Suicide and Crisis Lifeline: Helping Children in the United States to Live Well and Foster Positive Relationships with the Children’s Mental Health
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline by dialing 9-8-8, or the Crisis Text Line by texting HOME to 741741.
“Because our mental health systems are so strained, with psychiatrists and therapists who work with youth in short supply, pediatricians like me are increasingly having to take on these roles,” Hadland said, adding that without more support and resources, the country may continue to see emergency department mental health patients revisit.
Brewer thinks the true numbers are much higher than a study suggests, because not all children who struggle with thoughts of suicide visit the emergency room.
To help more of these children, Holmes’ hospital system is working with county health and human services to help create a pediatric-focused mental and behavioral health campus. In order to better serve children who need counseling but don’t need to be hospitalized, there will be a doubling of the size of the behavioral health unit.
In the last nine years we saw anywhere from a single patient to two patients a day, but now we see more than 20 a day.
The US isn’t so lucky. A lack of beds for kids who need mental health help is a nationwide problem. A 2020 federal survey found that the number of residential treatment facilities for kids has decreased from 2012 to 2020.
Poverty, historical trauma and marginalization, trouble at school, online Bullying and the pressures brought by social media are just a few of the traumas and influences children are responding to in their lives.
Brewer said adults can intervene if a child is thinking about suicide. She advises caregivers to be on the lookout for problems at school or among friends and to watch for a child who is isolating themselves or showing signs of more anxiety or aggression than usual.
They might have a problem with sleep or act out. Irritability and being more withdrawn and isolating themselves are a lot of things that we oftentimes will think about,” Brewer said.
It is important for parents to listen to their children and talk to them. Brewer said to try to understand what’s happening with them and promote positive relationships.
“We really need to develop more of a strategy to help support all kinds in different ways and really focus on some of those traumas and social influences of health,” Brewer said. We need to make sure there are safe places for children to grow and thrive.
Why are so many mental health patients stuck in an emergency department? A study of children’s hospitals in the United States from October 2015 to February 2020
In the six months that followed, over one in five mental health emergency department visits had a revisit. Patients with diagnoses associated with behavior disturbance, including disruptive or impulse control disorders, neurodevelopmental disorders and psychotic disorders, were at the highest risk of revisiting. Patients with substance use disorders were less likely to return to the emergency department.
The data on more than 200,000 patients seen at 38 children’s hospitals across the United States during the period October 1, 2015 to February 29, 2020 was included in the new study. The data came from a database of the children’s hospitals.
The American College of Emergency Physicians believes that more and more mental health patients are stuck in emergency departments. I’ve heard stories of months, weeks, and even years.
“Given more-than-doubling in fentanyl overdose deaths in teens from 2019 to 2021 just published by the CDC, it concerns me that we may only get one opportunity to intervene and help this highly vulnerable population who we urgently need to keep,” pediatrician Dr. Scott Hadland, chief of adolescent and young adult medicine at Mass General for Children and Harvard Medical School, who was not involved in the new study, wrote in an email to CNN.
This rise is absolutely happening for us. I run a primary care clinic for teens in Boston, and on a typical day, more than four out of every five teens I see are struggling with mental health concerns. We know that Covid kept young people away from school in order to keep them out of harms way. Rates of mental health problems are likely to rise as a result.
Hadland added that there is a growing need for improved access to mental health services for youth and better funding to keep these services sustained.
Visiting Youth Villages for Mental Health Services: Carmen and Haley’s Second Day in the Emergency Room at the Massachusetts Department of Mental Health
Carmen said that she didn’t know the risk that she was taking. “Anything can happen while walking in the middle of the night.”
Carmen picked up Haley, unharmed. She learned that her daughter had sent provocative photos, and that she was going to meet up with an older boy. A few years back she remembered when Haley said she wanted to die and she was being bullied. NPR told Carmen that they would not give the family’s last name.
The only place they knew to go for help in an emergency was the hospital, where Haley ended up on agurney in a hallway with other young people who had also come with a mental health problem.
Mental health advocates argue that the need for diversion will decrease as Massachusetts launches a plan to improve mental health care. Carmen and other parents with mental health crises who go to the ER may be offered intensive counseling at home.
The psychological evaluation of Haley on her second day in the ER was how hospitals in Massachusetts start to decide what’s best for each child.
The liaison between the departments of psychiatry and pediatrics at the medical center considered recommending a mental health unit for patients who needed to be there.
“She was doing a lot of high-risk things,” Pedro says. There was a large amount of thought given to the fact that we might need to go to something crazy like a mental hospital.
Both Pedro and Haley’s parents were worried about this option. It would be a dramatic change for a 12-year-old whose only experience with mental health care was her school counselor. Pedro contacted Youth Villages, which was one of the youth diversion agencies the state hired during the epidemic. And Haley’s family met with a supervisor right there in the ER.
“We look under rugs, we look behind picture frames, we look in the dirt of plants,” says Laura Polizoti, the counselor from Youth Villages assigned to Haley’s case. Youth Villages also provided window and door alarms that Haley’s parents could activate at night.
Counseling for Haley and her parents started right away. A key goal was to understand why Haley was sneaking out at night and taking sexually inappropriate pictures.
One State Looks to Get Kids in Crisis Out-of-the-er and Back-Home: A Case Study on the Values of Home-Based Services
“Have you ever done an emotional thermometer before?” Polizoti asked, laying an oversized picture of a thermometer on the table. It had blank lines for five emotions, from cool to hot.
Haley told the person that her palms get sweaty and she makes a weird face. Haley frowned to demonstrate. Polizoti grinned.
As the exercise unfolded, Polizoti asked Haley to calm down before she got angry. Haley said that she wanted to spending time alone, watching TV, playing with her siblings or jumping on the trampoline.
Advocates for parents of children with mental health issues say the main complaint they hear is that hospitals don’t present the at-home care programs quickly enough, and that when they do, there is often a wait.
In Massachusetts, the Parent Professional Advocacy League has an associate director who said that they’d love to get more diversions with more families. Families have told us that the program to get children in the right place to heal faster has been a great success.
On average, the cost for the typical course of care is $8,522. At Youth Villages, that’s three 45-60 minute counseling sessions a week, in a patient’s home or other community setting, for three months. The savings are significant. One study calculated the cost of pediatric boarding at $219 dollars an hour, or $5,256 for just one day. And that’s before the expense of a psychiatric hospital stay.
If state and local governments don’t take the lead, hospitals need to vet possible community mental health partners, create new care agreements and figure out how to pay for home-based services. All this while hospitals are already overwhelmed by staffing shortages.
Making these kinds of systemic changes might require getting past inertia, as well as being hesitant to say that is what we need to do.
Diversion in Children’s Hospitals: Psychiatric Discrimination, Diversion, and the Mental Health of Children in Youth Villages
Some families hesitate to try diversion if their child takes psychiatric medications or if they think the child needs to start them. Youth Villages does not have prescribers on staff. Outside of the program, children might see a Psychiatrist or primary care doctor.
Many of the mental health challenges that these children are facing are influenced by factors in their natural environment, according to Stone. “We think it’s really difficult to address those factors with a child in a placement.”
Sometimes family members are brought to the hospital for therapy on family and social issues. There’s no data yet to compare the outcomes, though.
She said that many parents don’t know what their kids are going through because they can’t accept that their kids really need help. Hopefully, this can help another family.