In case of a mental emergency, MeckLINK, the county’s new $280 million gateway to behavioral care, sends clients down a familiar path.

Go to the nearest emergency room, its consumer handbook says.

Mental-health patients continue filing into emergency departments in increasing numbers, even if the hospitals often lack the staff, equipment and training to meet crisis needs.

Consider:

• From 2008 to 2011, visits by mental health or substance abuse patients increased by 38 percent, the N.C. Hospital Association says. That compares with an overall 6 percent increase in ER trips.

• Once there, mental health patients often stay longer than other clients.

A 2012 emergency room study by the state’s hospital association showed that the average stay for behavioral patients has increased 65 percent since 2010, to almost 16 hours.

Experts say the longer waits, often resulting from the difficulty in finding a psychiatrist or more specialized care, increase the odds that a crisis will worsen, risking the safety of patients and hospital staffs alike.

Even so, MeckLINK executive director Phil Endress has no qualms singling out hospitals as first responders to an emotional crisis.

“Psychiatry is part of medical care,” he says. “It’s incumbent for EDs to be able to handle the brunt of the medical problems presented to them.”

Hospitals have little choice. In the shifting sands of statewide mental-health reforms, their emergency rooms are familiar places where people in crisis can turn for help.

That has made ERs “de facto mental health facilities,” says Dr. Greg Clary, medical director of Presbyterian Hospital’s psychiatric wing.

If so, “the state should fund and staff them to do so,” says Mebane Rash of the N.C. Center for Public Policy Research, who is helping lead the nonprofit’s study of N.C. mental health. Instead, millions of dollars for low-income medical care appear in jeopardy.

State support has varied wildly, going up and down from year to year during the recession. The current $700 million budget of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services is about $50 million smaller than it was five years ago.

Now the governor and legislature have rejected hundreds of millions of dollars from President Barack Obama’s expanded Medicaid coverage for the poor. Sequestration could cut Medicaid payments even more.

Some hospitals might lose between $50 million and $100 million a year, says Dr. Marvin Swartz, head of Duke University’s Division of Social and Community Psychiatry. “Hospitals have been left in a terrible squeeze.”

Despite this atmosphere, and with one of the country’s worst recessions just ending, both of Charlotte’s major hospital chains are expanding their mental-health footprints.

Carolinas Healthcare Systems has not only taken over control of CMC-Randolph (the hospital had run the psychiatric facility under a contract with Mecklenburg County since the mid-1980s), it also plans to open a new 66-bed psychiatric hospital in Davidson a year from now.

At CMC-Randolph, emergency visits dropped by 8 percent in 2012; admissions rose by 18 percent.

The hospital system declined requests to discuss the issue. But in a prepared statement, it said its commitment “to providing care to these patients who need it so desperately” remains strong.

Few hospitals have the “initiative and strength” to take on a new psychiatric hospital, particularly since facilities serving indigent or underinsured patients often lose money, the statement reads. “... We look forward with others to address this important community and national need.”

At Presbyterian, mental health trips have increased by 11 percent from 2010 to 2012. Admission to the hospital’s psychiatric unit increased 17 percent over the same period. Presbyterian opened 15 new psychiatric beds in July, an expansion that has eased pressure on its emergency room.

Yet the hospital continues to see mental-health patients from hundreds of miles away “because they can’t find a bed any closer,” Clary says.