The number of children seeking urgent behavioral health care at Connecticut Children’s has tripled since the summer, forcing families to wait hours on end for an emergency department bed
Hartford Courant, published 10/6/21
Connecticut Children’s is struggling to manage a surge in children showing up to its emergency department seeking urgent behavioral health care.
In the past few weeks, the number of children in need of such care has tripled in comparison to what it was over the summer, forcing families in crisis to wait in hallways for hours on end before obtaining a bed for their child.
The overburdened emergency department has drawn the attention of the state Department of Public Health, which has been working with the hospital on how to transfer patients at least 16 years old to other hospitals in the state.
On Monday evening, Dr. James E. Shmerling, the president and chief executive officer of Children’s, said that there were about 43 children in “Zone C” of the hospital’s emergency department, the area for children seeking behavioral health care, including for suicidal ideation, self-harm and other mental health conditions.
At one point last week, there were as many as 47 children in Zone C.
Over the summer, there were typically about 15 or 16 children in Zone C — a third of the current volume.
“This is our COVID surge,” Shmerling said.
The hospital saw a similar surge this past spring, when pediatric mental health clinicians reported significantly increased rates of anxiety and depression among children. The situation eased during the summer, but has returned in full force this fall, as children return to school.
Currently, there are only 11 beds in Zone C, although the hospital has added additional areas for about a dozen other children, for a total capacity of about 20 to 25 children, Shmerling said. But over the past month, the number of children in Zone C has ranged from 30 to 50, according to hospital spokesperson Monica Buchanan.
“A lot of these children are on stretchers and there’s no physical space right now, other than in the hallway,” Shmerling said. “That’s unfortunately the status.”
After the initial wait to obtain a bed in the emergency department, children who require inpatient psychiatric care must then wait even longer for an available bed at another institution, since Children’s does not have any licensed psychiatric beds. Often that wait lasts days, sometimes as long as a week.
That’s what happened to a pair of Connecticut parents who realized last week that their child was self-harming and seriously contemplating suicide.
They rushed to Children’s — only to spend eight hours sitting on plastic chairs before their child was given a bed in Zone C.
Three days passed until a pediatric psychiatrist visited their child and informed the family that “it would take 7-8 days for a bed to open in a psychiatric hospital,” one of the parents, who asked to remain anonymous to protect their child, wrote in an email.
“Being stuck in the emergency unit of CCMC means that our child is receiving no treatment of any kind even though we came here for a potentially life-threatening situation,” the parent said.
Children’s has hired more than 100 people this year alone to work in Zone C, Shmerling said, but the larger issue is not one of staff — but of space. The hospital has seen a significant rise in its volume of patients seeking medical and surgical care, which means that there are no extra beds or any “flex space” to offset the surge in demand for behavioral health care.
“We’re having a medical and surgical surge, and a behavioral health surge at the same time,” he said. “We can handle a medical, surgical surge, but we’re at a breaking point with the behavioral health.”
The hospital plans to build 15 medical psychiatric beds, but Shmerling said that it would take 12 to 18 months before they become operational.
“It’ll help us in the long run but it won’t help us tonight,” he said.
Six months ago, pediatric mental health providers, who reported that they were already severely overburdened, warned that they expected to see an even greater surge in demand for care in the fall, as children returned to school.
For many children, the profound disruptions of the COVID-19 pandemic — from remote learning to reduced social contact — significantly exacerbated, or led to the emergence of, experiences of anxiety and depression. And while for some children, this fall offered a return to the familiar routines of in-person learning, for others, it brought yet another destabilizing change.
“Especially for kids who have anxiety, their preferred methods of coping is avoidance,” Dr. Ruby Lekwauwa, a child adolescent psychiatrist at the Yale New Haven Psychiatric Hospital, told the Courant in May. “They’ve had six, seven, eight months of not having to deal with their peers, not having to deal with their teachers, and the idea of having to go back to school is a huge, huge obstacle and a source of a lot of stress for them.”
During the summer, when the number of children arriving at the Children’s emergency department for behavioral health services dropped to around 15 or 16 on a given day, the rate of children showing increased risk of suicide also declined.
All children ages 10 and older who visit the emergency department at Children’s for any reason undergo a suicide risk screening. Usually about 16% of children show signs of increased risk of suicide, but that rate rose steadily over the course of the pandemic, to 22% this past January and up to 25% by March. Then it began to decline, to 21% in April and May, 19% by June, 14% by July and 15% by August.
That metric is typically at its lowest point during the summer, when children are not in school. And while the hospital does not yet have data for September, that proportion will likely rise again given the high demand for behavioral health services that Children’s has seen in the past month.
Attempting to reduce the volume of patients in its emergency department, Children’s is working with the state Department of Public Health and the Connecticut Hospital Association to potentially transfer older patients — those who are 16 to 18 years old — to hospitals with more capacity. Each week, there are about 30 patients in that age group in the Children’s emergency department, Shmerling said.
Chris Boyle, a DPH spokesperson, confirmed Monday that the agency and the CHA are “in discussions to provide support to Connecticut Children’s with the diversion of behavioral health patients ages 16 and older to hospitals with appropriate psychiatric services.”
The Department of Public Health also sent a representative to Children’s over the weekend to assess the situation in the emergency department.
While other hospitals are often similarly overburdened, some have offered to take in a few of those older patients, Shmerling said, including, recently, Stamford Hospital — nearly 80 miles away.
“If we can just reduce the demand for the older patients that might have better alternatives, that takes the pressure off us so we can take care of the younger kids,” he said.
Meanwhile, the parents who rushed their child to Children’s last week are still spending 24 hours a day in Zone C, waiting for an inpatient psychiatric bed to open up.
They know that every day that they wait further exacerbates an already traumatic situation.
Their child is confined to “an enclosed space that is not intended to serve as a hospital room, without the possibility of walking or moving around,” according to one of the parents.
But they have no other options.
“If we take our child home we lose the ‘privilege’ of getting our child the treatment that is needed because our child would lose the ability to get admitted to a psychiatric hospital,” the parent wrote.
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.
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