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When children and teens are overwhelmed with anxiety, depression, or thoughts of self-harm, they often wait days in emergency rooms because there aren’t enough psychiatric beds.
The problem has only worsened during the pandemic, according to reports from parents and professionals.
With schools closed, routines disrupted, and parents worried about loss of income or an uncertain future, children must take on new burdens many of which are not equipped with.
And with the growing number of COVID-19 hospital patients, bed space is even more scarce.
In early fall, many emergency departments in Massachusetts were seeing about four times as many children and adolescents in psychiatric crisis each week than usual, said Ralph Buonopane, director of the mental health program at Franciscan Hospital for Children. from Boston.
“I have been the director of this program for 21 years and have worked in child psychiatry services since the 1980s and it is unprecedented,” said Buonopane. Her hospital receives emergency transfers from across the state.
While emergency room visits for many health reasons other than COVID-19 declined early in the pandemic as people avoided hospitals, the share of children’s mental health-related visits has steadily increased from mid -April to October, according to a recent Federal Center for Disease Control and Prevention Report. Of the children who showed up, more were for mental health than in the same time period last year, although this may indicate others have stayed on the sidelines, the authors warned.
Claire Brennan Tillberg’s 11-year-old daughter was among those children who sought care. The Massachusetts girl suffers from autism, depression and anxiety and has been hospitalized twice in recent months after revealing she had been having thoughts of suicide. The second time, in September, she waited a week in an emergency room before being transferred to another hospital. The first time, in July, the wait was 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 live. Suddenly, the structure and rituals that many children with autism thrive on are gone.
“She had never met the teacher, never met the children,” said Tillberg, psychotherapist. “She felt more isolated, more and more like things weren’t improving. Without the distraction of getting up and going to school or camp … staying at home with your own thoughts all day with a computer has made it worse.
Studies and surveys in Asia, Australia, the United States, Canada, China and Europe have shown a general deterioration in the mental health of children and adolescents since the start of the pandemic. In a World Health Organization survey of 130 countries released in October, more than 60% reported disruptions in mental health services for vulnerable people, including children and adolescents.
Emergency rooms are often the first place children facing a mental health crisis seek help. Some are stabilized there and sent home. Some require hospital care, but many hospitals do not offer psychiatric treatment for children and transfer these children elsewhere.
Some treatment centers won’t accept children without proof they don’t have COVID-19, “which is difficult because you can’t always find a quick test,” said Ellie Rounds Bloom. Her 12-year-old son suffers from “serious mental health problems”, including trauma, and has experienced several crises since the start of the pandemic. The Boston-area boy has been hospitalized since October, after spending 17 days in the emergency room.
Many mental health advocates see these expectations as unacceptable. For parents and their children, they are that and more.
“There were times of frustration and times of sheer hair-pulling,” Rounds Bloom said.
Public health insurance covers her son’s treatment, but not all providers accept it. Deficiencies in the U.S. health care system can leave families feeling powerless, she said.
“You can’t give up because he’s your kid,” Bloom said.
There are no national studies on the expectations of children in emergency departments for mental health treatment, a practice called “boarding,” according to a recent review published in the journal Pediatrics. The review included small studies showing that between 23% and nearly 60% of American children who need hospital care have to wait in the emergency room to receive it. They remain stable but often receive little or no mental health care during these wait times.
Yale-New Haven Children’s Hospital has started offering teletherapy to children waiting in its emergency room for mental health care, said Dr. Marc Auerbach, a pediatric emergency doctor.
According to the CDC, one in six American children has a diagnosed mental, behavioral, or developmental disorder. Data shows that problems like depression become more common in adolescence; 1 in 13 high school students have attempted suicide and at least half of children with mental illness do not receive treatment.
Shortages of psychiatrists in some areas and hospital closures have compounded the problem and contributed to the increase in mental health emergency room visits, according to the journal Pediatrics.
The number of US children’s mental health hospitals increased from 50 to 38 between 2008 and 2018. The number of US hospitals reporting inpatient psychiatric services to adults or children fell by nearly 200 between 2008 and 2018. 2018, when the total was 1,487, Data from the American Hospital Association shows.
Children who need to be admitted with complex mental problems and behavioral crises often have the longest ER waits. Children like Laura Dilts’ 16-year-old son, who is chronically suicidal, suffers from mild autism, anxiety, severe depression and attention deficit disorder.
“Hospitals often refuse to take it,” said Dilts, a human resources recruiter who lives near Worcester, Massachusetts.
Earlier this year, before the pandemic hit, he waited twice for a hospital bed, once a week, the second time for more than two weeks. He lived in an intensive residential treatment center and has returned there since April.
Dilts is worried about what will happen if he has another seizure.
“There weren’t enough beds before COVID and there really aren’t enough now,” she says.
At the 66-bed Clarity Child Guidance Center in San Antonio, demand has increased, says CEO Jessica Knudsen. About half of their patients are Hispanic, and 60% have some form of public health insurance.
Some nights five or six children slept in an observation area waiting for beds, she said.
“I feel good once they join us,” even though in the observation room, she said. “A mental health professional is watching them.”
Children who wait for emergencies without doing anything or who don’t seek emergency care, “that’s my real worry,” Knudsen said.
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The Associated Press’s Department of Health and Science receives support from the Department of Science Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.
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