As Children’s confronts crisis in behavioral health care, leaders say urgent solutions are needed. Meanwhile, children must wait for treatment.

·7 min read

Confronting a surge in demand for pediatric behavioral health services at Connecticut Children’s in Hartford, state leaders called for increased attention on the crisis Wednesday, as well as deeper investments in long-term solutions.

Children’s is facing triple the volume of patients seeking urgent behavioral health care that it did over the summer, forcing many families to wait for hours for an available bed — and often for days after that for an inpatient psychiatric bed to open up at another institution, the Courant reported Wednesday. Dr. James E. Shmerling, Children’s president and chief executive officer, described the situation earlier this week as “a breaking point.”

“We in Connecticut and other states have not figured out the riddle of kids in crisis coming to the emergency department,” Connecticut’s Child Advocate Sarah Eagan said Wednesday.

While the issue of adequate psychiatric resources for children in the state has a long history, she said, the COVID-19 pandemic has severely exacerbated an already-tenuous situation.

“What we need now is some urgent proposals,” she said. “They’re not going to be perfect, but what are the things that we can and should be doing right now to bring more mental health services to kids, bolster what schools are doing, reduce the volume in the ED?”

At Children’s, a collaborative effort between the hospital, state agencies and other health care providers was well underway Wednesday to ease the surge in demand.

Shmerling, Children’s president and chief executive officer, said Wednesday that several hospitals, including Saint Francis Hospital in Hartford, had offered to take in some older teenage patients.

Last week, when there were as many as 47 children in Zone C, no patients were being transferred. By Wednesday morning, Children’s had close to 40 children in Zone C, with a few patients in the process of being transferred.

Rep. Liz Linehan (D-Cheshire) urged families not to forgo seeking care for a child in crisis because of long wait times at emergency departments like Children’s. She implored parents to reach out to the 211 crisis hotline, which can discreetly send a social worker to a family’s home, usually within an hour, to provide support and determine if a child needs additional care.

Linehan, who serves as the House Chair of the Committee on Children, added that one of her top legislative priorities is to use funding from the American Rescue Plan Act of 2021 to hire greater numbers of school psychologists and social workers, since “school is often the first place that many see there are issues.”

Another critical issue, she said, is ensuring that parents know where to seek out behavioral health services before a crisis emerges. A bill that passed in the last legislative session stipulates that if a child visits the emergency department, for any reason, their family leaves with resources about psychiatric services in their local area. The bill goes into effect in hospitals by Jan. 1, but Linehan is hoping to accelerate that timeline.

“We’ve found that in the past year or two, parents really don’t know what to do in a crisis situation,” she said. “As the problem gets bigger, we really need to address the lack of available information for parents.”

Among a range of short-term solutions to the surge in demand for pediatric mental health, Eagan, the state’s child advocate, suggested piloting behavioral health urgent care centers, making deeper investments in the pediatric mental health care workforce, and directing available funding toward community-based providers.

Like Linehan, Eagan emphasized that ARPA funding could be used to expand pediatric mental health teams, for instance by embedding mobile crisis workers in schools that might be struggling to address mental health challenges among children.

“The state has had, and has, a lot of important initiatives in the works. It has dollars allocated for mobile crisis, it has dollars earmarked for access to mental health, it has a working group thinking about behavioral urgent care,” she said. “I think we just need to move up the timeline on some of this and add some other innovative thinking, of what can we do to bring the most care to the most people?”

At Children’s, one idea under discussion is to create a triage center that could redirect some patients to other hospitals before they even arrive at the emergency department. Of the patients that go to Children’s for urgent behavioral health care, 57% arrive by ambulance, Shmerling said.

“Can we somehow direct EMS systems to go to a triage center so that the children can be evaluated to make sure, what is the best place for them to be sent to? Is it a hospital? Is it an outpatient clinic? Those assessments are being done in the emergency room, and if they could be done ahead of time, it might reduce the volume in our ED,” he said.

Shmerling also emphasized the need for more psychiatric beds for children in the state, as well as the need for greater preventive care, such as integrating mental health screening systems in school districts.

“We’ve got to get them out of the hospital as safely and quickly as we can, but preventing the admission altogether is the space we need to be in,” he said.

Department of Children and Families commissioner Vannessa Dorantes said in a statement that the department remains in collaboration with Gov. Ned Lamont’s office, various state departments and agencies, private providers and the Connecticut Hospital Association to provide behavioral health support for children and families.

“Notable improvements have been made that enhance the children’s behavioral health system including in-home and community based services in particular,” Dorantes said. “We maintain our commitment to working with Connecticut’s behavioral health network to advance the overall system and address additional behavioral health needs exacerbated by the pandemic leading to improving the lives of Connecticut’s children and families.”

The state Department of Public Health continues to work with Children’s and the Connecticut Hospital Association to address the surge in demand for mental health care, spokesperson Chris Boyle said in a statement.

“The children and their families are the priority of all the partners who are actively involved with this urgent issue,” he said.

Two physicians who serve in the legislature — State Senator Dr. Saud Anwar, a South Windsor Democrat, and State Rep. Dr. William Petit, a Plainville Republican — say the crisis is a multifaceted problem that requires a coalition of providers working on the issue.

Access to mental health services must be increased so that the problems can be treated long before a patient needs to go to the emergency room in crisis, Petit said. Pediatricians need to be given “whatever support they need” because families and children generally see a pediatrician — rather than a psychiatrist — when they are starting to deal with mental health issues, Petit said.

The legislature took a major step on the issue this year when lawmakers passed Senate Bill 2, a high-priority bill that is designed to improve mental health services for children with the goal of enacting youth suicide prevention training for every school district through the local health districts, Anwar said. The legislation passed by wide margins in the House and Senate and was signed into law by Lamont.

While the demand for behavioral health care has spiked recently at Children’s, the issue has been growing during the COVID-19 pandemic as children face a wide range of issues.

“Social isolation, the stresses in the family, having family members who were sick, including losing grandparents in many circumstances and having one of the parents losing jobs, and the stress of being stuck in the same household — all of those were contributing factors to the stresses even before the schools opened up,’’ Anwar said.

Anwar also noted that even beyond the COVID-19 crisis, there is often an increase in demand for pediatric mental health services when schools reopen in the fall, due to “the extra stress of being in a newer environment with new people and new classes and leaving the comfort of home.”

State Rep. Jaime Foster, an Ellington Democrat, said she is ready to study the issue as a member of both the children’s and public health committees.

“I talked to legislators this morning, and a lot of us are ready to roll our sleeves up and dig in on this issue,’’ Foster said.

If you are in Connecticut and experiencing thoughts of suicide, call 211 or text “CT” or “HELLO” to 741741. The National Suicide Prevention Lifeline is available at 1-800-273-8255 (TALK). Connecticut’s domestic violence hotline is 888-774-2900. Residents looking for more information on youth suicide prevention and mental health can read the CDC’s COVID-19 Parental Resources Kit, and visit www.preventsuicidect.org or gizmo4mentalhealth.org.

Eliza Fawcett can be reached at elfawcett@courant.com. Courant staff writer Chris Keating contributed to this report.

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