Acknowledging that children with mental health challenges are spending more time in emergency rooms, Gov. Dannel P. Malloy announced a plan Wednesday to address what medical professionals describe as a “crisis.”
It spiked in May. According to a Connecticut Health Investigative Team report, the emergency department at the Connecticut Children’s Medical Center saw 367 children in mental health crisis that month. During that same time period, Yale-New Haven Hospital also saw a 10- to 15-percent increase in emergency room visits.
“No child in mental health crisis should have to wait days to get access to the treatment they need,” Malloy said in a press release.
Malloy’s plan focuses on crisis stabilization and opens 14 respite beds to children who aren’t under the care of the Department of Children and Families.
Most of children with mental health issues end up in the emergency department because they struggle to find services in the community and the emergency department can’t turn them away.
Malloy’s plan calls on the Department of Social Services to submit a request for an increase in Medicaid rates for Psychiatric Residential Treatment Facility capacity. If the state plan amendment is approved by the federal government then the Malloy administration is hoping it will encourage private providers to open additional beds.
“New beds would be available for children with behavioral health needs regardless of DCF involvement or payer,” according to the plan.
If approved by the federal government it means an additional $1.6 million in Medicaid funds for existing providers, but warns that the state faces additional costs if new beds are created.
Malloy’s plan piggybacks on a Department of Children and Families’ proposal finalized earlier this month. DCF’s plan focuses on developing a mental and behavioral health plan for youth, regardless of their insurance coverage or status with DCF. Many parts of the plan also will require legislative approval, but the legislature doesn’t reconvene until January.
Sen. Beth Bye, co-chairwoman of the Appropriations Committee, applauded the governor for taking immediate steps and acknowledging the crisis.
“We have to do something now within the confines of what we have because it really is a crisis,” Bye said.
She said she understands there’s a longer conversation the legislature will need to have with the governor when it comes to funding these initiatives in the next two-year budget.
The plan Malloy released Wednesday increases existing funds by about $4 million with the option of increasing them by another $7 million if legislators decide to embrace the creation of a community-based Behavioral Health Assessment Center as an alternative to hospital emergency rooms.
Malloy’s plan also uses $160,282 in federal funds previously approved by two legislative committees to fund an emergency mobile psychiatric services employee who will staff emergency rooms and help children and families find the appropriate treatment.
Dr. Lisa Namerow, a child and adolescent psychiatrist at the Institute of Living who practices at the Connecticut Children’s Medical Center, said she’s taking a “wait-and-see” approach. She said she’s happy the message that there is a crisis has gotten out there and people are listening. However, she still feels like she and her colleagues don’t have a seat at the table.
“Did anyone sit with child psychiatrist to say, ‘what kind of model is working with the kids you’re seeing in the emergency room?’,” Namerow asked Wednesday.
Opening up more beds for children with acute mental health problems is desirable, but Namerow wonders whether the respite beds that are part of Malloy’s plan are “going to be able to handle” the kids she’s seeing in the emergency room.
However, she is very pleased the crisis is being addressed.
“We hope someday, there will be the same level of services for children with mental health care needs as there are for children with medical needs,” Namerow said.
Susan Kelley, child and adolescent policy manager at National Alliance on Mental Illness in Connecticut, said it’s still not clear from what was released Wednesday what the best way is to address the crisis in the emergency room.
“The real issue is not to have them go the ER,” Kelley said.
However, the plan is a little “murky” on exactly what the system should look like. She suggested instead of re-creating the wheel with a community-based Behavioral Health Assessment Center — which would act as an alternative to emergency rooms — the state should look at the regional child guidance clinics. The clinics already exist and communicate with the Emergency Mobile Psychiatric Service network.
Meanwhile, Republican Sen. Len Fasano wonders if DCF is up to the task.
“Increasing treatment capacity for children with mental health needs is essential to improving care across our state, but these programs will only succeed if competently implemented,” Fasano said. “We need to seriously consider whether DCF currently has the expertise and ability to effectively implement such a broad ranging mental health overhaul.”
Department of Children and Families Commissioner Joette Katz said that the plan announced by Malloy reflects the fact that the best way to respond to children in crisis is to enhance the community-based services that can intervene before a crisis occurs.
“We have seen repeatedly that if we provide effective in-home and community-based services, we can prevent children from having to go to less-than-ideal settings — like a hospital emergency department — when the situation becomes acute,” she said. “The best solution is to offer help before that becomes necessary.”
But medical professionals say Katz’s desire to close so many group homes and congregate care beds has contributed to the current crisis in the ER.
“When they started to put pressure on placements to congregate care settings, they shut the door to sub-acute care kids with chronic conditions,” Namerow said.
DCF officials have repeatedly said in numerous public forums that they don’t believe that’s the case.
Editor’s note: This story has been updated to clarify the difference between in-patient and respite beds.