On January 24, an 8-year-old boy from Jamaica Plain was taken to the emergency department at Boston Children’s Hospital. He was in a mental crisis and had just had a blast at home.
Karin Broadhurst became the boy’s adoptive mother when he was 4 years old. She adopted him a few years later. Broadhurst knew that he had been abused and neglected before he was in her care. He has post-traumatic stress disorder and sometimes acts dangerously or aggressively, she says.
On the night in question, he took her medicine.
“He was on my bed and he took my medicine organizer, he threw it as hard as he could on the floor and it opened up,” recalled Broadhurst. “It has a lock, but it is not overweight. I think it is for the elderly, not for children with mental problems. Then it opened and my medicines flew across the room … he started trying to get the drugs and threaten to swallow them. And I I had to physically hold him until the police arrived. “
Broadhurst, a single mother, says that because of her son’s history of trauma, he goes into “fight or flight mode”.
“And he is feeling out of control,” she said. “I don’t think he had any intention of killing himself. I think he was just … trying to do something that he knew would be very bad and upsetting.”
Broadhurst says he sometimes has no choice but to call 911 to transport his son safely to the hospital.
When they arrived at Children’s, the doctors wanted to hospitalize the child. But there were no pediatric psychiatric beds available anywhere in Massachusetts. He spent five nights waiting, or “boarding” the emergency room. Then he was transferred to a regular medical floor at the hospital. On February 26, he had been staying at Children’s for 33 days.
“If he [had an inpatient psychiatric bed], he would stay in a unit with other children of similar age, “said his mother.” These children would have therapeutic activities and groups throughout the day. The psychiatrist who attends you would be making changes to your medication, if necessary. He would meet with a clinician, and that clinician would be doing therapeutic work with him, setting goals for him.
“Basically, he sits in a room playing Legos all day, watching TV and playing video games,” she added.
Broadhurst said his son’s daily check-in from a hospital psychiatrist or social worker basically involves them asking some of the same questions about whether he is feeling safe or thinking about hurting himself or others.
Dr. Patricia Ibeziako, associate head of clinical services in the psychiatric department at Boston Children’s Hospital, said that doctors initiate and change treatments while patients are hospitalized – but the situation is far from ideal.
“What we really want is for children to receive the right care in the right environment at the right time. And boarding is not a reflection of people being in the right environment for the right care they need, ”Ibeziako said. “Boarding affects children and adolescents with psychiatric illnesses significantly more than those with medical illnesses. And the problem worsened significantly during the pandemic ”.
At the end of this week, there were 40 children admitted to Children’s while waiting for psychiatric beds – 16 of them hospitalized in the emergency room and the rest in medical rooms, said Ibeziako.
“It’s ridiculous … And we can’t wait six months or a year for some hospitals to build or add rooms. They need to find a solution now.”
Karin Broadhurst
According to the State Department of Health and Human Services (EOHHS) of the state, since June, the boarding for psychiatric beds of children and adults has increased between 200% and 400% per month in relation to the same months of the previous year.
After a patient has been hospitalized for 60 hours, the case is referred to the state’s Department of Mental Health, which must try to locate a bed. For pediatric patients, it takes an average of four days to find one, said an EOHHS spokesman.
Broadhurst’s son is waiting four weeks longer than that. Earlier this week, they celebrated their ninth birthday at the hospital. She says she wants legislators and state officials to prioritize children’s mental health more than they currently do.
“… this is a crisis, and they can find a way in an emergency to make extra beds for COVID. And they should be able to find a way in an emergency to find extra psychological beds for our children who are in crisis, “Broadhurst said. “It’s ridiculous … And we can’t wait six months or a year for some hospitals to build or add rooms. They need to find a solution now.”
The state’s Department of Mental Health says it is working with providers to make more psychiatric beds available this year. About 200 beds are expected to be created starting in the spring, and the state is offering special incentives for pediatric beds, including increases in reimbursement rates. Boston Children’s Hospital says it is adding 12 psychiatric beds for inpatients to its Waltham facility this fall. He currently has 16 beds in his Boston hospital and 12 beds for short-term acute residential treatment in Waltham.
The providers say it is difficult to know what kind of dent the new beds will make because the full extent of the shipping problem is unclear.
“There is no real comprehensive source of data out there about the full scope of the boarding problem,” said Amara Azubuike, director of behavioral health and defense policy at the Department of Government Relations at Boston Children’s Hospital. “We don’t have the full number of how many children are staying, where they are staying, what level of care they need and how many beds are actually functioning at any given time.”
The legislation was just introduced in Beacon Hill to create an online portal that would track in real time how many children are hospitalized in which hospitals, what their needs are and how many beds are available in hospitals across the state, said Azubuike.