To address crisis in children’s mental health care, providers urge Connecticut legislators to invest
HARTFORD COURANT | OCT 28, 2021 AT 6:31 PM
The emergency department at Connecticut Children's, which has seen a surge in demand for urgent behavioral health care in recent weeks. (Eliza Fawcett)
Providers and experts on the front lines of Connecticut’s pediatric mental health crisis urged state legislators to increase support for mental health care staff, deepen investments in community-based programs and expand mobile crisis units during a legislative forum held in Hartford on Thursday.
In recent weeks, providers have described an “overwhelming” surge in demand for pediatric behavioral health care, as greater numbers of children, with more acute symptoms, arrive in emergency departments and turn to community providers, seeking care.
Howard Sovronsky, Connecticut Children’s chief behavioral health officer, told legislators on the Committee on Children that the mental health crisis is not limited to emergency departments — which have been inundated with young patients — but rather reflects “the breakdown in our entire system of care.”
The current crisis has deep roots — rates of childhood mental health issues and suicide have been rising for at least a decade — but was exacerbated by the COVID-19 pandemic, according to the American Academy of Pediatrics, which last week joined other pediatric organizations to declare the issue a “national emergency.” Over the past year and a half, children have confronted social isolation, disruption, sickness, and death and rates of anxiety, depression, and suicidality have significantly risen.
Dr. Deidre S. Gifford, the commissioner of the Department of Social Services, told legislators that state agencies were working collaboratively on the crisis and are “very committed to working through solutions on this very challenging set of problems.”
Among other efforts, the state is focused on the creation of a “universal home visiting program,” is developing a community health worker program that would address prevention and care coordination issues, and is working on behavioral health workforce issues, Gifford said.
Department of Children and Families commissioner Vannessa Dorantes noted during the forum that part of her department’s allocation of federal funding from the American Rescue Plan Act is targeted for the expansion of emergency mobile crisis services.
When asked by committee co-chair State Sen. Saud Anwar, D-South Windsor, what could be done immediately — using funding available from the federal government — to address the pediatric mental health crisis, multiple behavioral health providers urged legislators to direct resources toward attracting and retaining staff.
“We absolutely need stabilization resources for our staff,” said Gary Steck, chief executive officer of Wellmore, a Waterbury-based behavioral health and substance use treatment provider.
Heather Gates, the president and CEO of Community Health Resources, which operates a statewide network of programs for adults and children impacted by mental illness, substance use disorder, or trauma, said that legislators could consider significant retention incentives, a pool of funding for staff to be reimbursed for educational expenses, repayment of student loans, and “absolutely anything that says to our staff, we value what you’re doing, we understand that you are a critical part of meeting the needs of the kids and families in Connecticut.”
Many providers stressed that issues with throughput — the ability to move patients through the flow of hospital services — are a key dimension of the crisis.
Length of stay on an inpatient unit should be no more than three to five days, but that is not always possible, said Patricia Rehmer, senior vice president at Hartford HealthCare.
“Being on an inpatient unit for kids is highly traumatizing, unfortunately, and so we really have a problem with throughput,” she said. “We don’t have enough community resources, we don’t have the programs that we need to discharge them to.”
At Yale New Haven Children’s Hospital, there were 10 children waiting for a behavioral health bed as of Thursday, and a few have been waiting almost three days, said Jason Malia, medical program director of the hospital’s emergency department.
“Just a few years ago, at Yale New Haven Health, we prided ourselves on not having kids stay in the emergency department overnight... we are no longer able to do that, because of volume and because of the need,” said Dr. Frank Fortunati, the medical director of the Yale New Haven Psychiatric Hospital.
Across Yale New Haven Health, the amount of time spent caring for behavioral health patients in the emergency department has increased 442% since 2014, due in part to increased wait times for getting patients into inpatient and outpatient facilities, Malia said. Moreover, about 40% of the children who come to the emergency department for behavioral health issues have a moderate to high risk for committing suicide, compared to 20-30% in past years.
“It’s a significant challenge to be able to handle this many children in our ED every day,” he said.
Roughly a third to half of young people who arrive at emergency departments do not actually require inpatient care, Jeff Vanderploeg, president, and chief executive officer of the Child Health and Development Institute of Connecticut, told legislators.
One way to address that gap, he said, is to use mobile crisis services to triage children before they end up at the emergency department, de-escalating situations and connecting children to community resources or more intensive care as needed. The state’s mobile crisis intervention services are available throughout Connecticut, free of charge, but are under-utilized by schools and families, he said.
Vanderploeg noted that a study commissioned by CHDI, working with the UConn School of Social Work, compared young people who had used mobile crisis against young people who had presented at an emergency department and found that those who used mobile crisis first had a 25% reduction in subsequent emergency department visits, over an 18-month period.
Even so, Vanderploeg noted that simply expanding mobile crisis services “is not going to be the silver bullet to address this issue,” and urged a holistic approach to the crisis.
State Child Advocate Sarah Eagan stressed that “there are structural challenges in our system, but there are things that money and resources can address.”
Those actionable steps include increasing the number of child and adolescent psychiatric hospital beds over the next three to six months, she said, through financial support or a public-private partnership that would enable a private provider to use state infrastructure to expand bed capacity. Eagan also stressed the need to ensure that reimbursement rates match children’s levels of need, as well as providers’ staffing needs.
Dr. Alice Forrester, the chief executive officer of Clifford Beers, a New Haven-based children’s mental health outpatient clinic, noted that the number of children showing up to emergency departments with behavioral health needs belies the true scope of the crisis.
“I can promise you that there are many more youth in mental health crisis who are not accessing our emergency department, or who are doing it through alternative ways: on a stretcher, because they’ve been shot in the community, or their families are there as a medical emergency because they have to use the ED as their primary care,” she said.
Forrester encouraged legislators to make deeper investments in community resources that already exist, like Clifford Beers.
“As community providers, we are the system of mental health in our communities, and we are not being recognized financially or even understood that the services that we do currently if funded properly, we can go and build on.”
Gates, of CHR, urged legislators to address the inadequate funding of community services, which drives providers’ challenges in finding and retaining staff.
“We cannot work miracles with the resources we get,” she said, noting that CHR outpatient clinics have been losing money and it has been difficult to staunch the flow of staff leaving for higher-paying jobs elsewhere.
In response to calls from behavioral health providers to receive increased state funding, committee co-chair State Rep. Liz Linehan, D-Cheshire, said that she recognized that funding is “a significant issue” and said she was working to inform other legislators about the “depth and the breadth of what the issue is, and how it does come down to funding.”
Although the pandemic has exacerbated the pediatric mental health crisis, the issue of rising demand for children’s behavioral health care is longstanding in Connecticut, said Dr. Laine Taylor, medical director for The Village for Families & Children.
“We’re in the same situation as we were six years ago,” she said. “If we take a temporary view of this and we think about programming and funding to just stop the bleeding, we’re going to be in the same situation, but worse, in another six years. Kids are dying.”
Eliza Fawcett can be reached at firstname.lastname@example.org.