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 in the U.S.
The problem has only grown worse during the pandemic, reports from parents and professionals suggest.
With schools closed, routines disrupted and parents anxious over lost income or uncertain futures, children are shouldering new burdens many are unequipped to bear.
And with surging numbers of hospitalized COVID-19 patients, bed space is even scarcer.
By early fall, many ERs in the northeastern state of Massachusetts were seeing about four times more children and teens in psychiatric crisis than usual, said Ralph Buonopane, a mental health program director at Franciscan Hospital for Children in Boston.
"I’ve been director of this program for 21 years and worked in child psychiatric services since the 1980s, and it is very much unprecedented,” Buonopane said. His hospital receives ER transfers from around the state.
While ER visits for many health reasons other than COVID-19 declined early in the pandemic as people avoided hospitals, the share that were for kids' mental health-related visits climbed steadily from mid-April through October, according to a recent federal Centers for Disease Control and Prevention report. Of the kids who showed up, more were for mental health than in the same period last year, although that might reflect that others stayed away, the authors cautioned.
Claire Brennan Tillberg's 11-year-old daughter was one of those kids who sought care. The Massachusetts girl has autism, depression and anxiety, and has been hospitalized twice in recent months after revealing that she'd had suicidal thoughts. The second time, in September, she waited a week in an ER before being transferred to a different hospital. The first time, in July, the wait was four days.
She'd been hospitalized before, but Tillberg said things worsened when the pandemic hit and her new school and therapy sessions went online. Suddenly the structure and rituals that many children with autism thrive on were gone.
“She’d never met the teacher, never met the kids,” said Tillberg, a psychotherapist. “She felt more isolated, more and more like things aren’t getting better. Without the distraction of getting up and going to school or to camp ... sitting at home with her own thoughts all day with a computer has allowed that to worsen.’’
'You can’t give up, because it’s your kid'
Studies and surveys in Asia, Australia, the U.S., Canada, China and Europe have shown overall worsening mental health in children and teens since the pandemic began. In a World Health Organization survey of 130 countries published in October, more than 60% reported disruptions to mental health services for vulnerable people including children and teens.
Emergency rooms are often the first place kids facing a mental health breakdown go for help. Some are stabilized there and sent home. Some need inpatient care, but many hospitals don't offer psychiatric treatment for kids and transfer these children elsewhere.
Some treatment centers won’t take kids without proof they don’t have COVID-19, “which is hard because you can’t always find a rapid test,” said Ellie Rounds Bloom. Her 12-year-old son has “significant mental health issues,” including trauma, and has experienced several crises since the pandemic began. The Boston-area boy has been hospitalized since October, after spending 17 days in ER.
Many mental health advocates consider these waits unacceptable. For parents and their kids, they are that, and more.
“There have been moments of frustration and moments of sheer pulling your hair out,” Rounds Bloom said.
State 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 helpless, she said.
“You can’t give up, because it’s your kid," Rounds Bloom said.
There are no national studies on kids’ ER waits 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 almost 60% of U.S. kids who need inpatient care have to wait in ERs to receive it. They are kept stable but often receive little or no mental health care during those waits.
Yale-New Haven Children’s Hospital in the northeastern state of Connecticut has started offering teletherapy to kids waiting in its emergency room for mental health care, said Dr. Marc Auerbach, a pediatric ER physician.
One in 6 U.S. children have a diagnosed mental, behavioral or developmental disorder, according to the CDC. Data show problems like depression become more prevalent in teen years; 1 in 13 high school students have attempted suicide and at least half of kids with mental illness don’t get treatment.