Missouri hospitals report rising ‘‘boarding’’ of psychiatric and developmental patients as long-term placements remain scarce

Leaders from Missouri hospital systems and child-service organizations told the House Committee on Health and Mental Health on Oct. 12 that emergency departments and inpatient beds are increasingly being used as de facto long-term care for people with complex behavioral-health needs when appropriate community placements are unavailable.

The testimony centered on children in state custody, adults with intellectual or developmental disabilities (IDD) and patients with chronic behavioral problems who repeatedly present to emergency departments (EDs). Mercy Health vice president Patty Morrow said hospitals are “closing entire units for 1 patient,” and gave an example of a case last fall in which one patient’s aggression forced a 12-bed unit to close for two weeks.

Those closures and lengthy stays, witnesses said, reduce hospital capacity for acute medical and trauma care and create workplace-safety burdens. Mercy reported that in 2024 its staff experienced 1,679 assaults by patients in Missouri, 206 of which involved injury, testimony said.

Why it matters: Committee members heard repeated examples of people who need months of specialized care but have nowhere to go. The result is “boarding” — patients who remain in EDs or medical/psychiatric beds long after the immediate clinical problem has been stabilized because no residential, waiver, or long-term placement is available. Witnesses stressed that boarding can amount to a human-rights…