ziller E, Loux S, Gale J, Lambert D, Yousefian AE. Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms. J Rural Health. 2007;23(2):108-115.

Publication Type: 
Journal Article
Publish Date: 
September 1, 2005

Nellie Mae Education Foundation nominates Pious Ali for the Lawrence W. O'Toole Award

Pious Ali

Pious Ali, Youth and Community Engagement Specialist in Cutler’s Children, Youth, and Families Programs, has been nominated for the Lawrence W. O’Toole Award by the Nellie Mae Education Foundation. Pious is one of six nominees from the New England states.

The Nellie Mae Education Foundation believes that student-centered learning – where learning is personalized, engaging, competency-based and not restricted to the classroom – will prepare young people to graduate high school ready to contribute to their communities and succeed. This award is given out each year to an individual, school district, or non-profit that has exhibited great leadership in moving student-centered approaches to learning forward in the New England region.

The winner will be selected by online voting and will be awarded a $100,000 grant to help advance student centered learning!


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