WEBVTT - ER Boarding Can Make It Especially Difficult for Kids Suffering a Mental Health Crisis

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<v Speaker 1>It's Thursday. I'm oscar A Mirrors from the Daily Dive

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<v Speaker 1>podcast in Los Angeles, and this is reopening America. The

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<v Speaker 1>demand for mental health care has overwhelmed supply for most

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<v Speaker 1>of the pandemic, and in some places like Massachusetts, the

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<v Speaker 1>need for those services is critical. If traditional hospitals and

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<v Speaker 1>treatment centers don't have available space for mental health services,

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<v Speaker 1>some may need to go to the e er in

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<v Speaker 1>what is known as emergency room boarding for psychiatric patients.

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<v Speaker 1>These types of stays have risen between two hundred and

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<v Speaker 1>four percent in Massachusetts during the pandemic, and e r

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<v Speaker 1>s are not equipped for this type of treatment. Martha b. Binger,

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<v Speaker 1>healthcare reporter at w bu R, joins us for what

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<v Speaker 1>to Know and one girl seventeen days stay in an

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<v Speaker 1>e er. Thanks for joining us, Martha, thank you for

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<v Speaker 1>having me. I'm gonna talk about an interesting piece you

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<v Speaker 1>wrote about kids and with mental health crisis is right now.

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<v Speaker 1>A lot of times hospitals are overrun, they don't have

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<v Speaker 1>enough space, and sometimes these kids have to go into

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<v Speaker 1>e r s and in some cases they can be

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<v Speaker 1>there quite a quite a long time. You profiled a

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<v Speaker 1>girl named Melinda who had to spend seventy seventeen days

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<v Speaker 1>in an e ER just really not the right setting

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<v Speaker 1>for what she was going through. But because of y

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<v Speaker 1>issues other places where she couldn't be placed, you know,

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<v Speaker 1>she had kind of tough it out through there. So

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<v Speaker 1>Martha tell us a little bit about her ordeal and

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<v Speaker 1>and the overall problem with uh, you know, staying in

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<v Speaker 1>the e R s but e R boarding as they

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<v Speaker 1>call it, right, So Melinda has anxiety and depression that

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<v Speaker 1>really got worse during the pandemic as she grew more

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<v Speaker 1>and more isolated. You know, her her saying lessons stopped.

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<v Speaker 1>She was going to school virtually, she was seeing therapist,

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<v Speaker 1>but that all switched to virtual sessions as well, and

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<v Speaker 1>she just wasn't connecting. So she had four trips to

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<v Speaker 1>the e R starting last December, in instances where she

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<v Speaker 1>threatened to kill herself, and the one where she ended

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<v Speaker 1>up spending seventeen days in the e ER started in April.

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<v Speaker 1>What happened was she got there and all of the

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<v Speaker 1>psyche beds for kids in Massachusetts and surrounding states were full.

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<v Speaker 1>Because we're seeing a lot of increasing demand for mental

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<v Speaker 1>health care and and really extreme cases where where children

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<v Speaker 1>are threatening to harm themselves, and so all of the

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<v Speaker 1>units are full. And in addition, during COVID, many of

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<v Speaker 1>the psyche beds have been converted to to COVID where

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<v Speaker 1>they needed them, or they had been switched from double

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<v Speaker 1>rooms to single so there was there was kind of

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<v Speaker 1>a shrinking of of space that for to take care

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<v Speaker 1>of these kids with psychiatric needs and more demand, and

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<v Speaker 1>Melinda ended up kind of caught in that bottleneck, waiting

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<v Speaker 1>seventeen days to be placed in a bed. You know,

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<v Speaker 1>in a lot of time, there's an individual a lot

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<v Speaker 1>of individual care that these patients need, and Melinda wasn't

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<v Speaker 1>getting that for her first ten days in the hospital.

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<v Speaker 1>Was kind of I guess you described this lecture hall

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<v Speaker 1>with a dozen other kids on gurneys, is just separated

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<v Speaker 1>by curtains and whatnot, and it's just tough to get

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<v Speaker 1>kind of get the treatment that you need. By the

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<v Speaker 1>time you caught up with her, she was already in

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<v Speaker 1>there for twelve days in the e er. Tell me

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<v Speaker 1>how that went well. She wasn't getting any care in

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<v Speaker 1>the e er, But that's not unusual emergency rooms. They're

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<v Speaker 1>kind of the place where you just assess the problem

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<v Speaker 1>and then move on. So you know, if you break

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<v Speaker 1>your arm, they might fix that in the emergency room.

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<v Speaker 1>If you have a heart attack, they're very likely going

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<v Speaker 1>to move you up to someplace in the hospital where

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<v Speaker 1>you can get care for that. But if you have

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<v Speaker 1>psychiatric need and there's no space, you just sit there

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<v Speaker 1>because emergency rooms aren't set up to provide any therapy,

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<v Speaker 1>any psychiatric analysis, anything like that. And so Melinda just

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<v Speaker 1>started to spiral downward, you know. She she eventually got

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<v Speaker 1>moved out of that lecture hall into a small room

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<v Speaker 1>off of the emergency room. But again, like she was.

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<v Speaker 1>She she was sitting on a gurney, no furniture in

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<v Speaker 1>the room, wasn't allowed to have her phone except for

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<v Speaker 1>maybe an hour a day. Um, she she wasn't getting

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<v Speaker 1>any treatment, so she just got worse and worse, which

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<v Speaker 1>meant that she had some behavior problems. She was screaming

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<v Speaker 1>at staff sometimes, she threatened to escape one time, and

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<v Speaker 1>that it made her harder to place. So it turned

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<v Speaker 1>into this kind of catch twenty two because the hospitals

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<v Speaker 1>didn't want this girl who was acting out, but she

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<v Speaker 1>was acting out because she had been stuck in the space.

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<v Speaker 1>You were also able to make contact with her mother, Pam.

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<v Speaker 1>And you know, as the days were progressing, you know,

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<v Speaker 1>she said, the longer that her daughter Melinda is there,

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<v Speaker 1>the more she's starting to decline. And basically what you

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<v Speaker 1>were just describing, she was lashing out, and and that

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<v Speaker 1>just complicates everything from then on out. Yeah, I mean, Pam,

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<v Speaker 1>Pam could see that, um, other children who were more

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<v Speaker 1>docile than her daughter were getting placed more quickly. Um,

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<v Speaker 1>people who didn't complain seem to be getting placed more quickly.

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<v Speaker 1>But the and the hospital administrators will tell you, look,

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<v Speaker 1>we have to sort of assess who's coming in to

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<v Speaker 1>be sure they were going to be a good fit

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<v Speaker 1>for a program. We don't want to take in somebody

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<v Speaker 1>who we think is going to kind of disrupt the

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<v Speaker 1>care that we're trying to provide for other people in

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<v Speaker 1>the unit. But it it becomes a very difficult situation

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<v Speaker 1>for for mental health patients who aren't you know, quote

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<v Speaker 1>unquote well behaved. Milinda and Pam, we're both doing like

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<v Speaker 1>audio diaries, so we're able to kind of hear from

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<v Speaker 1>Melinda and her own words what was going on. And

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<v Speaker 1>she said that she wished in a lot of cases

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<v Speaker 1>that someone would just understand her she really couldn't get

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<v Speaker 1>across anybody how bad things were for her. Yeah, No,

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<v Speaker 1>she's she's had a very hard time, um what during

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<v Speaker 1>the pandemic, especially finding people who she felt she could

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<v Speaker 1>um explain the stresses that she was under and get

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<v Speaker 1>some help. I mean, I think she also describes that

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<v Speaker 1>she just had way too much unstructured time to kind

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<v Speaker 1>of ruminate in her head, you know, to sort of

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<v Speaker 1>get stuck in these loops of of negative thinking that um, really,

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<v Speaker 1>we're not healthy, we're not helping her or or anybody else.

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<v Speaker 1>And that's unfortunately something that we're hearing from from a

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<v Speaker 1>lot of kids who have been stuck at home during

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<v Speaker 1>the pandemic. You know, we're talking about Melinda and her

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<v Speaker 1>and her struggle here and her mother, Pam. You know,

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<v Speaker 1>obviously this is just one example of it. But this

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<v Speaker 1>emergency reomboarding of psychiatric patients, uh, they say have has

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<v Speaker 1>risen between two hundred and four monthly in Massachusetts during

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<v Speaker 1>the pandemic. So this is just kind of a snapshot

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<v Speaker 1>of what's happening. But this is happening in a lot

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<v Speaker 1>of places to a lot of people. Uh. Following along

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<v Speaker 1>with the story, you know, it wasn't until day seventeen

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<v Speaker 1>that Melinda was in all of this that she was

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<v Speaker 1>finally going to be taken away and placed into another

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<v Speaker 1>program where she would be able to stay for two weeks.

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<v Speaker 1>They adjusted her medication and she started to see a

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<v Speaker 1>little bit of change finally. Yeah, Melinda has been not

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<v Speaker 1>completely stable um since she's been home. UM, but she's

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<v Speaker 1>definitely doing better. I mean, some of her therapy is

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<v Speaker 1>back in person. UM. It's possible that the medication adjustments

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<v Speaker 1>made at the hospital helped. She's had some she's got

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<v Speaker 1>some additional therapy. She's got a therapeutic mentor now, so

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<v Speaker 1>somebody who kind of walks through the world with her

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<v Speaker 1>a little bit, helping her avoid the trigger points that

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<v Speaker 1>that used to kind of send her into these downward spirals.

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<v Speaker 1>So she's got some additional assistance and UM, the family

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<v Speaker 1>is very hopeful that that the that the summer will

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<v Speaker 1>will go well for her. Is the hope that now

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<v Speaker 1>that the pandemic is easing in some cases that this

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<v Speaker 1>would get better in these e R boarding stays, UH,

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<v Speaker 1>the won't won't last as long anymore. In the other

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<v Speaker 1>hospital beds can open up. Is that the hope now

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<v Speaker 1>or is there other stuff being done to to limit

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<v Speaker 1>this kind of thing. Well, I think there's a lot

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<v Speaker 1>of uncertainty about that, because the numbers of kids boarding

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<v Speaker 1>in Massachusetts have not started to drop yet, even though,

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<v Speaker 1>as you said, the pandemic conditions are easing. So it's

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<v Speaker 1>possible that we have a backlog of these mental health

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<v Speaker 1>cases that UM need to be addressed. Honestly, people don't

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<v Speaker 1>really know what to expect in the next few months.

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<v Speaker 1>There are some efforts to try to take care of

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<v Speaker 1>kids more at home, to try to offer some urgent

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<v Speaker 1>care in the community, UM, to open up some psyche

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<v Speaker 1>beds that are not actually in hospitals but in more

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<v Speaker 1>like halfway houses. There are some things underway to try

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<v Speaker 1>to reduce the numbers, but it's still pretty tough in

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<v Speaker 1>Massachusetts and in many states right now. Well, I mean,

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<v Speaker 1>I hope that all these people, all the kids especially,

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<v Speaker 1>can get the help that they need and not have

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<v Speaker 1>to kind of languish there in the e r s

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<v Speaker 1>because it's just not the setting that that they need

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<v Speaker 1>to be in to get the proper help. So hopefully

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<v Speaker 1>we can bring some awareness to all of this and

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<v Speaker 1>and conditions can get better. Martha B. Binger, healthcare reporter

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<v Speaker 1>at w B you are thank you very much for

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<v Speaker 1>joining us. Thank you for having me. I'm Oscar Ramrrors

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<v Speaker 1>and this has been reopening America. Don't forget that. For

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<v Speaker 1>today's big news stories, you can check me out on

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<v Speaker 1>the Daily Dive podcast every Monday Friday. So follow us

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<v Speaker 1>on I Heart Radio or wherever you get your podcast