by William Van Ornum, Ph.D. on
Parents and those who work with children have long recognized the difficulty in gaining a bed for a child in a children’s psychiatric unit of a general hospital (these are rare), a large university or teaching hospital, or a specialized children’s psychiatric center. These kinds of placements are crucial when a child is psychotic, suicidal, violent, or otherwise out of control. The high level of staffing can help to keep the child safe and the intensive medical staffing can assist in the timely and appropriate use of medication, all the while monitoring for side effects. In the past, many children have been forced to wait until a bed is open.
The Boston Globe reports a paradox: there are open beds, but children who require them are not being admitted
“Meridith Viano, a Leicester mother, said she was told earlier this month that her 15-year-old son, who was hearing voices and not recognizing members of his own family, was “too acute’’ to be admitted to MetroWest Medical Center in Framingham, the closest hospital licensed to admit children and adolescents with mental health problems.
“She had taken him to the emergency room of UMass Memorial Medical Center in Worcester, and he ended up spending two nights in a locked area of the waiting room near the emergency department’s adult mental health section. UMass is not licensed to admit mental health patients younger than 16.
““So for two days he had to hear adults screaming and being detoxed. It was horrible.’’ Viano said. “I was with him and saying, ‘He really needs help.’ ’’
“Finally, on the third day, Lambert, the health advocate, said she called the Vianos’ insurance company and was able to speak to the company’s chief executive. Within 20 minutes, the Vianos were told that a bed suddenly opened up for the teen at MetroWest. He was treated there for two weeks and is now back at school. But Viano worries that her son’s two-night experience in the locked waiting room may make him less open to help in the future.
““My biggest fear is suicide, that . . . he will hide [symptoms] and kill himself,’’ she said.”
Many reasons are given for turning the children away. Some administrators point out that a bed in a double room may not be available due to the other child in the room being extremely psychotic or violent. Others point out lagging reimbursement rates from state and private insurers. Still others note that hospitals lose money on these kinds of beds, typically being reimbursed 75 cents for every dollar spent.
A spokesperson for the insurers responded.
Eric Linzer, speaking for the Massachusetts Association of Health Plans, which represents most insurers, said hospitals are expected to honor their contractual obligations for pediatric mental-health services, regardless of the reimbursement rate.
“We recognize there may be certain instances in which a provider refuses to take a child, in which case the health plan will work with the family to find a bed at an appropriate institution,’’ said Linzer.
He said soaring hospital costs, not inadequate payments from insurers, are the problem.
While these issues are discussed back and forth, the sad reality remains that there are not enough beds for children in Boston, a need that is pressing when a child is in the midst of a serious psychiatric illness.
The American Academy of Child and Adolescent Psychiatry offers an eleven-point checklist for parents to review when their child is being considered for admission to a psychiatric hospital.