Children in crisis are checking into ERs amid months-long waits for mental health services |

Children in crisis are checking into ERs amid months-long waits for mental health services

Callan Gray
Updated: November 17, 2021 11:15 PM
Created: November 17, 2021 10:57 PM

As hospitals face shortages of staffing and beds amid a surge in COVID cases, they're also treating more kids in crisis. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association declared a national state of emergency in children's mental health in October.

According to the organizations, emergency room visits have increased dramatically for mental health crises, including suspected suicide attempts. Twin Cities providers are also seeing a growth in demand.

“This year alone, in 2021, Children's Minnesota has seen a rise in mental health presentations to our emergency departments upwards of 30%” said Scott Elsbernd, the interim director of emergency services at Children’s Minnesota. “Of those kids that are presenting there, 50% of them are presenting sicker, more highly acute than we're accustomed to. These are anywhere from behavioral issues to a harm to themselves or others, to overdoses, ingestions.”

Children’s Minnesota expects to treat 2,100 children in its emergency departments this year for mental health needs. 

“There's really a number of factors that we feel like contributed to this,” said Jamie Winter, director of behavioral health at Children's Minnesota. “The stress of being amidst a global pandemic and then our children are really feeling this with the transition to distance learning and the increased social isolation that that has been a part of our last year. We also have removed kids from that primary source of early identification for mental health challenges, which is school. And so COVID-19 has made early identification and intervention especially difficult.”

It's a trend reflected across the country. 

“We’re seeing increased wait times as a result across our communities based on the supply of mental health clinicians that really cannot keep up with and meet the demand or the need that kids have for services,” Winter said.

She explained youth across the metro are waiting one to six months, in some cases, for longer-term mental health services, including ongoing therapy, medication management or further assessment. 

“You definitely get to the point where it no longer feels safe to continue to wait for care and so then we're seeing more kids who are needing to come into one of our emergency departments or one of the emergency departments in the metro,” Winter said.

Elsbernd said another factor is the limited capacity for pediatric and adolescent inpatient beds. 

“And then I just think the services in the metro are limited or reduced, and – or – because we’ve seen this marked increase, the beds that are available are at capacity nearly every day,” Elsbernd said. 

Work is currently underway at Children’s Minnesota in St. Paul to add the first inpatient mental health unit in the east metro to treat children under the age of 12. It will have 22 beds and is expected to help more than 1,000 children and adolescents each year. It’s set to open in the later part of 2022.

“St. Paul has always seen a disproportionate amount of behavioral health kids presenting to our emergency department, especially compared to our Minneapolis campus,” said Elsbernd. 

For now, the system relies on partners for inpatient child and adolescent psychiatric beds. Children stay in the emergency department until they're transferred, which can range from several hours to overnight, or longer, according to Elsbernd. 

“Every major system has kids waiting in their emergency room,” said Dr. Mary Beth Lardizabal, the system medical director for child and adolescent psychiatric services at Allina Health. “That's what we call boarding — they're boarding waiting for a bed. We've assessed them, we've determined that they need to come in, but there's nowhere for them to go.”

She said Allina has also seen an increase in children’s mental visits, particularly among teenagers. 

“Since the beginning of 2021, kids have started showing back up in our emergency rooms, needing crisis services, and actually probably doing worse than had been, say, at the beginning of the pandemic,” Lardizabal said.

Hospitals reported 206 pediatric mental health beds across the state in 2020 according to the Minnesota Department of Health.

Allina has 35 adolescent inpatient beds and 72 seats in day programs. A spokesperson told us all of those are usually filled and have been since well before the pandemic.

“This was happening before the pandemic but since the pandemic, it's become almost unmanageable,” Lardizabal said. “What would also say is that this is not just isolated to the Twin Cities or Minnesota — it's a national what we call a mental health crisis. We might call it a public health crisis.”

About two years ago, Allina launched a program in collaboration with the Washburn Center for Children to help children receive care.

“Where kids can get immediate access to crisis intervention services, working with an in-home therapist that literally can meet them in the emergency room and then see them the next day at home,” she explained.

To alleviate pressure on the system, she said there needs to be a continuum of care to treat youth before they arrive at the emergency room. 

“That really means things like school-based mental health treatment, giving kids resources before they actually get a diagnosis of depression or anxiety or become suicidal,” Lardizabal said. “And then we need to have mental health services available in primary care because we know that there's a severe shortage of child and adolescent psychiatrists in the state of Minnesota, in the country.”

According to Lardizabal, there are only 150 child and adolescent psychiatrists in Minnesota.

She also supports the expansion of outpatient programs, which allow kids to receive intensive treatment during the day but return home at night. 

In July, Children’s Minnesota opened a partial hospitalization program in Lakeville. The outpatient option allows patients 12 to 18 years old to receive intensive mental health care during the day and then return home at night and on weekends. The healthcare system expects it will reach nearly 400 teenagers each year.

According to the Minnesota Department of Human Services, its licensing records indicate a total of 590 licensed mental health beds in children’s residential facilities, which includes mental health treatment facilities and psychiatric residential treatment facilities. DHS does not have information regarding the number of open beds.

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