When children and adolescents are overwhelmed by anxiety, depression, or thoughts of harming themselves, they often wait days in emergency rooms because there are not enough psychiatric beds.
The problem only got worse during the pandemic, reports from parents and professionals suggest.
With schools closed, routines disrupted, and parents worrying about a loss of income or uncertain future prospects, the children face new burdens that many cannot bear.
And with the number of COVID-19 patients in hospitals increasing, bed space is even tighter.
By early fall, many Massachusetts emergency rooms were seeing about four times more children and adolescents in psychiatric crisis per week than usual, said Ralph Buonopane, mental health program director at Franciscan Hospital for Children in Boston.
“I’ve been the director of this program for 21 years and have worked in child psychiatry since the 1980s. It’s unprecedented,” said Buonopane. His hospital receives emergency transfers from across the state.
While emergency doctor visits declined at the start of the pandemic for health reasons other than COVID-19 as people avoid hospitals, the percentage of visits related to children’s mental health rose steadily from mid-April to October, according to a recently published federal report disease control and prevention. Of the children who showed up, more were responsible for mental health than in the same period last year, although that might suggest others stayed away, the authors warned.
Claire Brennan Tillberg’s 11-year-old daughter was one of those children in need of care. The Massachusetts girl suffers from autism, depression and anxiety and has been hospitalized twice in the past few months after it was revealed she had thoughts of suicide. The second time, in September, she waited in an emergency room for a week before being transferred to another hospital. The first time in July the waiting period lasted four days.
She had been hospitalized before, but Tillberg said things got worse when the pandemic hit and her new school and therapy sessions went online. Suddenly, the structure and rituals that many children with autism live on were gone.
“She had never met the teacher, never the children,” said Tillberg, a psychotherapist. “She felt more isolated, more and more like things weren’t going to get better. Without the distraction of getting up and going to school or camping … sitting at home with a computer on my own mind all day, that has made it worse. ”
Studies and surveys in Asia, Australia, the US, Canada, China and Europe have shown that the mental health of children and adolescents has been deteriorating overall since the pandemic began. In a World Health Organization poll of 130 countries published in October, more than 60% reported disruptions in mental health care for people in need, including children and adolescents.
Emergency rooms are often the first place that children facing a mental disorder seek help. Some are stabilized there and sent home. Some require inpatient care, but many hospitals do not provide psychiatric treatment for children and move those children elsewhere.
Some treatment centers do not accept children without proof that they do not have COVID-19. This is difficult because you can’t always find a rapid test, “Ellie Rounds told Bloom. Her 12-year-old son has” significant mental health problems “including trauma” and has had several crises since the pandemic began. The boy from the Boston area has been hospitalized since October after spending 17 days in the emergency room.
Many mental health advocates find these waiting times unacceptable. For parents and their children, they are that and more.
“There have been moments of frustration and moments of pulling your hair out of your head,” Rounds told Bloom.
State health insurance will cover your son’s treatment, but not all providers will accept it. Deficiencies in the U.S. health system can make families feel helpless, she said.
“You can’t give up because it’s your kid,” Rounds told Bloom.
There are no national studies of how child emergency rooms wait for mental health treatment, a practice called boarding. This emerges from a review recently published in the journal Pediatrics. The review included small studies that found that between 23% and nearly 60% of US children in need of hospitalization had to wait in emergency rooms to receive them. They are kept stable, but often receive little or no psychiatric care during these waiting times.
Yale-New Haven Children’s Hospital offers teletherapy to children waiting for mental health in its emergency room, said Dr. Marc Auerbach, a pediatric ambulance.
Every sixth US child has a diagnosed mental, behavioral, or developmental disorder, according to the CDC. Data shows that problems like depression are more common in teenage years; 1 in 13 students have attempted suicide and at least half of children with mental illness are not receiving treatment.
The shortage of psychiatrists in some areas and the closings of hospitals have made the problem worse and contributed to increased visits to the mental health emergency room, according to Pediatrics.
The number of children’s psychiatric hospitals in the United States decreased from 50 to 38 between 2008 and 2018. The number of U.S. hospitals reporting providing inpatient psychiatric services to adults or children decreased by nearly 200 from 2008 to 2018, when the number was 1,487. American Hospital Association data show.
Children admitted because of complex mental health problems and behavioral outbursts often have the longest waiting time in the emergency room. Children like Laura Dilts’ 16-year-old son, who is chronically suicidal, suffer from mild autism, anxiety, major depression and attention deficit disorder.
“Hospitals often refuse to admit him,” said Dilts, a recruiter who lives near Worcester, Massachusetts.
Earlier this year, before the pandemic, he waited for a hospital bed twice, once a week, the second time over two weeks. He lived in an intensive care home and has been back since April.
Dilts worries about what will happen if he has another crisis.
“Before COVID, there weren’t enough beds and now there really aren’t enough beds,” she said.
Demand has increased at the 66-bed Clarity Child Guidance Center in San Antonio, says CEO Jessica Knudsen. About half of their patients are Hispanic and 60% have public health insurance.
On some nights, five or six children slept in an observation area and waited for beds, she said.
“I feel fine when you come to us,” she said, “when you are in the observation room.” You will be seen by a psychologist. “
Children sit idly in emergency rooms or do not seek emergency care. “That is my real concern,” said Knudsen.
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