Dr. Christian Pulcini: Immediate action needed on mental health crisis in Vermont

This commentary is by Christian D. Pulcini, M.D., of Shelburne, a pediatric emergency medicine physician at the University of Vermont Children’s Hospital, an assistant professor of surgery and pediatrics at the Larner College of Medicine at the University of Vermont and executive board member of the Vermont chapter of the American Academy of Pediatrics. 

On Tuesday, Oct. 19, a coalition of national organizations supporting the health and well-being of children across the country — the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association — declared a national emergency in children’s mental health.

This declaration was issued on the same day that the Biden administration released a brief focused on “Improving Access and Care for Youth Mental Health and Substance Use Conditions.” 

Both documents cite suicide as a leading cause of death among youth, as well as a 24 percent increase in emergency department visits for mental health in youth ages 5 through 11 and more than a 30 percent increase in those who are 12 to 17 years old in the last year.

Unfortunately, although Vermont has fared well with the Covid-19 pandemic in comparison to the rest of the country, we are falling short regarding a concerted, urgent response to our pediatric mental health crisis. 

In Vermont for example, emergency department visits for mental health among youth were 66% higher in May 2020 than in May 2019, and 35% higher from April through December 2020 as compared to the previous year.

I can state confidently, as a pediatric emergency medicine physician and member of a variety of professional societies, our children in Vermont with mental illness are also in a state of emergency. Just as the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, the Children’s Hospital Association and the federal Department of Education have acknowledged the gravity of the situation, we too must acknowledge the gravity of the situation here in Vermont to holistically address the crisis that continues to unfold.

It is important to note, however, that many individuals and groups across the state are working diligently on efforts to bolster the mental health infrastructure for children and youth in Vermont. I have personally had the opportunity, alongside many colleagues, families and key stakeholder groups, to testify before the Legislature regarding this crisis. 

We have all expressed deep concern and dedicated significant resources to this issue in the last year. This is in addition to the thousands of health care providers across the state (notably in emergency departments) who have faced with the dual challenge of a pandemic and a mental health crisis. 

Families and providers are desperate for a more urgent and immediate statewide response, as Vermonters continue to wait in our emergency departments for extended periods of time without access to needed mental health services. This is true across all emergency departments in Vermont and is happening while we face significant staffing issues shortages. This in turn leads to poorer access to all emergency health services for Vermonters, putting our entire population at unnecessary risk during emergencies due to emergency department overcrowding.  

We must also acknowledge that both an immediate response is needed, as well as longer-term strategies and resource allocation. This is not a new issue in Vermont, as suicide rates were noted pre-pandemic to be 30% higher in Vermont than the national average (2-3 deaths per week). 

Such overarching propositions as strengthening school-based mental health supports, psychiatric urgent care, mobile health crisis, and family respite care are all extraordinarily important, but they are not the immediate assistance that is needed today.

What is needed immediately are allocation of resources and the removal of barriers for organizations to create tailored strategies to bolster their mental health infrastructure, while longer-term solutions are enacted. Specifically:

  1. Key organizations (hospitals, designated mental health agencies, organizations serving children) should come together in each of our communities to develop programs, potentially including space outside of their emergency departments, for individuals needing mental health care.
  2. The state should allow maximum flexibility with the certificate of need process for the construction of much-needed mental health spaces.
  3. The Legislature must allocate adequate funding in the first weeks of the session to allow for meaningful change and to support our critical organizations that are struggling to hire and retain enough staff to provide care. 

It will take all of us, coming together, to address this issue. I urge anyone reading this piece to contact your legislators today to encourage immediate action on this issue in Vermont. 

Your voice is needed to facilitate an immediate concerted response and, more importantly, help alleviate the suffering of the too many children and families who are forced to spend too much time in emergency departments across Vermont every day versus receiving the treatment they so badly need.


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