Children face delays in mental health care
Shortage of beds, facilities leading to record backups
The state's mental health system for children is clogged with some of its worst backups in years, leading to long emergency room waits and a record number of "stuck kids" who are deemed well enough to leave hospital units but have nowhere to go.
The logjam tends to worsen in late winter and spring, when mental illness often worsens. But it is particularly bad this year: in the latest count, state monitors found 156 stuck children at the end of February, some 50 percent more than the average number in recent years.
When the system backs up, patients can have long waits from start to end. They may have to wait in emergency rooms during full-blown psychiatric crises, because no hospital beds are available. They may end up as boarders, stuck for days or weeks in medical pediatric wards because they cannot get a bed in a psychiatric ward or hospital.
And then there are the classic stuck children, who are deemed well enough to leave psychiatric hospitals or units but cannot, for lack of outside treatment programs.
"There are more stuck kids in Massachusetts right now than there have ever been," said Lisa Lambert, interim director of the Parent/Professional Advocacy League, which advocates for children with mental illness.
Bottlenecks in psychiatric care for children have been a problem in Massachusetts and around the country for many years.
But the numbers and the concerns they evoked last peaked four or five years ago. The backups then abated, as state officials and care providers put programs into effect to keep the system flowing better and focused on the problem child by child.
But in recent weeks, the backups have "dramatically increased" again, said Dr. Joseph Gold of McLean Hospital, director of Community Child Psychiatry Services for Partners Healthcare.
The number of children needing psychiatric hospitalization has grown by 8 percent in the last two years, but that is not enough to explain the recent spike in stuck children, said Joan Mikula, assistant commissioner of child and adolescent services for the state Department of Mental Health.
State officials and care providers are trying hard to understand what is going wrong and how to fix it, she said.
"We're parsing data nine ways to Sunday, trying to really understand who these children are and what's happening," Mikula said.
Last week, the managed-care company that provides mental health care for the state's Medicaid population issued an alert to all its care providers that children's beds were getting exceedingly tight.
The company, the Massachusetts Behavioral Health Partnership, told them that its protocols for times of scarce beds were taking effect and asked them to consider bed-freeing measures such as moving older adolescents into adult wards when appropriate.
"For the past four or five years, we haven't needed to be in this mode of kicking in our protocols," said Anne Pelletier Parker, who oversees management of the Partnership's provider network. "We're doing everything we can to make sure it doesn't become a trend or a long-term situation."
To solve the problem, she said, children must be moved through the system more quickly after they are stabilized.
Children in state custody seem to constitute the core of the stuck children problem: Of the 156, 120 are under the auspices of the Department of Social Services, and 20 more are under the Department of Mental Health.
Oftentimes, Mikula said, the problem is that children who do not live with their families and must be discharged to intensive foster care, where they can be served well, face months of waiting for such homes .
This time, the backup seems especially bad in emergency rooms, said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents private psychiatric hospitals.
The backup fluctuates, he said, but at times, "you can call all 15 hospitals" that can accommodate children with mental illness, "and nobody's got a bed -- 'We're full. We're full.' "
At Children's Hospital Boston, the backup does not seem nearly as bad as several years ago, in part because it is using new support techniques to help even suicidal patients go home from the emergency room, said Elizabeth Wharff, director of the hospital's emergency psychiatry service.
Last month, Mary Ann Tufts of Plymouth found herself facing such backups as she tried to help her 16-year-old daughter, who has bipolar disorder.
Her daughter started to unravel on a Saturday, and spent that afternoon through Monday afternoon on a gurney in a hallway of the Jordan Hospital emergency room, Tufts said.
A psychiatric bed was finally found in Waltham, she said; the only problem was that it was in an adult eating disorders unit, and her daughter does not have an eating disorder.
At week's end, the teenager was moved to an appropriate bed at McLean Hospital, thanks largely, Tufts believes, to high-placed contacts she made as parent coordinator of the Parent Information Network, which helps parents of children with mental illness.
It ended well, but the experience appalled her.
"I don't think children and adolescents, many of them traumatized, need to spend days in an emergency room where they're seeing blood and drunks and drug addicts," she said. "Is it a failure of the system? Absolutely."
Carey Goldberg can be reached at goldberg@globe.com. 