No mercy in mental health system, even for children
Was ever a bait-and-switch more cruel than this?
There is so much to anger and appall us in the new Spotlight Team investigation into the grim consequences of state psychiatric hospital closings in Massachusetts. Decades ago, we were promised a humane, community-based system to replace the awful institutions where mentally ill people were warehoused and forgotten.
What we got is tragically far from humane. It’s not even a really a system. Instead, it’s a tangled mess of impossible choices.
The murders described in the Spotlight story represent the most dramatic consequences of inadequate treatment. But behind those shocking cases are legions of invisible stories: of men and women falling through giant cracks in the health care system, unable to get help for illnesses that cut short or lay waste to their lives; of mothers and fathers and brothers and daughters, with jobs and families to keep up, devoting their lives to fulfilling a duty that is the fundamental reason government exists — protecting the vulnerable.
We closed the institutions and shifted the burden of care to the very people least able to take it on. We ask people with serious mental illness to navigate a system that they are, by definition, unable to command. We put it on the people who love them — people already in worlds of pain — to somehow find a way over the insurance companies’ high hurdles and into criminally underfunded inpatient services. We set them up to fail, driving them to emergency rooms, courtrooms, prisons.
We have shown no mercy, even when the patients are children. South Shore Hospital in Weymouth, like so many hospitals, has been forced to pick up the slack, taking in people with mental illnesses that require intensive, around-the clock treatment — treatment the hospital is not equipped to give. Children have been stranded in the emergency department there for days or weeks, waiting for a miracle: a bed in a residential program that can make them better. One girl was recently stranded at the hospital for 52 days.
“At any age, it’s unconscionable to spend weeks awaiting care,” said Dr. Jason Tracy, the hospital’s chief of emergency medicine. “But it particularly hits us hard when we have a young child — 8, 9, 10 years old — spending weeks in a busy emergency department with no access to natural light.”
Tracy and his colleagues take this hard: They’ve spent years trying to do right by kids with mental illness, but in the end, they’re at the mercy of the system, just like the kids and their parents are. They can’t just order up treatment for mental illness the way they would for diabetes: Everything has to be approved by the insurance companies. Patients with good coverage get more options. Patients with poor or no insurance are out of luck. And no patient can be moved to a treatment center if there are no beds available there.
“I want to take care of these patients,” said chief of pediatrics Mark Waltzman. “I wouldn’t stand there and let a trauma patient bleed out without doing something. I feel like I am letting these patients down because I am not able to help them.”
Waltzman arrived for an ER shift a few weeks ago to find that nine of his 11 pediatric beds were taken by mental health patients. When we fail patients with mental illness, the whole system feels the strain. The ER is already scary enough for children. Being around other kids who are potentially violent, or who are crying out in pain while they’re being sutured, just multiplies the trauma for everybody.
Parents who bring their kids into the ER because they’ve threatened to harm themselves or others grow to regret their decisions when they’re stuck there for days or weeks.
“The system is failing all of us,” Waltzman said.
He worries that being trapped in an ER once will make parents more reluctant to seek help in other emergencies, preferring to take their chances at home.
“It rips my heart apart,” Waltzman said.
It’s bad enough that we do this to adults. These are children, for heaven’s sake.
We don’t warehouse people with mental illness any more. But it seems we’re as determined as ever to forget them.