MONTPELIER – Parents and pediatricians are sounding the alarm about a concerning trend playing out at hospital emergency departments throughout Vermont – on average, children in a severe mental health crisis are facing a wait over four days in the emergency room before receiving treatment.
According to the Vermont Department of Mental Health, children and youth are going to the emergency department for mental health concerns at a much higher rate than before the pandemic, even as overall emergency department visits are declining. The already limited number of beds at inpatient facilities have dwindled even further due to COVID-19 restrictions, and parents say the emergency room is an unforgiving place to wait for a child in crisis.
“There’s nothing that’s kid-friendly about it, we were across the hall from a woman who was screaming for hours,” said Robyn Freedner-Maguire.
Freedner-Maguire and two other parents of children who have experienced a severe mental health crisis provided testimony to the House Committee on Healthcare on Thursday. They described ill-equipped emergency rooms and days of isolation, all while their children were going through an urgent and unpredictable mental health struggle.
“You cannot leave the hospital,” said Kathleen Kourebanas. “If you’re truly in crisis, you wouldn’t be in crisis if you went back home. I just thought ‘we’ll never survive this.”
“It took us about 24 hours to realize that there was zero care that was going to take place in the emergency department,” said Andy Anderson.
About 30 percent of Vermont’s bed capacity at adolescent inpatient programs has been temporarily cut due to the pandemic, leaving just 48 openings across the state. Department of Mental Health officials said the bed shortage combined with a weakened workforce has worsened a logjam within the state’s mental health system.
“This is impacting the Brattleboro inpatient units, it’s impacting our hospital diversion program, and it’s also impacting our community-based system and the ability to truly meet the need locally,” said Laurel Omland, Director of the Child, Adolescent and Family Unit.
Omland said resources are also being pulled from the prevention side of the Department of Mental Health’s work to try and meet the current needs.
The department is hoping that COVID-related barriers will be eliminated in the near future, and officials are also collaborating with CVPH Medical Center in Plattsburgh to try and shorten the wait time for treatment.
Pediatricians also gave testimony Thursday, and echoed parents’ concerns that long waits in the emergency room have the potential to worsen a child’s mental health crisis.
“When I went to my shift yesterday, there were five children who had been waiting at least five days in the emergency department for an inpatient mental health placement,” said Dr. Christian Pulcini, a pediatric emergency medicine physician at UVM Medical Center. “One of those children had been waiting two weeks. This is unfortunately becoming the norm.”
“Recently, we had a 7 year-old child with a history of being abused who needed access to inpatient mental healthcare. It was a really heartbreaking situation, and that child had to wait almost 24 hours to get access to inpatient mental healthcare,” said Dr. Alison Kapadia, Emergency Department Site Director at Brattleboro Memorial Hospital.
Beyond the short-term measures to address the crisis mentioned above, the Department of Mental Health is advocating for enhanced services in schools, expanded mobile response and stabilization services, and additional support for workforce recruitment efforts.
Rep. Lori Houghton, a ranking member on the House Committee on Healthcare, said there would be clear benefits associated with better mental health outreach in Vermont schools.
“There has not been enough emphasis on the connection between what can happen with the Vermont Department of Mental Health and schools,” Rep. Houghton said. “I think this is a key place we should be spending a lot of time focused on – what more can we do in these schools to prevent the downstream effects?”
Committee Chair Rep. Bill Lippert said it’s critical that lawmakers take meaningful action, and earlier this session, he had hoped that would be the case.
“I’m thinking of the families, the children, for the people whom its no relief to hear we’re thinking about this in the Legislature,” Rep. Lippert said. “They’re in the emergency room with a child or family situation, and they’re absolutely horrified. What is it that we would need to do to never have another child or young person wait in an emergency room for mental health treatment?”
Additional data on child and youth wait times for mental health treatment can be found here in the Department of Mental Health’s April 2021 update, which was presented to the House Committee on Healthcare Thursday prior to testimony.