Kids In Mental Health Crisis Face Inpatient Bed Shortage, Revolving Door Of Treatment
Jodi is a mom who lives in Franklin County, Massachusetts. Her daughter started experiencing symptoms of anxiety and depression about five years ago at age 13. Those symptoms, along with a serious problem with alcohol abuse, spiked during the pandemic.
“In November, we had two pretty serious incidents,” said Jodi, who asked to use only her first name in order to protect the privacy of her daughter. “It was the anxiety and depression, but also suicidality. She was really not wanting to be alive at that point.”
Jodi described some of the most brutal experiences a parent can go through, including seeing her daughter become fully unresponsive and despondent.
“I had at one point resolved myself to the fact that my daughter probably was going to kill herself,” Jodi said, and then lowered her voice. “It's not calming, but it was just a strange realization that there's nothing I could do about it, because it's not possible to watch your teenage child 24/7 for extended periods. It’s not.”
'We could see progress'
Approximately 24 new youth psychiatric beds are scheduled to become available in Holyoke and Springfield hospitals in the near future. That’s welcome news for parents like Jodi, whose kids have faced severe mental and behavioral health crises during the pandemic.
A report from the Substance Abuse and Mental Health Services Administration found that the number of Massachusetts youth experiencing major depressive episodes doubled (PDF) during the 10-year period ending in 2019. That year, one out of six kids (age 12 to 17) experienced a major depressive episode. Young adults experiencing serious thoughts of suicide also doubled during that period.
Prior to the pandemic, Jodi’s daughter received care for her conditions from a wide range of psychiatric hospitals. Some of those experiences were helpful, such as the three months she spent doing intensive therapy at Brattleboro Retreat.
“The program itself while she was there was really good,” Jodi said. “We could see progress almost weekly when we talked to her. We could see how much better she was doing.”
But Brattleboro Retreat closed its services to out-of-state patients last April, and a spokesperson said their capacity to accept new youth patients from outside Vermont remains very low.
As Jodi and many other Massachusetts parents have discovered, it can be extremely difficult to find a psychiatric hospital that has room for your child.
The Behavioral Health Network offers crisis services for youth in parts of Hampshire and Hampden counties, including coordinating placement for kids who require what BHN refers to as a “higher level of care.” This includes acute psychiatric hospitalization and a slightly less intensive placement called CBAT, or Community Based Acute Treatment. (There is one CBAT facility in Hampden County, also operated by BHN.)
Since November, BHN has had 28 or more children and teens requiring a higher level of care each month. Wait times of a week or more are common. The vast majority of those children are boarding at Baystate Health Center’s pediatric emergency department, where a record number of youth are currently awaiting inpatient placement. Some kids have had to wait in the ER for more than a month.
Ellie Du Toit, the Mobile Crisis Intervention Coordinator for BHN, said there are now consistently more children waiting for placement than adults.
News beds coming soon
That situation might be about to improve. Health Partners New England, which runs a psychiatric hospital in Devens, Massachusetts, is opening MiraVista Behavioral Health Center at the former Providence Hospital in Holyoke.
“We will be creating at least 12 beds — 12 inpatient beds that are designed to serve children, adolescents,” said Michael Krupa, CEO of Health Partners New England.
MiraVista is scheduled to open April 21, but the youth beds won’t be ready immediately.
Krupa said the hospital still needs to hire adequate staff for youth care, something the previous owner of the hospital said they struggled with.
“It still is very difficult to recruit child psychiatrists, and what are referred to as advanced practice nurses, or APRNs,” he said. “So it's really a matter of when do we find those resources.”
Baystate Health has also announced plans to open a new psychiatric hospital in Holyoke that will include youth beds. That facility won’t be open for at least two years, but Baystate says they intend to make a dozen youth beds available in the interim. Those beds are scheduled to open April 28.
The new beds, Du Toit said, are desperately needed.
“I think we're going to see a huge difference in terms of the boarding times,” she said. “That's my hope, that we’re going to see a much faster turnaround.”
But Du Toit also stressed that psychiatric beds can’t be the sole answer to the surge in youth mental health crises, especially since many children experience a recurrence of symptoms after they’re hospitalized.
“There's something that's happening in their day-to-day life that they're struggling to manage,” Du Toit said. “And that can't be fixed necessarily through a psychiatric admission. They can be given medications. They can be given coping skills. But ultimately, there needs to be that long-term therapy and treatment.”
For Jodi’s daughter, short-term, acute hospitalizations weren’t enough to interrupt the cycles of depression or addiction. Jodi described the way her daughter moved in and out of acute hospitals.
“Her experience had been, ‘I'm feeling awful, I go to crisis services, they send me somewhere for two weeks, I get a new med, and they send me home,’” Jodi said.
This happened repeatedly, leading Jodi’s daughter to a feeling of hopelessness.
“Especially for a teenager,” she said, “how could you see past that? That's all it's ever gonna be?”
'I wanted to bang my head against a wall'
Michael Krupa agreed that the revolving door of acute care is an issue.
“Almost all of our re-admits, in theory, are avoidable,” he said, adding that long-term care with an outpatient provider is key to keeping kids from ending up back in his hospitals.
Krupa said that if a patient can see a therapist frequently enough, that provider might detect a reemergence of symptoms earlier in the cycle.
The problem is the outpatient care that experts agree is crucial is often difficult to access.
“It's hard to find a therapist that works with teenagers,” Jodi said. “And it's hard to find a therapist that works with teenagers that has hours that fit into a teenager’s schedule, with school and homework and sports.”
Jodi experienced some of her greatest frustrations seeking a specific type of therapy called DBT, or dialectical behavior therapy. DBT made a huge difference while her daughter was at Brattleboro Retreat, but when she got out, the only DBT group accepting teens was a half-hour away, in Northampton.
“And there was a waitlist for teenagers, so she couldn't get into the program,” Jodi said.
In a report from before the pandemic, the Blue Cross Blue Shield Foundation found that clients regularly experience excessive wait times (PDF) for initial appointments. Clients and clinicians say accessing outpatient care in Massachusetts is “complicated and onerous.”
Jodi described frustration at the hoops she needed to jump through with insurance and other aspects of the mental health bureaucracy.
“I wanted to bang my head against a wall,” she said. “I wanted to just scream at the top of my lungs. But all the while this is happening, knowing that — if I'm going to be the support that my daughter needed — I had to just hold everything together.”
Jodi has no problem being doggedly persistent in her search for the right care. Her daughter is currently at a long-term residential hospital in California. But getting her to that facility took more than persistence. Jodi and her husband retained COBRA insurance coverage from his previous job in order to have increased options for placing their daughter. She said they’re currently paying for two separate insurance plans.
“So we're paying an awful lot of money right now for insurance that most people couldn't afford to do,” Jodi said.
Jodi’s daughter recently turned 18 at the hospital in California. She’ll return home an adult, and Jodi’s role as protector and advocate will have changed in fundamental ways. Based on recent conversations, she said she thinks her daughter has changed, too.
“I think she finally realizes that [for] the kind of program she's in, it's not like you're going to a hospital for surgery, and you go in and you do the surgery and then you'll be healed,” Jodi said. “It's not like that. This is the beginning of the work you're going to do for the rest of your life.”
The National Suicide Prevention Lifeline can be reached by calling 1-800-273-8255 or at suicidepreventionlifeline.org.
This is the second report in a three-part series about the challenges faced by families seeking mental health care for children and adolescents in western Massachusetts. Read part 1 here, and read part 3 here.