Access to mental health care within 48 hours

To address the pressing need for crisis mental health services, Optum has launched an innovative urgent mental health care access option. The psychiatric urgent care program is designed for members experiencing serious mental health concerns that are not life-threatening but could rapidly worsen without intervention. It helps ensure these members gain access to a psychiatrist within 48 hours for evaluation.

By creating urgent mental health care access, Optum aims to improve clinical outcomes and reduce out-of-pocket costs for members while saving plan sponsors up to 500% in claims for hospital emergency department (ED) visits.¹ In-network state, regional and national in-person and virtual providers are participating in the program.²

Why offering urgent access to mental health care is critical

Optum developed the program in direct response to skyrocketing mental health needs and related visits to EDs, especially among children, adolescents and young adults. The proportion of mental-health-related ED visits reached all-time highs during the COVID-19 pandemic.³

In many cases, individuals turn to EDs as a readily available resource for serious but not necessarily life-threatening mental health concerns. Nearly half the U.S. population lives in an area with a shortage of mental health providers.⁴ Meanwhile, with depression, anxiety and suicidal ideation on the rise, especially among young adults ages 18-24, individuals seeking primary care treatment face long wait lists and appointment backlogs.⁵ So, many go untreated while others struggle to cope through treatment delays and interruptions. As a result, their conditions may worsen and become urgent.

Unfortunately, EDs struggle to meet the needs of these individuals. By purposeful design, EDs are available 24 hours a day to treat severe health problems that require immediate medical attention. Staff prioritize cases based on severity, so life-threatening and serious injuries come first. 
 
Furthermore, EDs generally are staffed and set up for medical triage, and have limited mental health resources. As a result, individuals with urgent but not life-threatening mental health concerns often experience long ED waits before they are seen by a medical provider. In addition, EDs are foremost medical centers. As part of the assessment process, individuals often receive medical evaluations and tests for potential physical causes of their condition. In certain cases, these tests are appropriate, such as when an individual has no prior history of mental illness. However, in many cases, they are unnecessary.

Once evaluated and referred to clinically appropriate mental health care, individuals often wait several days or even weeks before a mental health professional becomes available. In some cases, patients with high risk and high needs — such as those posing a risk to themselves or others, or experiencing a severe psychotic episode — are “boarded” in an emergency room until they can be transferred to psychiatric care. Excluding pregnancy and birth-related cases, depressive disorders are the most common reason individuals under age 18 are hospitalized.5 Mood disorders, including depression and bipolar, drive most hospitalizations for individuals under age 45.⁶

How we support members with urgent mental health needs

When a member reaches out to Optum for support, they are connected to a licensed mental health care specialist immediately. If, based on established clinical standards, the specialist determines the member needs urgent care, they make sure the member is safe. Then, they warm transfer the individual (or their caregiver) to an urgent care provider in the area. The urgent care provider’s office intakes the member and schedules an in-person or telehealth evaluation to be held within 48 hours.

By connecting members to urgent mental health services immediately, this program:

• Prevents or avoids a mental health condition from worsening in severity or into crisis. For example, a member with bipolar disorder who reports being out of medication and who is experiencing the onset of manic symptoms.
• Maintains or regains a member’s maximum function. For example, an adolescent who may be passively suicidal and refusing to go to school or engage in usual activities.
• Prevents and helps a member avoid experiencing severe pain or discomfort. Emotional pain is as debilitating as physical pain. If left unaddressed, emotional pain can spiral a person into an emergent need requiring higher levels of care, such as inpatient or residential services.

In a recent case, a mother called Optum after her teenage son texted her that he wanted to harm himself. She didn’t know where to go and asked if she should rush her son to the local hospital emergency room. The Optum licensed mental health care specialist redirected and warm transferred her to an urgent access care provider with an adolescent mental health treatment center. The specialist provided step-by-step guidance to the mother, instructing her to remove her son from school and to take him directly to the treatment center for evaluation. When the mother and son arrived at the center, a clinical specialist immediately processed the intake. The teenager promptly received the right level of care for his condition.

1. Optum emergency room data for the commercial line of business, 2022–2023.
2. This program will be evaluated for effectiveness throughout 2024.
3. Anderson KN, Johns D, Holland KM, et al. Emergency department visits involving mental health conditions, suicide-related behaviors, and drug overdoses among adolescents — United States, January 2019–February 2023. MMWR Morb Mortal Wkly Rep. 2023;72:502–512.
4. KFF. Mental health care health professional shortage areas (HPSAs).
5. KFF. Latest federal data show that young people are more likely than older adults to be experiencing symptoms of anxiety or depression. March 20, 2023.
6. NAMI. Mental health by the numbers. Updated April 2023.