Children Psychiatric Cases Double in ERs
Children's outcry puts ERs to test
Psychiatric cases double as parents recall Columbine; can facilities handle
burden
By Samantha Marshall Crain's New York Business
New York City emergency rooms are seeing an alarming spike in the number of
visits by mentally troubled children as desperate parents turn to them as a last
resort.
At two of the largest health care centers, Children's Hospital of New
York-Presbyterian and Bellevue Hospital, the number of psychiatric emergencies
among children has more than doubled in the last several years. At Children's
Hospital, psychiatric emergencies among children have an even higher rate of
admission than medical emergencies.
"Psychiatric emergencies in children have reached epidemic proportions," says
Dr. Meredith Sonnett, associate director of pediatric emergency medicine at
Children's Hospital. That institution saw the number of emergency room visits by
pediatric psychiatry patients jump to about 800 in the past year, from around
200 in 1994, with much of the increase coming in the past two years.
More children are showing up in ERs for a combination of reasons. Hospitals are
seeing some patients who cannot find treatment elsewhere, either in the state's
overburdened outpatient clinics or with private doctors. Also, parents are more
concerned about their children's mental health, especially after the April 1999
Columbine High School shooting.
This increased vigilance isn't a bad thing. Until recently, many conditions,
such as bipolar disorder and schizophrenia, weren't diagnosed until early
adulthood. If parents and teachers understand the symptoms, children can get
help sooner.
But the big increase is adding to the burden on the city's emergency rooms,
which are already strained. New York City ER visits increased almost 12% in the
decade between 1990 and 2000, the last year for which figures are available.
Anecdotally, hospitals say ER visits have increased more sharply over the last
two years.
Also, psychiatrists are worried that mentally disturbed children aren't getting
the care they need in emergency rooms. Few hospitals in the area have units
dedicated to pediatric emergencies, let alone wards tailored for child
psychiatric cases.
Disturbed children, with symptoms including uncontrollable tantrums, biting and
hallucinations, have to wait several hours as medical emergencies take
precedence. Surrounded by the blood and chaos of a typical ER, they are also
often in close proximity to psychotic adult patients.
"We do our best, but these are far from ideal settings for these kids," says Dr.
Raul Silva, deputy director of child psychiatry at New York University and
Bellevue Hospital Centers, who treats child patients in Bellevue Hospital's ER.
No single illness dominates the trend, leading doctors to believe that they're
seeing cases that formerly were being handled elsewhere in the system. Because
of parents' concerns, problems that once would have sent children to their room
or the principal's office are being treated as pathological.
Nebulous categories
"Whether there is truly an increase in mental illness in general, I don't
know," says Dr. Sonnett. "But people are much more acutely aware that kids have
issues."
Schools have also been referring students for behavior that might have once got
them detentions. Off-the-cuff remarks, like an upset child declaring he's going
to kill himself, are no longer being ignored, even when the child is just
seeking attention.
"You can't get away with a kid making a comment like that in public these days,"
says Dr. Sonnett. Many of the children being brought into ERs for signs of
suicidal behavior actually fall into the nebulous category of suffering from
mood disturbance, such as attention deficit disorder, she adds.
Not all of these cases belong in emergency rooms, or even in the health care
system. But emergency room doctors say they're seeing a large number of children
whose parents have run out of options elsewhere.
Welfare agencies are also dealing with increased caseloads of children who've
been abandoned or neglected as their parents struggle with job loss, drug
addiction and immigration problems.
Some community mental health centers, already struggling with staffing shortages
and inadequate funding, have been forced to turn those children away. The state
had set aside funds for children's mental health in 2000. But after the state's
bare-bones budget was passed late last year, a hiring freeze took effect.
"If there were adequate outpatient resources and ways to secure them, many of
these children may not have to come to the emergency department at all,"
comments Dr. Sonnett.
Even when families are insured, it's hard to find doctors who will take on
children with psychiatric complaints. Their illnesses are so time-consuming
they're difficult to treat within the managed care system, says Evelyn Roberts,
executive director of the National Alliance for Mental Illness' New York City
branch.
One mother, who prefers to remain anonymous to protect her 16-year-old bipolar
son from the social stigma of mental illness, says her child would never have
had to go through the added trauma of being in an emergency ward if he had been
receiving the outpatient care he needed. He recently became violent, punching
holes in walls and breaking his hands.
"By the time many of these cases get to us, they are train wrecks," says Dr.
Silva. Less severe cases, such as attention deficit disorder, are too
complicated to be treated effectively in an ER.
Trying to relieve pressure
Hospitals say they are trying to reorganize ERs better to handle the new
influx. Bellevue has just received a small grant for a team of physicians to
provide services in patients' home settings to prevent them from coming into the
ER. The hospital is also deploying doctors from other departments to help with
the ER overflow.
Children's Hospital has a separate area for child psychiatric patients and is
recommending that younger children be kept apart from teens as it studies the
differing needs of the two groups.
Some pediatric psychiatrists say they have been verbally petitioning the
government to mandate comprehensive psychiatric emergency programs for children,
as it has done for adult patients. Parity in child and adult emergency mental
health would guarantee a certain number of beds designated for pediatric
psychiatric patients and a minimum of 72 hours for evaluation.
Meanwhile, "anyone who ends up in ER is probably not getting the level of
psychiatric care they need," says Ms. Roberts.
Source: http://www.crainsny.com/article.cms?articleId=17044&a=f
This "Mental Health E-News" posting is a service of the New York Ass'n of
Psychiatric Rehabilitation Services,
a statewide coalition of people who use and/or provide community mental
health services
dedicated to improving services and social conditions for people with
psychiatric disabilities
by promoting their recovery, rehabilitation and rights.
To join our list, e-mail us your request and, where appropriate, the name of
your organization to NYAPRS@aol.com.
Save these dates!
September 10 - 13, 2002
NYAPRS 20th Annual Conference Celebration
'Now More Than Ever: Hope, Healing and Recovery'
at the Nevele Grande Resort, Ellenville New York
contact: Mary McLaughlin, NYAPRS
1 Columbia Place Albany, NY 12207
(518) 436-0008; fax: (518) 436-0044
