What the Latest Research Says About Behavioral Health Transfers

By Jennifer Davis, Executive Administrative Assistant @ highMor | July 2025

Behavioral health transfers—moving patients with mental health or substance use disorders between facilities—present unique challenges in healthcare systems worldwide. Unlike general medical transfers, these often involve heightened risks due to patients’ vulnerabilities, such as acute crises or co-occurring conditions. Recent research highlights complexities like prolonged wait times, bed availability issues, and breakdowns in care continuity. This article explores emerging strategies and research-backed insights to improve behavioral health transfers across systems and regions.

Prolonged Wait Times: A Barrier to Timely Care

Behavioral health patients often face longer emergency department (ED) stays compared to general medical cases. In rural Midwestern hospitals, telehealth decreased ED wait times from 27 minutes to 12 for behavioral health patients¹. Ontario EDs saw a median time of 140 minutes from decision to transfer². In the US, mental health visits lasting more than six hours were significantly more common in the Northeast, with median delays of 4.6 to 3.3 hours³.

Crisis situations—such as the COVID-19 pandemic—worsen these delays. For instance, mental health wait times ranged from 3 to 18 months globally⁴. In Norway, imaging delays stretched 7.9–11.4 weeks for ultrasound and 8.7–12 weeks for MRI⁵. Machine learning is now being used to predict and reduce wait times in mental health clinics⁶. Chronic issues like no-shows and limited session availability also play a role in extended delays⁶.

Patients with substance use disorders see the highest ED costs and longest stays. For example, cases involving resuscitation saw costs average $4,556¹. International studies show that dissatisfaction with medication and consultation wait times leads to delayed care and increased costs⁸. Ultimately, these delays disrupt transfer efficiency and patient recovery⁷⁸.

Bed Matching Challenges: Finding the Right Fit

Matching patients to appropriate beds is a frequent barrier. In high-security UK hospitals, average transfer delays reached 44.3 days due to limited availability and instability risks¹⁰. Newer strategies, like real-time bed matching and “just-in-time” assignment models, show promise in improving this⁹.

Regional disparities amplify these issues. Norway’s public sector saw longer imaging wait times than private systems⁵, and California EDs showed an average psychiatric bed delay of 10.05 hours, stretching to 12.97 for pediatric patients¹¹. Predictive analytics is now being used to optimize triage and identify fast-track pathways for urgent cases⁶. Without it, poor bed matches increase readmissions and strain systems⁶¹¹.

Legal Considerations in Transfers

Legal frameworks surrounding behavioral health transfers—such as involuntary commitment, consent, and privacy—introduce significant delays. During the COVID-19 pandemic, Texas saw abortion return rates shift from 90.4% to 82.8% due to executive orders, highlighting how legal restrictions delay access¹². UK guidelines require transfers of mentally ill prisoners within 28 days, but these often stretched to 93–102 days, even after policy improvements¹³¹⁰.

Lack of compliance also complicates things—about 50% of patients do not adhere to medication, disrupting ethical transfer processes¹⁰. Legal obligations, such as HIPAA compliance in the US, can also slow transfers without necessarily improving safety or quality¹.

Ensuring Continuity of Care During Transitions 

Disrupted care continuity is a major risk in behavioral health transfers. Queensland’s health system removed 35–89% of patients from waitlists by streamlining pathways—avoiding the need for specialist consultation¹⁵. ED studies show that telehealth improved outcomes in co-occurring disorder cases by reducing rural disparities¹³. 

Norwegian data showed patients with severe depression faced seven-week waits, breaking care continuity¹⁴. Strategies like rapid intake telemedicine and accelerated engagement in therapy have shortened gaps and improved satisfaction⁴. In California, 10-hour bed delays in EDs further fractured continuity¹¹. Digital tools and team-based coordination are now viewed as essential to reduce readmissions and improve outcomes¹⁵⁴.

References

¹ Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. Telepsychiatry and e-mental health services: clinical, educational, and research applications. Liebertpub.

² Foo PK, Abdel-Baki S, Dong K, et al. Wait times in the emergency department for patients with mental health diagnoses. NIH.

³ Anderson K, Davidson L, et al. Waiting for Care: Length of Stay for ED Mental Health Patients. Cureus.

⁴ Chan SR, Parish MB, Yellowlees PM. Using a tele-behavioral health rapid intake model to address COVID-19. NIH.

⁵ Sund K, et al. Variations in wait times for imaging services: a register-based study. Biomedcentral.

⁶ Bate A, Eshraghian P, Hart G. Predicting Patient Wait Times by Using Highly Deidentified EHR Data. Jmir.

⁷ Johnson A, et al. The Impact of Long Wait Times on Patient Health Outcomes. Premierscience.

⁸ Smith R, Thomas R. The Association Between Wait Times and Patient Satisfaction. Sagepub.

⁹ Mitchell R, et al. Evaluation and implementation of a Just-In-Time bed-assignment strategy. Springer.

¹⁰ UK Department of Health. New procedures to cut delays in transfer of mentally ill prisoners. Cambridge.

¹¹ Dobbs C, et al. Impact of the Mental Healthcare Delivery System on Care Continuity. NIH.

¹² White K, et al. Abortion Return Rates and Wait Times Before and After COVID Orders. Aphapublications.

¹³ Robertson S, et al. A suitable waiting room? Hospital transfer outcomes and compliance. Cambridge.

¹⁴ Strand BH, et al. Referral assessment and patient waiting time decisions in Norway. NIH.

¹⁵ Haines TP, et al. Allied health primary contact services: results of a 2-year Queensland trial. Csiro.