It is not uncommon for children to come to the emergency room at Marietta Memorial Hospital for mental health help. Linda Sistrunk, social worker and director of behavioral health at Southeastern Ohio Hospital, says that’s a big difference from 20 years ago.
“Our emergency systems are now being used as a community mental health system,” she said.
Sistrunk is a social worker and director of behavioral health at the hospital. She says the ER used to see more injuries and illnesses, but now the facility has to be ready to meet a wide range of needs. Some of the most distressing cases involve children going through a crisis.
About a quarter of the children Sistrunk sees need acute psychiatric hospital treatment, she says. If a young patient has been hospitalized before, they often expect to be hospitalized again. But Sistrunk says that’s not always the best option. Recently, she treated a 12-year-old child who had previously been hospitalized.
“[She was] victim of drug trafficking, and she had nine hospitalizations,” Sistrunk said. “And so I said, ‘We won’t do that anymore. She is a traumatized child; she needs in-depth trauma counseling because you’re not going to heal the fact that she was raped for three years.
Nationally, a trend has been growth in recent years – children seeking mental health treatment in emergency rooms. Often this means waiting several days until they are safe or until a psychiatric bed for teenagers becomes available. Self-inflicted wounds have also increase among the children.
Across the Ohio Valley, experts say the mental health care system needs to be strengthened with community and school mental health resources, expanded outpatient treatment, and additional options to help children before they die. need to be hospitalized.
An increase in injuries, longer waits in the emergency room
According to data from the Kentucky Injury Prevention and Resource Center, 7,679 Kentuckians between the ages of 5 and 19 visited the emergency room for self-harm injuries from 2016 to 2021.
The data also shows that more Kentucky youths died by suicide than youths killed in homicides. Between 2010 and 2021, a total of 430 suicide deaths have been reported and 302 homicides have been recorded among Kentuckians between the ages of 5 and 19.
A similar trend is occurring in West Virginia. Between the ages of 10 and 34, suicide is the second leading cause of death in West Virginia, according to the state Department of Health and Office of Behavioral Health Resources.
In Ohio, about 52% of children with major depression do not receive treatment, according to Mental Health America.
Last fall, the Children’s Hospital Association reported that self-harm injuries among children had increased dramatically across the country. In the first six months of 2021, children’s hospitals across the country reported a 45% increase in self-harm and suicide cases among 5- to 17-year-olds, compared to 2019.
Amy Wimpey Knight, president of the Children’s Hospital Association, said the numbers point to a mental health crisis.
“So basically if a child comes to the emergency room in a mental health crisis, who can’t be safely sent home, they often need to be sent home – some can – but many often need to be sent home. continuing care,” she said. “And there aren’t enough mental health beds right now and/or intensive outpatient programs.”
Dr. Lindsay Ragsdale, chief medical officer at Kentucky Children’s Hospital, said he has seen an increase in the number of patients seeking mental health treatment.
“Every day we have patients who come to our emergency room for an assessment of a mental health crisis, and whether it’s suicide attempts or thoughts, other diagnoses related to anxiety [and] eating disorders,” she said.
At West Virginia University Medicine, child psychiatrist Dr Kirk Ramsey said beds for children ages 12 to 18 are usually full and it’s hard to find an open bed.
“If it’s not every day, it’s at least five to six days a week where we try to put out a call for a hospital bed,” Ramsey said.
Outside of cities with larger hospital systems, children requiring hospitalization in rural areas may be sent hours away from home. Sistrunk, of Marietta Memorial Hospital, said social workers must make tough decisions about how best to care for these patients.
“I spend the majority of my time with the children I’m assessing, wondering if it’s appropriate at this time to make a route recommendation to send a nine-year-old four hours away from his family?” Sistrunk said.
Epidemic meets pandemic
Before the COVID-19 pandemic, the Ohio Valley was battling the opioid epidemic, which WVU Medicine’s Ramsey said was creating far-reaching problems for children.
“We have children who lose their parents to opioid use or lose their guardians,” he said.
Children who lose their parents are often placed in foster care or go to live with a relative, sometimes a grandparent.
“And then COVID comes in, which can make their child an orphan, because they don’t have their grandparents to be their parents anymore because of COVID,” Ramsey said. “So they’ve lost twice, you know, and that makes it harder to make them feel safe.”
For children who do not live in safe environments, staying home during the pandemic has put them at greater risk of physical and emotional abuse. According to the Centers for Disease Control and Prevention, just over a third of High school students reported having poor mental health.
Ragsdale of Kentucky Children’s Hospital says the pandemic has severed social ties for children.
“There’s a lot of fear and worry, and it’s really turned a lot of children’s lives upside down.”
More mental health resources needed
The University of Kentucky Children’s Hospital began designing a psychiatric unit before the pandemic, and it is expected to be completed by November.
But Dr Amy Meadows, director of child and adolescent psychiatry in the UK, said the demand for mental health treatment means the new unit will not have enough beds.
“Not only do we need more hospitalized patients, but we also need a better care system to help manage children out of hospital, keep them at home when possible.” she declared.
Meadows says kids need lots of different options.
“From schools where children do education about emotions and mental health, to the possibility of having outpatient therapy,” she said. “We need more psychologists, therapists, social workers, to have psychiatrists available in the community.”
When hospitals work with community mental health resources on treatment plans for children, Sistrunk said it strengthens care.
“If we include our community partners in the care plan for the patient, we have less chance of that patient hurting themselves or someone else, and we have a better chance of success with them than relying on the community resources rather than the emergency room. or hospitalized,” Sistrunk said.
One of the biggest barriers to making more resources available is funding. Wimpey Knight of the Children’s Hospital Association said the pay for children’s mental health professionals is low and the cost of specializing in the field is high.
“So asking someone to go to school, whether it’s medical school or just another vocational school and going out with student loans and not being able to pay them based on the rates reimbursement…it’s a huge, huge problem,” she said. said.
The Biden administration has asked $1 billion in funding from the US Department of Education to place more psychologists, nurses, counselors and social workers in schools.
The Association of Children’s Hospitals supports the Strengthening Mental Health for Children Now Act of 2022which would allow better remuneration for pediatric mental health services and an expansion of the behavioral health workforce.
But it’s unclear whether that funding, along with several bills dealing with children’s mental health, will make it through Congress.
If you or someone you know is struggling with thoughts of harming or killing yourself, you can get help by calling the confidential National Suicide Prevention Lifeline at 800-273-TALK.