Children are not only waiting days for inpatient psychiatric services, clinician and treatment shortages are making them wait days to be released from the hospital to outpatient care, according to Dr. Frank Fortunati, director of Yale New Haven Psychiatric Hospital and Associate Chief of Psychiatry.
“We had 900 days for children alone who were cleared for discharge but waiting for a level of care that was not available,” Fortunati said.
It’s a problem that has escalated rapidly during the pandemic to epic proportions, according to state Child Advocate Sarah Eagan, who told legislators Friday that she has dealt with 14 child suicides in the past year – the most ever in the position she’s held for nine years.
“There were multiple children as young as 11 or 12 years old,” Eagan said. “Every one of those deaths is preventable,” Eagan added.
Legislators heard about the urgent need for expanded mental health services for children during a marathon public hearing Friday on two bills that would increase access to treatment and other supports, including child care and preschool, that are being crafted with input from people with lived experience and professionals.
More than 250 people testified before the Public Health Committee and the Committee on Children. Lawmakers heard from youth and families impacted by mental health concerns, fellow legislators, health care professionals, the mayors of Stamford, Hartford and New Haven and state agency heads who deal with children.
HB 5001 would temporarily waive examination requirements for individuals providing mental health care who are supervised, expand telehealth to include mental health treatment for children, provide treatment for truancy instead of punishment, increase the number of mental health beds by 2026 and develop a protocol for transporting children with mental or behavioral health needs to an urgent care center operated by the state Department of Children and Families.
The bill would also set up a grant program for schools to hire more behavioral health staff and a loan forgiveness program for those seeking careers in mental health. Other changes would make it easier for parents to access inpatient and outpatient treatment.
SB 2 would extend access to child care and preschool and provide support for kids disconnected from school. It would allow out-of-state psychologists to practice telehealth and in-person treatment through an interstate pact and involve parents in social and emotional learning.
The mental health crisis in children had already escalated by the time the pandemic hit, many stakeholders said. But the public health crisis which closed schools and canceled social activities exacerbated mental health issues in children who are now exhibiting more acute symptoms, experts said.
“The demand for services has exceeded the capacity,” said DCF Commissioner Vanessa Dorantes, whose agency is working on opening urgent care facilities throughout the state that would treat all children in crisis, not just her agency’s clients.
The initiative includes treatment and intervention based on urban trauma, she said. But in prepared testimony, Dorantes pointed out that while communities of color and families in lower socioeconomic status have been disproportionately affected, families with insurance also have felt the effects.
Dorantes and several others are calling for the creation of a Behavioral Health and Prevention Cabinet made up of agency heads that deal with the state’s youth. The cabinet would be a mechanism for accountability and would have oversight of the operational practices of the children’s behavioral health system.
She is also calling for a children’s behavioral health and prevention community council with at least 50% of members being parents, youth and family members with lived expertise.
“The role of the Council would be to independently monitor the Cabinet’s recommendations, provide input where appropriate, and inform the Cabinet’s decision-making regarding behavioral health policies, practices and procedures,” Dorantes said.
A large part of the problem is low reimbursement rates for behavioral health care, Fortunati said. “Reimbursement is critical,” he said. “We lost five very experienced licensed clinical social workers to school systems. It takes a while to build those skills. We need to retain folks who we spent years training and are quite good.”
The problems with inpatient and outpatient treatment are hitting hospitals throughout the state, according to a spokesman for Bristol Hospital. “The crisis demonstrated that available resources do not match the severity of the need for children who present to hospital emergency departments for behavioral health care,” said Johnny Burnham, spokesman for Bristol Hospital. “Discharges for children from inpatient and emergency care settings have been delayed for days, weeks or even months, because the next level of care needed is not available.”
The consequence, Burnham said, is that children aren’t being stabilized in a safe setting. “These children are being discharged home to a setting that is stressed due to the pandemic and only further triggers their symptoms,” Burnham said. “As a hospital providing intervention to these children, the lack of resources for this increased demand is beyond troubling.”