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Mental illness and related health inequities are disproportionately concentrated in economically disadvantaged urban neighborhoods. The COVID-19 pandemic has been associated with a rise in mental illness prevalence, with women generally at greater risk than men. Urban areas facing multiple structural and socioeconomic challenges may have limited capacity to meet the mental healthcare needs of residents, leading to increased reliance on emergency departments (EDs) for acute care. This ecological study uses data over four years (2018-2021) and examines spatial variations in ED utilization at the census tract level, focusing on geographic areas with women of reproductive age diagnosed with mental illness to compare patterns before and during the COVID-19 pandemic. Of the 22,565 ED visits in the four-year period, 12,832 occurred before COVID-19 and 9733 during COVID-19. Our findings highlight persistent structural disparities in mental healthcare access across census tracts characterized by high concentrations of vulnerable women of reproductive age. Understanding these spatial disparities allows for geographically targeted interventions and the prioritization of resources for neighborhoods identified as most underserved.