The mom’s voice was urgent, agonized: “I am a physician, but I don’t know what to do. My fourteen year old girl has been in the ER here in Boston for five days. My husband brought her in because he was so upset she hadn’t been doing her homework for three weeks–and then she said she would kill herself! But they aren’t giving her any therapy there.”
Houston, we have a problem
There is a mental health care crisis rippling across our state. According to the Boston Globe, this family is not at all alone: many children–and adults–are stranded in the ER with mental health issues–but are waiting many days before receiving care. According to the Massachusetts Hospital Association’s Senior Director of Healthcare Policy Leigh Simons Youmans, “More than 500 behavioral health patients, including 74 children, were “boarded” in Massachusetts hospital emergency rooms at the beginning of last week.” Many of these “boarders” may stay from a week to over a month waiting for a bed. “For mental health patients, the ER is a BLACK HOLE where your friends and family go and get lost,” one family member wrote to me.
The Takeaway: To help kids, friends and family members in a mental health crisis avoid prolonged ER stays, try looking into 1/ what other treatment options may be available; and 2/ prevention, which involves recognizing mental health issues and getting treatment early.
Some of these options and prevention ideas include:
- Mobile crisis units;
- Respite care: programs that can offer parents a break and help defuse stressful situations at home that may worsen kids’ mental health;
- Making sure to seek treatment for your own anxiety and depression–this will help your kids, too;
- Prevention: seek out care before things escalate into a mental health crisis: https://finder.psychiatry.org/;
- Make a plan: if your child has a therapist, make sure you have a number to call and a strategy in place in the event of a crisis.
How not to end up in the ER in the first place.
Why don’t you want to take a ride to the ER if confronted with mental health issues? Clearly, for certain crises–drug overdoses or suicide attempts–the emergency room is the place to be. Your child needs urgent medical attention and in the state of Massachusetts, that is commonly the only place to get it. But some kids who end up there are experiencing panic attacks or other behavioral issues. The ER is not the best place to address many of these crises, because 1/ many ERs lack the resources to address these issues and 2/ by their very nature, they are stressful environments not conducive to mental healing.
So what alternatives can parents or relatives of those facing a mental health crisis turn to?
Mobile Crisis Units
In Massachusetts and many other states, there are mobile crisis units available 24/7 to both pediatric and adult patients on MassHealth and Medicare.
According to the mass.gov website,“if your child is experiencing a mental health or substance use crisis, Mobile Crisis Intervention (MCI) is available 24 hours/day, 7 days/week, 365 days/year. How to contact them? “Call toll-free 1-877-382-1609 any time day or night and enter your zip code. Have a pen or pencil and piece of paper handy. Once you enter your zip code you will get the phone number of the closest MCI team that serves your area.”
What about those patients who don’t have Masshealth or Medicare? “If you have a different health plan, you still may be able to get ESP/MCI services. “You can call 1-877-382-1609 to learn more about this,” according to the mass.gov website.
Note: while Mobile Crisis Units can assess the child in the home or at school and can potentially avoid an ER trip, if they determine that your child needs a higher level of care, they will send the child to the ER via ambulance (mobile crisis units in Massachusetts don’t provide transportation).
Respite Care
Another important intervention available in Massachusetts and other states is respite care. High stress environments correlate with both increased child distress and also with domestic violence. This program gives parents a break, which can then ease domestic tensions–often a trigger for kids’ mental health issues.
In general, children are placed in respite with the assistance of specific agencies (DDS, DMH, DCF).
Addendum: This approach, although little studied, may be of help to families not eligible for respite care via state agencies. I asked a local child psychiatrist here in Boston whether she had ever recommended that families send kids to stay with other family members (if safe) as a way to decrease stress both for parents and kids? She said she has not. But families have thought of this option and for some it has been highly successful. The child of a clergy member I know was having thoughts of suicide (suicidal ideation); the family brought her to the emergency room for evaluation. What really ended up helping their child, according to the family, was not the ER or hospital admission, but relocating the child to live with a relative, where she spent the rest of the school year. After that, they found her an apartment with her older sister in another part of town, and she finished high school at a different institution. She is now a successful college student.
Clearly, this option requires a willing and suitable family member; but it is an alternative that families may be able to turn to without agency intervention and may be very empowering, as in this case.
Prevention: recognize the problem and seek treatment early
First step: recognize the problem
According the NAMI, the National Alliance on Mental Illness, some of the most common symptoms of mental illness include:
- Excessive worrying or fear
- Feeling excessively sad or low
- Confused thinking or problems concentrating and learning
- Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
- Prolonged or strong feelings of irritability or anger
- Avoiding friends and social activities
- Difficulties understanding or relating to other people
- Changes in sleeping habits or feeling tired and low energy
- Changes in eating habits such as increased hunger or lack of appetite
Prevention
If your child is experiencing these symptoms and you are concerned, connecting them to mental health resources before things reach crisis level is optimal. Here is a resource to help locate a therapist: https://finder.psychiatry.org/. Due to the shortage of mental health professionals, however, this may not be the easiest thing to accomplish at that moment, and paying for psychiatric services can be challenging.
Connecting kids to care is key: there is good data that shows prevention is effective on many levels. First, avoiding the stress of a prolonged ER stay is huge. Second, preventing hospital admission may improve a patient’s long term outcomes, since once an adolescent has been admitted for a mental illness, they are at high risk of readmission–so recognizing these issues early is important.
Make a Plan
If you already have a therapist you are working with–make a plan with them for what to do if your child has a mental health crisis. The plan should include what you will do and who you will call in a crisis (and write down the numbers!).
Preventing mental health issues in your kids: recognize your own
Another important preventive approach if your child has mental health issues is to make sure you have the support you need. According to CDC, studies show that “parents who have their own mental health challenges, such as coping with symptoms of depression or anxiety (fear or worry), may have more difficulty providing care for their child.”
The timeworn idea of ”it’s best to put on your oxygen mask first” in a plane that is making an emergency landing before you put on your child’s is an apt metaphor here. A parent’s state of mind is deeply connected to that of their child. So it is critical for health systems to address the stress that parents are under, too–since struggles kids are experiencing are often closely intertwined with that of their parents.
The take-away: The best way to help kids avoid long unproductive ER stays when they are experiencing a mental health crisis is: 1/ consider whether other treatment options might be better suited or available; and 2/ prevention, which involves recognizing mental health issues and getting to treatment early. Some of these options and prevention ideas include:
- Mobile crisis units;
- Respite care: programs that can offer parents a breakand help defuse stressful situations at home that may worsen kids’ mental health;
- Making sure to seek treatment for your own anxiety and depression–this will help your kids, too;
- Prevention: seek out care before things escalate into a mental health crisis: https://finder.psychiatry.org/;
- Make a plan: if your child has a therapist, make sure you have a number to call and a strategy in place in the event of a crisis.
A lot of news coverage lately about the mental health care crisis in this country has focused on the problem–but has not offered much concrete guidance for parents about how to avoid having your children end up in the ER in the first place. These ideas may be helpful to you, your child, or a friend or relative facing mental health issues.
Next up: policy changes to help address the mental health crisis.
Resources: Anxiety, eating disorders, suicide hotlines
NAMI Mass (a great resource!!) NAMI, the National Alliance on Mental Illness has many helpful links about how to respond to emergency mental health crises.
https://www.mcpap.com/ProgramsAndLevelOfCare/MobileCrisisIntervention
Respite programs:
https://www.childwelfare.gov/topics/preventing/prevention-programs/respite/
National Suicide Prevention Lifeline: 1-800-273-8255 The National Suicide Prevention Lifeline is a network of local crisis centers that are available 24/7 to provide support for youth and adults who are in any kind of emotional crisis.
The Trevor Project – 1-866-488-7386 The Trevor Project is a 24/7 crisis intervention and suicide prevention hotline for LGBTQ youth.
SafeLink: 1-877-785-2020 SafeLink is for anyone who is being affected by domestic violence or dating violence.
National Runaway Safeline:1-800-786-2929 The National Runaway Safeline helps youth who have run away, are thinking about running away, or who already ran away but are ready to come home. Parents and guardians can also contact the hotline if they are worried about their child running away or if their child has already left home.
Eating disorders
MEDA or Medainc.org is the Massachusetts Eating Disorders Association website, which includes a list of providers who specialize in eating disorders. They also have other resources listed.
Renfrew Center has a good book list on their website with ED resources.
Life without Ed by Jenni Schaeffer.
And for parents:
Help Your Teen Beat an Eating Disorder by James Lock and Daniel LaGrange
Anxiety and Panic:
ADAA: Anxiety and Depression Association of America
Lawrence Cohen, The Opposite of Worry.
This blog may be helpful to both children and parents experiencing panic and/or anxiety:
https://www.lundberghealthadvocates.com/panic-and-covid-overcoming-stress-in-stressful-times/
Medical Disclaimer:
The suggestions given here are not intended as a substitute for the medical advice of your physician, psychiatrist or psychologist. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention. For additional questions, please call your healthcare provider for reliable, up-to-date information on testing and symptom management of all medical concerns.
