This commentary is by Jake Ermolovich, Amanda Galenkamp and Sean Taylor, third-year medical school students at Larner College of Medicine at University of Vermont. They have just completed their rotation with the Department of Psychiatry within the University of Vermont Health Network, with time spent at UVM Medical Center, Central Vermont Medical Center and Champlain Valley Physicians Hospital.
Every day in Vermont, children wait in windowless rooms in the emergency department for a bed at one of the few area inpatient pediatric psychiatric facilities.
As medical students at the Larner College of Medicine, we have spent six weeks in the field of psychiatry to learn about their practices and to gain exposure to a field that we may wish to pursue. The intensity and intimacy of hearing people’s stories every day is a privilege and an honor, but when it comes time to find access to treatment options, it can be next to impossible.
On April 18, VTDigger reported that the UVM Health Network is putting its plan for a pediatric psychiatry unit on hold. In the article, UVM Health also vaguely threatened to pause or cut the plan for an expanded adult psychiatry unit in Berlin. This piece mentioned that available beds for adults with psychiatric needs are lacking while leaving out the dire need for pediatric beds.
Imagine a few of the novel difficulties faced by youth today. In recent years, many have suffered pandemic-associated isolation at a stage where social development is pivotal, leading to further social media use to compensate — social media that has notably become the forefront of bullying and abuse.
These new factors come stacked on the gauntlet of growing pains that adolescents must navigate, as well as other psychosocial stressors that aren’t immediately apparent. Perhaps the mystifying rise of child suicide isn’t so mystical.
For some, these problems come to a head, the hallway narrows, and the only solution seems to be ending it all. They come to the emergency department. Their clothes are taken, and they are given thin, paper scrubs due to safety concerns. Then, they are isolated in a room in a locked wing of the department, often away from parents. They are seen briefly by a doctor and told someone else will come see them. An hour goes by. Nothing. Then another. Still, no one comes to talk to them.
A day passes. Then another. They hear commotion outside their room. Alas, it’s a new patient. An adult in crisis. The new patient is afraid and seeing things that others can’t — and they make it known. They scream words the child has never heard; however, their violent tone alludes to the words’ meaning.
As the child watches, this adult proceeds to strip naked and urinate in the hallway outside the child’s room. The adult assaults the door as the urine pools under it on the floor. Terrified, the child hides under their sheets, stowing their fear in the far corners of their thoughts, holding it there for years until it re-emerges explosively — a cicada of the mind, waiting to sing of the trauma it slumbered with. Who will hear that song? Apparently not the UVM Health Network administration, judging by its recent actions.
When it takes days to weeks for placement in a dedicated psychiatric unit, these children are often screaming out to leave, get help, and feel safe again. They beg to get out of the emergency department whenever we stop by the room. When we exit their rooms, we often still hear wails echoing through the wings of the emergency department.
When similarly distressing situations happen daily, we as students feel helpless and angry because the medical system has failed to help them when they needed it most. We find ourselves contemplating how our “care” affects the emotional and physical well-being of these children as they grow into adults.
Despite physicians, case workers and crisis clinicians doing all they can, patients stay in the emergency department for up to a week or more because no beds are available. The emergency department is the best place to bring someone in crisis, but it is designed for acute remedies. With each day, they become more distraught, hopeless and isolated.
Many of these kids are alone with only the medical system to care for them, and yet it too has let them down.
Although inpatient units are not perfect, they’re more able to offer longitudinal care than the emergency department. Patients can work through their problems in group therapy sessions, sharing their experiences and hearing how others would react to them. They also have access to individual therapy, stimulating activities, coping skill building, and even windows. Mostly, they are validated. They are told their thoughts and feelings have value and are worth being shared, heard, and worked through.
This system needs to change. How many more children will need to sit alone in an emergency department room for weeks, waiting for treatment? How will this experience impact their future health? How can we expect providers and staff to help patients effectively against a system that is not designed to be therapeutic?
Right now, it feels like UVM Health Network cares about neither us nor the kids stuck in the emergency department and instead are acting out Walter Cronkite’s statement that “America’s health care system is neither healthy, caring, nor a system.”
