PROVIDENCE — When Emma Pendleton Bradley Hospital opened in 1931, it was the first psychiatric hospital in the US that was devoted exclusively to children and adolescents.
Ninety years later, it is still serving kids in crisis.
The hospital is named after Emma Bradley, who was born in 1879 and stricken with encephalitis when she was just 7 years old. The disease left her with developmental disabilities, epilepsy, and cerebral palsy. Psychiatry and neurology were not yet well-developed fields of medicine, hospitals were primarily for adults, and pediatric services were not readily available.
Her parents, George and Helen Bradley, conducted a worldwide search for a cure or treatment for their only child’s condition. But after 18 years of in-home care, Emma had not improved. In their wills, her parents requested that their Providence Estate be converted into a hospital for children. The trustees opted to establish the treatment center in a less-urban area and, in 1931, The Emma Pendleton Bradley Hospital was established.
Since then, the nation has come a long way in terms of pediatric medicine and services. But the COVID-19 pandemic took a toll on the mental health of children and adolescents, creating a clinical challenge that advocates say will take a long time to solve.
“We still have two pandemics going on. One is COVID-19 and the other is more of a behavioral health pandemic that dates back far before this virus,” Dr. Henry Sachs, president of Bradley Hospital, said in an interview. “We were busy before the pandemic. We’ve been busier since, seeing more kids, and they are younger.”
While the total number of emergency department visits for children declined across the country, data published by the Centers for Disease Control and Prevention shows that from April through October 2020, hospital emergency departments saw an increase in the share of total visits by kids for mental health needs. Compared with 2019, the proportion of mental health-related visits for children aged 5 to 11 and age 12 to 17 increased approximately 24 percent and 31 percent, respectively.
There aren’t any national numbers of suicide data for the year yet, but Sachs said more 9- to 12-year old kids are being hospitalized due to serious suicide attempts.
Dr. Karyn Horowitz, chief medical officer and director of outpatient psychiatry at Bradley, said she’s dedicated her career to trying to keep kids out of the hospital. The pandemic led them to serve more patients through telehealth visits, but doctors learned that remote care did not help all of their patients. It was difficult to communicate with younger children, especially those who struggled to verbalize their feelings, and in-person was still necessary for patients with autism and developmental disabilities.
While virtual learning helped decrease the spread of COVID-19 at first, it also stripped away structure for kids, and mandatory reporters of behavior, like teachers and school districts, could not report troubling issues. Horowitz said there’s “no question” that Rhode Island kids are getting left behind in accessing mental health help.
“We know that the mental health needs of children are a public health crisis right now,” she said. “We also don’t know what their parents are going through and how or if they’ll be able to support their kids.”
She added, “I’m not sure how — or what — coming out the other side looks like right now.”
Emergency department visits in Rhode Island among youth ages 10- to 17-years old related to suicidal thoughts and actions was approximately twice as high from March through June 2020 compared to that same time period in 2019. According to data provided by the state health department, 7.3 percent of youth emergency department visits from March to June 2020 were related to suicidal thoughts and actions, compared to 3.5 percent of visits from March to June 2019.
Bradley has 86 beds for kids awaiting psychiatric placement. The number of kids waiting for a space there increased 60 percent since last year. And the number of days the kids are spending has gone up 80 percent, said Sachs.
“The need has totally exploded, and it’s not changing anytime in the near future,” said Sachs. He said while Rhode Island may have more psychiatric beds per capita than any other state, it’s “nowhere near enough right now.”
He said that on any given day, about 24 to 35 adolescents from Rhode Island are waiting for beds. He said that does not include kids from nearby states who need treatment at Bradley. Most of them stay at Hasbro Children’s Hospital, which is also owned by Lifespan Corporation, in empty surgical beds that are dedicated to children waiting on psychiatric placement. But some hospitals, Sachs said, place some of these young patients in the emergency room, which isn’t designed for long-term or overnight stays. He said Bradley recently received a transfer patient, a child, from an unnamed hospital in a different state, who spent 46 days in the emergency department.
Complicating matters is the fact that some families are not able to access mental health services for their children, and others simply don’t believe their kids when they say they are feeling anxious or depressed.
“We hear a lot in schools that kids will say they tell their family members that [they are struggling] and their response is, ‘What do you have to be anxious or depressed about?’ They don’t believe them,” said Dr. Marge Paccione, director of clinical innovation at Bradley. “They are asking us to go tell their parents because they aren’t being believed. We’ve had a lot of that in our school programs, especially during the pandemic.”
Paccione said the answer to tackling the crisis isn’t more beds and in-patient services. She said it is critical to implement suicide prevention “everywhere, and immediately.”
“COVID-19 was very traumatizing for our children. It uprooted their structured schedules of school and extracurricular activities. So they were struggling to cope with the loss of their normal lives and then on top of that, they were lonely, isolated, and it worsened the grief,” said Mary Sullivan, Bradley’s chief nursing officer and grief expert.
Sullivan said that while children require a lot of strategies on how to reduce stress and increase resiliency, the long-term affects on their mental state from the past year is yet to be seen. She said researchers don’t have a full answer yet, but believes there will be consequences from a prolonged period of lock-down.
“There’s a second wave of the mental health crisis coming,” she said.
US Senator Jack Reed announced Wednesday that more than $11.4 million in federal funds allocated to Rhode Island will be used to bolster mental health and substance use disorder programs. However, it’s unclear how much of that will be dedicated primarily to children.
When Sachs was asked how much funding could be needed to deal with the mental health crisis in children and adolescents in Rhode Island, he sighed and said, “I have no idea. It would just be a lot.”
He added, “There will never be enough.”