The avalanche of ER visits for children and teens suffering mental health crises amid the pandemic has exposed families to an awful truth: Too few hospital beds are available in North Texas for those who need inpatient help.
Already facing the indescribable terror that they might lose their child, parents hit the brick-wall realization that the medical institution’s response is vastly different from its triage of traditional illnesses.
Mental health advocate Vanita Halliburton, whose nonprofit has long focused on opening doors to resources, finds the shortage of beds maddening — and another stigma on these brain conditions.
“If you have a serious, life-threatening condition, you get help,” she said. “That’s what a suicidal crisis is, a life-threatening condition, and one that is treatable, just like diabetes or a broken leg.”
A recent Centers for Disease Control and Prevention report put data behind the drumbeat of stories Halliburton has heard for the past year. From April through October, the proportion of mental-health issues among all pediatric ER visits increased and remained high.
For children 5 to 11, visits increased 24% over the same months in 2019; the spike was 31% for teens 12 to 17. Girls were significantly more likely to experience these emergencies, but visits increased for boys as well.
Perhaps parents simply avoided ERs for their kids’ other medical problems, but studies document the bombshell of stressors that the pandemic has set off in young people.
In the best of times, adolescents deal with some amount of anxiety and depression over how they fit into the world and what the future holds. Now they are doing that dance amid isolation and widespread social inequities.
When a parent recognizes a mental health crisis, the family nearly always heads immediately to the closest emergency room. That’s wise because someone who has articulated suicidal thoughts can act on those feelings in a heartbeat.
Once stabilized and evaluated, the patient might be allowed to return home with a treatment plan. Other times, the young person needs inpatient care and ends up “boarding” in the ER, remaining in a bed there for days until space is found elsewhere.
Local experts told me that psychiatric beds, especially for teens and children, have long been in short supply: Part of this nationwide problem is the dearth of child psychiatrists, a field that people traditionally haven’t clamored to get into.
Adequate reimbursement for the cost of the care delivered is another roadblock. The safety protocols imposed by the pandemic have only added to the shortage.
Take Children’s Health, the gold standard for pediatric care in North Texas. The hospital allocates only a dozen beds to mental health cases and those go to kids with other serious medical conditions.
That’s why a vital part of the Grant Halliburton Foundation’s free navigation line is to provide advice on immediate action to keep children safe and to provide options for inpatient needs.
“I want to first rule out that safety is an issue,” said Blanca Garcia, director of mental health resources at the foundation. “We can then have conversations about other services, if it’s not a level red.”
A mother’s call to the navigation line earlier that day illustrated Garcia’s point. Her 10th-grader, who occasionally has revealed thoughts of suicide in recent years, was in distress about recent aptitude testing.
“That opened the floodgates and talk of suicidal thoughts came again,” Garcia said. The mother told the Halliburton navigator, “I don’t know how bad this is. I don’t know how much she’s telling me and not telling me.”
The foundation connected the mother with a behavioral health facility available to do an immediate assessment.
Most important is that first step: A parent summoning the courage to look a child in the eye and ask unthinkable questions:
Do you feel bad enough that you want to die? Have you thought about how you might do it or when you might do it? Even answers such as “people would be better off if I wasn’t even here” are red flags.
Have you given up hope that life will get better? A discernible aura of hopelessness and helplessness is among the most serious warning signs.
“If the answer to any of those questions raises concerns, that’s when you say, ‘Let’s go get in the car and get you some help,’” Halliburton said.
If only it got easier from there.
The brain is an organ, and, no different than the lungs and stomach, things can go wrong in it. But we are still a long way from the medical community treating mental illness like it does physical maladies.
No one in North Texas has worked harder to change that attitude than Dr. Madhukar Trivedi, director of the Center for Depression Research and Clinical Care at UT Southwestern Medical Center.
Dr. Trivedi spends much of his time advising parents of children with suicide-risk symptoms. “There aren’t enough beds, there aren’t enough intensive outpatient programs,” he said. “We’ll never have enough psych doctors. We’ll never catch up.”
That’s why Dr. Trivedi has focused on making mental health treatment more accessible and creating tools that help pediatricians and primary care doctors accurately assess and treat these conditions.
Some cases will be so complex that, despite every effort, inpatient care is the only answer, he said. But too often “we wait until these teens get to that point to even start thinking about the need for anything.”
Dr. Trivedi believes that if children were screened early and accurately, only those most severe cases would need a specialist. He compares the approach to the evolution of diabetes treatment, which 20 years ago was seldom done in primary care, but now is almost always handled that way.
“We are just so afraid of psychiatry,” he said.
Like Dr. Trivedi, Sue Schell, vice president and clinical director of behavioral health at Children’s Health, told me that the best solution is “going upstream” to help children.
“When a child comes to our ER as a result of a suicide risk or a behavioral health issue, they haven’t just started experiencing that,” she said. “That child has been suffering for quite some time.”
Rather than build new facilities or add beds, Schell said, Children’s recently added two freestanding operations into its care network, Haven Behavioral Hospital in Frisco and Perimeter Behavioral Hospital of Dallas, located in Garland.
Children’s also is integrating mental health care into the community through two state-funded programs.
The Child Psychiatric Access Network allows pediatricians and primary care providers to consult at no charge with a psychiatrist on a particular patient. Texas Children’s Health Access Through Telemedicine allows Schell’s team to operate virtually on 100 local school campuses.
“It’s all about providing help to children long before they might need hospitalization,” Schell said. “That leaves more resources specialists available for the complex cases.”
Lifelines of support
Here For Texas Mental Health Navigation Line: Grant Halliburton Foundation initiative that connects North Texans with mental-health resources customized to each caller at 972-525-8181 or go to HereForTexas.com
National Suicide Prevention Lifeline: 24-hour crisis hotline at 1-800-273-8255. Confidential online chat is available at suicidepreventionlifeline.org
Crisis Text Line: 24-hour support by texting HOME to 741741. More information at crisistextline.org
North Texas Behavioral Health Authority: 24-hour crisis hotline at 1-866-260-8000 or go to ntbha.org
Suicide and Crisis Center of North Texas: Speak to a trained counselor on the 24-hour hotline at 214-828-1000 or 800-273-8255 or go to sccenter.org
Dallas Metrocare Services: For help, call 1-877-283-2121 or go to metrocareservices.org
