A Roadmap for Reducing Pediatric Mental Health Boarding

When a child experiences a mental health crisis, getting the right care at the right time can make all the difference.

Yet across the country, thousands of children spend days, weeks, and sometimes even longer in emergency departments or inpatient units after they no longer need hospital-level care because an appropriate behavioral health placement is unavailable. This practice, known as pediatric mental health boarding, has become an increasingly common challenge for children, families, and health care providers.

Children's hospitals have seen a dramatic increase in behavioral health-related emergency department visits in recent years. According to our Pediatric Health Information System® (PHIS), in 2025, children’s hospitals’ mental health emergency department cases (ages 3-18) were 50.7% higher than in 2016.

For children and families, boarding can mean delayed access to treatment, prolonged uncertainty, and additional stress during an already difficult time. Research has linked boarding to clinical deterioration and increased costs. Hospitals also face significant challenges when emergency departments and inpatient resources are occupied by children awaiting appropriate placements elsewhere in the care continuum.

The problem is visible in hospitals, but its causes extend far beyond them.

Hospitals are doing their part

Children's hospitals across the country have invested in innovative approaches to improve care for children experiencing behavioral health crises. From dedicated crisis assessment teams and expanded stabilization services to improved discharge planning and community partnerships, hospitals have developed promising strategies that help reduce harm and improve patient outcomes.

These efforts are making a difference, but even the most successful hospital-based interventions cannot solve boarding on their own.

Hospitals do not control many of the factors that determine whether a child can quickly access the next appropriate level of care. Community behavioral health capacity, Medicaid payment policies, licensing requirements, workforce shortages, and coordination across child-serving systems are largely shaped by state policy decisions.

Why state action matters

Our new policy framework outlines practical steps states can take to address pediatric mental health boarding and improve access to care.

The report recommends several key actions, including:

• Establishing statewide behavioral health coordination systems that can identify boarding cases, track available capacity, and help facilitate timely placements
• Expanding community-based behavioral health services and alternatives to hospitalization
• Aligning Medicaid payment and coverage policies with children's behavioral health needs
• Improving accountability for placement decisions and cross-system coordination
• Supporting active treatment and family services during unavoidable boarding periods

The framework also highlights examples from states already implementing innovative approaches to improve care coordination, increase transparency around available services, and reduce delays in accessing treatment.

A solvable problem

Boarding is not an inevitable consequence, nor should it be viewed as an inevitable consequence of rising behavioral health needs. As the white paper notes, boarding is a symptom of broader system gaps and misalignments that can be addressed through thoughtful policy action and sustained investment.

Children deserve access to timely, appropriate behavioral health care in the least restrictive setting that meets their needs. Families deserve a system that works when they are facing a crisis. And hospitals need stronger community infrastructure and policy support to ensure they can focus on delivering the specialized care children require.

States have both the responsibility and the opportunity to help make that vision a reality. By strengthening behavioral health capacity, improving coordination, and aligning policy with children's needs, state leaders can create a more effective behavioral health system for children and families.

To learn more, read our white paper.