UPDATE: The boy got an inpatient psychiatric bed at Cambridge Hospital the night of March 1. That was the 36th day he had boarded at Boston Children's Hospital while waiting for an inpatient placement.
On Jan. 24, an 8-year-old boy from Jamaica Plain was brought to the emergency department at Boston Children's Hospital. He was in mental health crisis and had just had an outburst at home.
Karin Broadhurst became the boy's foster mother when he was 4. She adopted him a couple of years later. Broadhurst knew he'd been abused and neglected before he was in her care. He has post-traumatic stress disorder, she said, and sometimes acts out dangerously or aggressively.
On the night in question, he reached for her medication.
"He was on top of my bed, and he picked up my med organizer. And he threw it as hard as he could onto the floor, and it burst open," Broadhurst recalled. "It has a lock, but it's not super heavy-duty. I think it's intended for old people, not for children with mental health issues. So it burst open and my medications flew all over the room. ... He began to try to grab the medications and threaten to swallow them. And I had to physically hold onto him until the police arrived."
Broadhurst, a single mother, said because of her son's trauma history, he goes into "fight or flight mode."
"And he is feeling out of control," she said. "I don't think that he had any intention to kill himself. I think he just was ... trying to do something that he knew would be really bad and upsetting."
Broadhurst said she sometimes has no choice but to call 911 in order to safely transport her son to the hospital.
When they got to Children's, doctors wanted to admit the child. But there were no pediatric psychiatric beds available anywhere in Massachusetts. He spent five nights waiting, or "boarding" in the emergency department. Then he was moved to a regular medical floor. As of Feb. 26, he had been boarding at Children's for 33 days.
"If he [had an inpatient psychiatric bed], he would be in a unit with other kids similar in age," his mother said. "Those kids would have therapeutic activities and groups throughout the day. The psychiatrist who sees him would be making changes to his medication if warranted. He would be meeting with a clinician, and that clinician would be doing therapeutic work with him, making goals for him.
"Basically, he's just sitting in a room playing with Legos all day and watching TV and playing video games," she added.
Broadhurst said the daily check-in her son gets from a hospital psychiatrist or social worker essentially involves them asking him a handful of the same questions about whether he is feeling safe or having thoughts of hurting himself or others.
Dr. Patricia Ibeziako, associate chief for clinical services in the psychiatry department at Children's, said doctors do initiate and change treatments while patients are boarding — but the situation is far from ideal.
"What we really want to see is for children to be able to get the right care in the right setting at the right time. And boarding is not a reflection of people being in the right setting for the right care that they need," Ibeziako said. "Boarding affects children and adolescents with psychiatric illness significantly more than those with [physical] medical illness. And the problem has been worsened significantly during the pandemic."
At the end of this week there were 40 kids boarding at Children's while awaiting psychiatric beds — 16 of them boarding in the emergency department, the rest in medical rooms, Ibeziako 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 right now."Karin Broadhurst
According to the state's Executive Office of Health and Human Services (EOHHS), since June, boarding for psychiatric beds among children and adults has increased between 200% and 400% per month over the same months the previous year.
After a patient has been boarding for 60 hours, the case is escalated to the state Department of Mental Health, which has to try to locate a bed. For pediatric patients, it takes an average of four days to find one, an EOHHS spokesperson said.
Broadhurst's son has been waiting four weeks longer than that. Earlier this week, they celebrated his ninth birthday in the hospital. She says she wants state lawmakers and other 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 psych 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 right now."
The state Department of Mental Health said it's working with providers to bring more psychiatric beds on line 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 reimbursement rate increases. Boston Children's Hospital said it's adding 12 inpatient psychiatric beds at its Waltham facility this fall. It currently has 16 at its Boston hospital and 12 short-term acute residential treatment beds in Waltham.
Providers say it's hard to know what kind of a dent the new beds will make because the full extent of the boarding problem isn't clear.
"There's no real comprehensive data source out there about the full scope of the boarding problem," said Amara Azubuike, director of behavioral health policy and advocacy in the government relations department at Children's. "We don't have the full number on how many children are boarding, where they're boarding, what level of care they need and how many beds are actually in operation at a point in time."
Legislation was recently filed on Beacon Hill to create an online portal that would track in real time how many kids are boarding at what hospitals, what their needs are, and how many beds are available at hospitals around the state, Azubuike said.
This article was originally published on February 26, 2021.
This segment aired on February 26, 2021.