A Looming Crisis

Summary

The pediatric mental health crisis is exacerbating extended emergency department stays for children due to limited inpatient psychiatric services. This article explores the depth of this crisis, highlighting the strain on emergency departments, the impact on young patients, and the urgent need for solutions. The need for increased resources and improved access to mental healthcare is paramount to address this growing concern.

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** Main Story**

Let’s talk about something that’s keeping me up at night, and probably you too if you’re working in healthcare: the kids. Specifically, the growing mental health crisis in our emergency rooms. It’s not just busy; it’s an absolute bottleneck, and young people are bearing the brunt of it. We’re seeing an alarming number of children and adolescents showing up in ERs needing serious mental health support, only to face incredibly long waits for inpatient psychiatric care. They call it ‘boarding,’ and it’s a problem, a really big problem.

Frankly, it’s a national emergency, and several professional organizations declared just that back in 2021. You see, it’s not like these problems suddenly appeared; issues were already there, but, factors like increased awareness, the aftermath of COVID-19 – remember how isolating that was? – and just the general pressure cooker of modern life have all piled on, creating this massive surge in demand. And the system simply isn’t equipped to handle it.

What Does ‘Boarding’ Really Mean?

So, what does ‘boarding’ actually look like? Imagine a child, in the midst of a mental health crisis, stuck in an emergency department for days, maybe even weeks. They’re waiting for a bed to open up in a psychiatric facility. Think about that. An ER is hardly the right environment for someone needing that kind of support, right? It’s loud, it’s chaotic, and it’s definitely not designed for long-term mental health care. And this is happening because we just don’t have enough inpatient psychiatric beds for our kids. And as you can imagine, it’s not doing them any favors. It’s actually making things worse. Being stuck in that kind of environment can amplify their existing mental health conditions. It can increase the risk of self-harm, cause behavior to escalate, and generally be a traumatic experience for both them and their families.

The Human Cost

The consequences of this situation are devastating. Think about the families, watching their children suffer in these inappropriate settings. They endure, immense stress, and anxiety, as their children struggle in unsuitable environments. Honestly, it’s heartbreaking. I saw a family the other day who had been in the waiting room for nearly 72 hours, just waiting for some news. The mother was in tears, and the kid was just… withdrawn. It’s a scene that sticks with you. Healthcare professionals are also under immense pressure, dealing with heavy workloads and the moral distress of knowing that they can’t provide the level of care these kids truly need, which can contribute to burnout and staffing shortages.

This all places an undeniable strain on the healthcare system. Emergency departments are already over crowded. Boarding contributes to these delays in care for other patients, and increases costs for hospitals. I think we’re all feeling the pressure, in one way or another.

What Can We Do?

So, how do we even begin to tackle this? It’s going to take a multifaceted approach, there’s no simple fix.

• Increased Funding: First and foremost, we need more money pumped into child and adolescent mental health services, which is crucial to expand the availability of inpatient psychiatric beds.
• Community-Based Programs: We need to invest more into community-based mental health programs, which is a great way to provide early intervention and prevent crises from escalating to the point of requiring emergency care.
• Telepsychiatry: Improving access to telepsychiatry can make a difference, along with other innovative models of care, which can bridge the gap in services and provide a life line for those in remote areas.
• Coordination: What about coordination between healthcare systems and community resources? It’s essential to ensure smooth transitions for patients from emergency departments to appropriate levels of care.

The Joint Commission recommends boarding time frames not exceeding 4 hours. That said, due to the current demand, boarding times are highly heterogeneous, and the average boarding durations range from 5 to 41 hours in EDs and 2 to 3 days for inpatient medical units. It’s a far cry from what’s considered safe and effective. Among youth awaiting inpatient psychiatric care, up to 58% were boarded in a pediatric hospital setting. These numbers speak volumes.

The state of pediatric mental health is a very serious issue, and without immediate and consistent action to address this crisis, the consequences will continue to escalate. It isn’t a problem that will solve itself. The time for action is now! We need to ensure that our children receive the care they deserve and protect the future of our communities. I think its the least we can do, don’t you?