spike, I'm so sorry you've had such long waits in the ER waiting for a bed in a psych hospital. The story you told about the man's extreme wait is terrible! From my years visiting bipolar forums it has been quite clear that mental healthcare, including waits, and other details, are not the same from state to state. I know such things are also different in various countries.

I live in a mid-Atlantic state in the US. There is a large population in my state, and many resources and hospitals within fairly short distances. Not that it is always easy to find mental health providers that take insurance or have no waiting lists, there are many mental health providers and Intensive Outpatient Programs (IOPs). Fortunately, there are also many hospitals with beds for people in mental health crises (I have no clue how many), most taking most insurance types. There is also a state psychiatric hospital, which I believe sometimes takes people with no insurance or people who need exceedingly long stays of many months or even longer? I happen to live within 20 minutes of two psychiatric only hospitals where stays are usually between four days and two months. One is even only a 15 minute walk from my house. Other hospitals do have psychiatric wings that keep patients a couple days to a week or two (and provide therapy groups, etc), but others just have psych ERs that transfer to psych hospitals. I've never heard of anyone staying in a psych ER, in my state, for more than 2 days.

I have had 10 psychiatric hospitalizations in the past. I have only entered a psych hospital from a hospital ER for two of those hospitalizations. In one of the cases, I waited just overnight (12 hours) in their psych ER wing to be transferred to a nearby psych hospital. In the other case, I was in the ER (that hospital didn't have a designated psych ER at the time) for maybe ??? 2-5 hours ??? before being transferred to a nearby psych hospital.

Most of my psych hospitalizations were from referrals from Intensive Outpatient Programs (IOPs), which I usually attended after a hospitalization (I was too sick for the IOP), or from private outpatient psychiatrists that I was seeing who called to get me in. In the former cases (five?), I usually waited no longer than 2 hours or so, and the psych hospital was literally a two minute drive from the IOP. In the latter cases (three), I usually waited until the next day, usually waiting from home with my husband with me (if I wasn't in imminent danger).

One of the psych hospitals I went to would occasionally add a cot into a double room, making it a temporary triple. I think they only did that when there was a patient (one time me) that was so severe that a wait elsewhere was not a good idea, despite beds being full.