Tag Archives: psychiatric hospital

Unlock that door

May 22nd, 2017

My dad’s face got that look when all the locks clicked.  You know, that l-sure-didn’t-expect-this look.

We were there to see my then-12 year old son.  It was his 5th or 6th hospitalization so I had stopped noticing all the locks that had to be unlocked, then re-locked to let visitors in.  I was thinking about what to say, what I’d brought and had my fingers crossed that it would be a good visit.  When I saw my dad’s face, I knew I should have mentioned the locks.

It was the first time he’d visited an inpatient psychiatric unit.  I had gone each time my son was hospitalized, of course, and during the first two or three hospitalizations, my younger son had come along once or twice.  But now he was old enough to refuse and he dug in his heels. My mother had come before too, but this time she was under the weather and stayed home.  So, my dad volunteered.

In this state, there are only two ways that children get locked up.  Either they commit a crime or a doctor determines that they are a danger to themselves or someone else and need to be in an inpatient psychiatric setting.  Only those two settings are locked.

I got used to the routine of entering a psychiatric unit and leaving one.  Waiting for staff to deal with the locks, knowing they never let more than a few people inside at a time.  Once, when they were extra careful, I heard that a young teen had just run out of the unit when a large group was coming in for a visit.  She timed things right and made a run for it.  They were very careful after that.

It’s not easy for a child or teen to be admitted to an inpatient bed.  They have to meet the criteria of being a danger to themselves or a danger to someone else, your insurer has to agree and there has to be an available bed.  Young children, the same ages my son was during his first few hospitalizations, might hurt themselves (or try to) as well as act aggressively toward their parents or siblings.  Some teens, as they get older, may do more of one than the other.  The really terrifying part of it for a parent is that your child can have a nonstop focus on suicide or aggression that is so extreme or unrelenting that you feel you’ve tried everything and everything has failed.  You’ve failed.

It’s a big step to take a child’s liberty away.  They enter a structured, locked and contained setting in the hopes that treatment there will work.  Distractions are stripped away.  Your visits with your own child are limited.  You have to take it on faith that the treatment and setting are a good match for your child’s desperate needs.  Not all hospitals are the same, far from it.

Sometimes it’s the only way to keep a child safe.  Mothers have told me they’ve slept in front of their child’s bedroom door to make sure she doesn’t hurt herself during the night.  Fathers have told me they’ve kept their son in a separate part of the house, away from his siblings, till his aggression runs its course.  You can only do that for a short while or for a limited number of times.

But once a child or teen is in an inpatient bed, we are a lot more loosey goosey about the other end of their stay.  Some stays are short, maybe as short as three days.  Others are longer.  Pretty often, not a lot of attention is paid to discharge, to going home and back to school, until it’s staring you in the face. Those doors will unlock and your child will go home with you.

Sometimes children aren’t discharged until Monday even though they are ready to go home on Friday night or Saturday morning.  Some hospitals say they don’t discharge on the weekend while others say that if a child needs therapy, no one is open on Saturday or Sunday.  (Don’t they know it takes weeks – if you’re lucky – to get an appointment even if it’s urgent?) It really bothers me that we take that child’s liberty away for two more days, when they might be ready to be at home.  Lots of parents would also prefer discharge be on a non-work day and having two days before the pressure of school makes an impact can be a blessing.

Many kids are released without a decent plan.  They are released with a piece of paper, a prescription and few instructions.  Sometimes the prescription is for a medication that requires an insurance okay (also known as prior authorization), which is an additional obstacle.  Parents aren’t sure what to say to the school or what adequate aftercare should look like.  Pediatricians are often not kept in the loop and they are the medical professionals parents are used to relying on.  With a sketchy plan or none at all, you feel like you’re on your own.

There are memories that stay with you, good ones and awful ones.  Some are visual memories, like a beautiful beach on vacation or angry look from a teacher.  Some are scent memories like a turkey roasting at Thanksgiving or your mother’s perfume. They have the ability to take you back to a moment in your past.  The sound of the locks clicking shut on that hospital door is one of those for me.  When my dad gave me that we’re-not-in-Kansas-anymore look, I thought about how we throw our child’s safety, their liberty and our hopes and dreams for them all into the pot.  Then we make the best decision we can.

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Acute mental health care for kids: a mirage in Massachusetts?

November 11th, 2014

TiredIt’s that time of year again.  Oh wait, it’s actually several months too early.  The “seasonal crisis” around psychiatric beds for children and teens has shown up far earlier this year and with a vengeance.  According to the calendar, there should be at least a few beds available for the children and teens that need them.  A logjam like this is supposed to take place in the spring.

At my office, the phone and emails are nonstop.  Often, they spill over to the weekend.  A few days ago, we heard from a mom whose 14 year old son had swallowed a bottle of Tylenol. This was his third suicide attempt.  She rushed him to the emergency room and got medical treatment right away.  But once that was completed, he needed inpatient mental health care.  “You have to wait, his mother was told twice a day.  “There are no beds.”  She’s a smart and proactive parent and was trying every avenue to budge a system that told her there was nowhere to admit her son for treatment.   When she called us he’d been waiting for four days and counting.

We are not the only state grappling with this issue.  Last summer, the Sacramento Bee reported that hospitalizations for California children and teens had spiked 38% between 2007 and 2012.  Nationally, hospitalizations have also increased but at a slower pace than California.  Connecticut also reports an increase in children and teens coming to emergency rooms in psychiatric crisis.  Data from the state’s behavioral health partnership shows that the number of children and teens stuck in emergency rooms rose by 20 percent from 2012 to 2013.

When a child is put in either a medical (not psychiatric) bed or waits in the emergency room, it is referred to as “medical boarding” or just “boarding.” We are hearing a new term this year:  boarding at home.  Parents are told their child needs a hospital or other acute care bed (which means they are a danger to themselves or someone else) and then told the child will be “boarded at home.”  Unsurprisingly, parents worry both about that child and any brothers or sisters.  This happened to Kelly, a mother of an 11 year old boy,  Her son was aggressive, diagnosed with a mood disorder and had been hospitalized before.  She would have to find someone to care for her five other children if he waited days in the ER.  She agreed to “board” him at home and her worst fears were realized when he attacked his younger sister.  Charges of neglect were filed against her for failing to protect her daughter and she is angry and frustrated.  “I did everything that was recommended, she said.  “And now this.”

Spending days in an emergency room can make some young people’s problems worse.  They see other kids leave and wonder why they are still stuck there.  Some have parents who stay the whole time, while others don’t. Often the behavioral health rooms are stark and isolated, not intended for long stays.

Hannah, the mother of a 16 year old called us after she and her son had waited for a bed for seven days.  His diagnosis was complicated and he was a large teen (over 6 feet tall) so several hospitals had turned him down.  His behavior had escalated at school, with lots of yelling and becoming agitated.  She feared he would be arrested and stayed up all night watching over him before she brought him to be evaluated.  She was told that if she left him alone in the ER she would be charged with abandonment, so she stayed and worried about her terminally ill mother-in-law and how long her employer would be patient.

Hannah’s son was finally sent to a hospital out of state.  Sometimes, that is the only option for children with complicated diagnoses.  But families can’t always make that work, particularly if they don’t own a car, work two jobs or don’t speak English.

There is no true planning going on to fix inpatient care for kids in Massachusetts.  We have meetings, we talk, we share our war stories.  There are worries that more beds will close because the rates don’t cover costs.  There are reports that the kids who are admitted are more acute than they were five years ago and inpatient care might need to be redesigned to address that.  Some speculate that because we have put strong community based services in place we are seeing the unintended consequence of families and clinicians managing children in their homes and communities until the last possible second.  This means children have very acute needs when they come to the emergency room.

Whatever the reasons, the impact on families is enormous.  They often weigh two terrible options.  If they wait for days with their child, their other children suffer or they put their job at risk.  If they bring their child home, they might not be able to manage things and someone could be hurt.  Stephanie, a single mother of three, stayed in the ER by her son’s side last month for four days.  She was told that she couldn’t leave him.  Her mother stayed with her eight year daughter, who missed school.  Even though she called the school to say she was stuck at the hospital, they filed against her saying her daughter was truant.

No one seems to be responsible.

At my office, we are recommending that parents call their insurers directly and ask them for help.  We tell them to call their legislator and let them know we can’t fix this alone.  So far, the best we can do is support each other and advocate like there is no tomorrow.


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Don’t let it consume you

September 19th, 2013

file0002108422738When I was in the hospital I felt very alone, in need of comfort. I had asked myself many questions and I wondered if God was forgiving or if I was going to hell. I was in a lot of pain, physically and emotionally.

The staff didn’t understand my mental illness.  I think it was either because they didn’t try or (this is what I believe) they didn’t know how it felt. The staff was pretty ignorant and mostly, thought about their paychecks, as they informed me. I do realize now how hard it is to understand someone else, but it felt so self centered.

My peers and friends made me feel better because they would be there for me. They understood me and my illness. They were like me, in a way and that really helped.

I got most of my support from my peers and friends because we were all in the same boat: we all had a lot of the same problems and experiences. The only real help I got was from them. They were the ones who got me through.

My friends understood me because we had a lot in common with one another and we could talk to each other like trustworthy friends do. We all needed each other in this scary foreign place.

What I learned in the hospital was that life had meaning. God was with me and would guide me through. You can find friends where you don’t expect to. Life has twists and turns but that is what gives it purpose. Life is worth living, it is a gift and you can choose how you use it. When people say mean things to you, it doesn’t really matter. All that matters is what you think of healing yourself — just ignore them.  And don’t let it consume you.

I learned an important lesson about people who have mental illnesses, people like me or the people I met in the hospital. We are just like everyone else and can be the best friends you’ll ever find. We don’t deserve abuse or neglect. We deserve love and understanding. We have needs and they are SPECIAL needs.

Our guest blogger, JesseRou,  is a high school student who loves sports and wants to work with animals.  She feels close to her family and connected to her religion.  She writes about her anxiety and her experiences with the hope it will help other youth.

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