Silence As Kids' Psych Beds Cut; What If Cancer Or Burn Beds?

The CDC has just released a report on the prevalence of mental illness among American children. It notes: "A total of 13%–20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to be increasing."

Yet as that prevalence increases, treatment options are decreasing, writes Lisa Lambert, executive director of the Parent/Professional Advocacy League, which advocates for Massachusetts families with mentally ill children. Below, she discusses one particular pending loss, of Cambridge Hospital children's psychiatric beds long especially valued by families. The hospital announced last month that it would consolidate two units with 27 beds into just one with 16 beds. It cited tight budgets, declining utilization and cyclical demand. The details are still in play.

By Lisa Lambert
Guest contributor

When Aiden was seven, it seemed like he would never be safe.

At home and in his second-grade classroom, he repeatedly talked about killing himself. He barely slept, raced from one spot to another and threatened to harm his younger sister. His parents stayed glued to his side, barely taking time to eat, shower or sleep.

One day, his mother caught him lighting a fire in his bedroom. Aiden ended up in the emergency room, and later in a bed in Cambridge Hospital. The staff had seen young patients like him before and they knew what treatment would work and what kind of follow-up care a seven-year-old needs. Without that hospital stay, his mother says, ”We don’t know where our family would be.”

No one likes the idea of admitting a young child to an inpatient psychiatric program. It is a last resort, something to be avoided at all costs. Parents will tell you, however, that when they’ve exhausted all the options, Cambridge Hospital has provided the best possible care. Now, it seems that a major piece of that care is coming to a close, unless a miracle happens.

Last week, the Department of Public Health held a hearing to receive comments about closing the Cambridge Hospital child psychiatric unit and eliminating beds. Nurses stood shoulder to shoulder to tell stories of families they’ve helped and of their pride in the wonderful care they’ve given. Parents came to say that this place was a lifesaver and without it, their children would never have improved.

The Child Assessment Unit is one of a kind, they all said, where parents can visit anytime and even stay overnight. Since PPAL is a grassroots organization, we surveyed families about this and want their voices to be part of the public conversation.

Three years ago, there were 310 inpatient beds for children and teens in Massachusetts. Today there are 252. If those 11 beds at Cambridge Hospital close, that number will be even smaller.

Each spring there is a surge in children with mental health crises and each spring there are waits of hours, even days, for the beds we do have. One mother reported that her very unsafe daughter spent “several days in a locked local emergency room” last fall and again this spring waiting for a bed to become available. Others tell stories of how their child was sent two hours away for inpatient treatment and worry this will become more common.

What they aren’t saying, but needs to be clearly pointed out, is that an additional burden will fall on families who are already overtaxed. Families whose children have mental health needs already have enormous responsibility for their child’s safety and care. When they cannot find a needed hospital bed, parents run a hospital-unit-for-one in their home at great cost to themselves and their other children.

'What would people say or do if they were closing a pediatric cancer center or burn unit? Isn’t anyone outraged that pediatric psychiatric beds are being closed?'

As one parent pointed out, closing beds has a “major long-term impact on the immediate family, the community and society as a whole. We have to stop removing help while we pile responsibility and blame on the families.”

And then there’s the lack of parity for mental health. Besides their worries about shrinking services, nearly all parents felt this trend in closing beds was a form of discrimination. One wrote, “What would people say or do if they were closing a pediatric cancer center or burn unit? Isn’t anyone outraged that pediatric psychiatric beds are being closed?”

It’s well documented that medical beds for children are filled throughout the year, while psychiatric beds are in demand in the winter and spring and often empty in the summer. But inpatient care is not like a product from Apple or the Gap that doesn’t sell well. If this care becomes scarce, children with suicidal or risk-taking behavior can’t find a substitute product.

Everyone agrees we should find a way to provide good care to children who need inpatient care. And we all seem to agree that Cambridge Hospital has long provided that care because of their dedicated staff and wonderful, innovative practices.

Massachusetts is the place where the telephone, chocolate chip cookie and zipcar were all invented. It seems like we have the ingenuity and dedication to create a solution. Many parents sure hope so.[Posted by Carey Goldberg]