The Department of Mental Health will propose a slate of options to help reduce the number of children waiting in emergency rooms for mental health care — but fully addressing the problem will require a system-wide overhaul, according to commissioner Sarah Squirrell.
Kids and teens who show up at the hospital while experiencing a mental health crisis have been left to languish in emergency rooms for days, waiting for open hospital beds or other treatment options.
In March, the average wait time in emergency rooms rose above 100 hours — more than four days. At one point this month, 19 children were waiting for care in hospitals around the state.
Squirrell said the system has reached a “crisis point.” Her department staff accelerated its work on the issue after lawmakers demanded an immediate response last week.
Officials warned that the issue arose from a confluence of factors — fewer beds and limited staffing, seasonal increases in demand for services, and higher levels of depression and anxiety among youth as a result of the pandemic — and would take time to resolve.
“None of the solutions that are on the table or even in the realm of possibility are going to solve this tomorrow,” said Jeff Tieman, CEO of the Vermont Association of Hospitals and Health Systems, who provided a list of proposals to the Legislature. “So we need to be immediate about it and also understand that some of this will take some time.”
Squirrell plans to present her department’s plan to the House Committee on Health Care on Tuesday. In it, she proposes relaxing Covid-19 restrictions at mental health facilities to open up more slots for young people, Squirrell said. About 15 of the state’s 48 mental health beds for kids under age 18 are currently closed, many because of Covid-19 safety precautions.
The state would push for in-person counseling and services for kids, she said.
Full-time, in-person schooling would also help, Squirrell said. About 48% of kids on Medicaid obtain mental health services through public school.
The commissioner diagnosed the backlog as a problem of “flow” in the system.
Many of the kids in the Brattleboro Retreat are ready to be discharged but have no place to go, she said. The state would seek to bolster services for families through the Department for Children and Families and for kids with disabilities through the Department of Disabilities, Aging and Independent Living. It would also have to open up temporary foster placements for kids in state custody.
As the legislative session winds down, it is unlikely that lawmakers will take any major action on the issue, though they could try to slip last-minute funding into the budget.
But Health Care Committee Chair Bill Lippert, D-Hinesburg, said he would push for immediate action from the state.
“We want to see (the Department of Mental Health) to address this as an urgent issue,” rather than simply a long-term project, he said. “A family needs to know they can get access to care.”
But Mike Smith, secretary of the Agency of Human Services, warned the officials against reacting to a spike in a way that misrepresented the scope of the problem.
On Thursday, four children were in emergency rooms, he said, down from more than a dozen last week. The state should respond “not to the highs and low (but to) what this is going to look like on an ongoing basis,” he said.
In the longer term, he said, the state has proposed $600,000 in the annual budget for a mobile response unit in Rutland — an approach that produced “great results” in other states, he said.
The unit, staffed by Rutland Mental Health, would respond to kids experiencing mental health crises at home or school to help families de-escalate the situation and to help ensure follow-up treatment. That effort, which could launch later this year, may serve as a model for similar teams around the state, Smith said.
Smith also said he planned to speak to leaders at Central Vermont Medical Center in Berlin about whether their plan for a 25-bed mental health facility could be amended to house youths rather than adults. Construction of the facility had been put on hold, first because of exorbitant cost and then due to Covid-19, and should “be picked up more rapidly,” Smith said.
University of Vermont Medical Center spokesperson Neal Goswami said the hospital, which is part of the UVM network, did not have a timeline for restarting the project, but was willing to engage in discussions with the state.
Squirrell said the Department of Mental Health will conduct studies on whether the state needs more mental health beds for youth and how to bolster staffing over the next five years.
“We need to strengthen the mental health system tip to tail and also be ready to respond in the short term,” Squirrell said.
‘Vermont isn’t equipped’
Families and advocates say kids languishing in emergency rooms is an issue the state could have foreseen and prevented.
“This is not rocket science. We should have geared up,” said Sandi Yandrow, executive director of the Vermont Federation of Families for Children’s Mental Health. Emergency room waits for kids had been a concern for at least four years, she said.
One 15-year-old went to Central Vermont Medical Center on April 8 and sat in the emergency room for two weeks until she got a bed at the Brattleboro Retreat on April 24, according to her mother, who spoke on condition of anonymity to protect her daughter’s privacy.
At one point, the teen sat for days in the locked emergency department unit with two adult men with mental illnesses.
“It has to add trauma, stress,” her mother said. For her, the process was mired in bureaucracy as she called hospital after hospital, trying to get a spot.
The mother couldn’t take her daughter home because she would lose her spot on the waitlist. ER staff once gave the teenager haldol, a powerful antipsychotic drug, without parent permission. Once the girl got a bed, her mom was not allowed to drive her — she had to be transported by ambulance — and she couldn’t meet her daughter at the Retreat because of Covid-19 precautions.
“I was frustrated also this time because I’m the type of parent who wants to know what’s going on with my child,” the woman said.
Despite the attention the issue is getting, the mother wasn’t optimistic the mental health system would change for the better. “Vermont isn’t equipped,” she said.
A problem around the country
Vermont is not alone in the challenge it’s facing, said Tieman of the Vermont Association of Hospitals and Health Systems. He said he reached out to hospital associations around the country and heard similar stories of emergency rooms inundated with kids who need mental health care.
The scope of the problem has led Congress to provide money for alternative treatment options.
But Yandrow and others say they hope to use the current focus on the issue to push for systematic changes. The head of Federation of Families for Children’s Mental Health approached Lippert about authorizing funding for peer support — someone to sit in emergency rooms with families and kids in crisis to provide company, advice and resources.
That approach has been shown “to have incredible efficacy,” Yandrow said.
Robyn Freedner-Maguire, a parent of a child with mental illness, has been urging Burlington to adopt a program started in Oregon called CAHOOTS (Crisis Assistance Helping Out On The Streets), which provides a community-based response team as an alternative to calling the police to de-escalate a crisis and get treatment.
The influx of federal Covid-19 relief money and the need for services make “dramatic change” possible, she said. “It’s kind of the perfect moment for people to think about all the ways in which we need to provide better services — both crisis services and prevention services.”
Correction: A previous version of this story included inaccurate information about the construction of the Central Vermont Medical Center psychiatric facility.
