Sultan: The kids needlessly stuck in hospitals

There’s simply nowhere else for them to go. The ongoing pandemic has caused mental health crises among the young to skyrocket. An increasing number of these children and adolescents are admitted to an emergency room where they are assessed and stabilized.

And then they wait.

A child at St. Louis Children’s Hospital has been waiting for somewhere to go for nearly six months, according to Trish Lollo, president of the hospital.

“This is something that is not only a Children’s (Hospital) issue. This is a national crisis that we are going to have to contend with immediately,” Lollo said. She was one of four St. Louis-area hospital presidents who wrote an open letter sounding the alarm about this catastrophe.

“On any given day our emergency department rooms are home to significant numbers of kids with mental health concerns, most of whom languish for days for access to a treatment facility. When we get to the point that there is no hope of transfer to an appropriate facility after holding these children for multiple days in our emergency department, we end up admitting them to a hospital room,” the letter said.

Imagine a child, who is already suffering from severe mental health problems, stuck in an emergency room department, which is not at all equipped to provide what they need, for days or weeks.

In some situations, the child needs a “step-down” alternative from a hospital, like an intensive outpatient program. Or the child needs a therapeutic bed in a residential facility that can provide treatment in a social setting or a foster home placement, but nothing is available in the state. In other cases, the parents or caregivers may refuse to bring a child back home after a child is stabilized because they believe the child will again become a danger to themselves or others.

“This has been a particularly heartbreaking component of the crisis,” Lollo said.

While they are waiting in the ER, these children are known as “boarders.” There have always been a few cases like this, even prior to the pandemic, but now there may be up to 50 children boarding in ERs across the state during COVID surges, according to Dr. Kyle John, vice president for behavioral health at Mercy and child psychiatrist. Children who test positive for COVID must be quarantined in the hospital before another facility will accept them. There are fewer residential beds for children and adolescents available in the state than before the pandemic because some facilities have shut down.

John said Mercy has a child staying in the hospital who was transferred from a neighboring state. She is medically cleared to return, but the state won’t take her.

“The home state can’t find a shelter, foster placement or residential bed,” John said. The consequences of lingering in an ER or hospital bed for weeks can be devastating for patients, who may start to regress and act out.

It can also be dangerous for the staff who have to care for them.

“It’s a very challenging situation to keep our staff safe,” Lollo said.

Alyssa Harrell, a nurse and clinical instructor at SSM Health Cardinal Glennon Children’s Hospital, has seen the toll it takes on patients and nurses. A handful of times during the pandemic she had worked a full day shift, then came back from 3 to 7 a.m. to serve as a one-on-one behavioral health “sitter” for a child. They are expected to keep their eyes on the child and document the status every 15 minutes. It can be difficult for the patients to understand why they have to be constantly watched. Once that sitting shift is over, Harrell has had to work her day nursing shift.

Some of the kids who are hospitalized with behavioral health problems “are just wanting to be loved,” she said. “As a nurse, you are wanting to love on your patients, but we don’t always have the time to provide the love we want to give.”

Heather Dolce, spokeswoman for the Missouri Department of Social Service, said the Children’s Division is in the process of securing a 15-bed emergency shelter facility in Jefferson City to provide temporary housing for some of these children. She could not provide a date of when the shelter might open.

“Although there is no specific date that we can provide at this time, facility build-out and staffing efforts are well underway. We assure you that the Children’s Division has made moving forward with this as soon as possible a priority,” Dolce said, in an email.

It will take a multipronged effort to address a crisis that has been building for years. The state needs to pay a living wage to caregivers who would be staffing these additional beds in order to attract and retain workers. Additionally, there needs to be a financial incentive for hospitals and facilities to open additional pediatric behavioral health units.

Lollo said that when she thinks about trying to manage boarders in the hospital, she thinks about the societal costs of children they cannot admit who need care and the long-term impact on a boarding child’s ability to recover and thrive.

The child who has been waiting at their hospital for 160 days had previously stayed with them for an earlier long-term admission.

“He’s been with us almost an entire year in a hospital room,” she said.

Waiting for a place that will take him.