NEW HAVEN, Conn. — For Christina Ferrante and her adolescent son Jaiden, the story began with a trip to the emergency room amid Jaiden’s persistent mental health and behavioral challenges and ended in a positive experience with a popular in-home treatment program.

In between was where things got messy.

First, Ferrante recalls, Jaiden spent five days in the emergency room waiting for a hospital bed, as she sat anxiously by his side, unsure how long the stay would last and desperately dialing anyone who might have advice or answers. He was eventually admitted to a psychiatric hospital, where he was treated for several days before receiving a referral for a program that he’d participated in before — but which had a wait list of several months.

Jaiden, who has autism, ultimately received the services he needed, but that time waiting — particularly those lonely days in the emergency room — still haunts his mother years later.

“It was a very long wait,” said Ferrante, who lives with Jaiden in Bristol. “It was not a big setting to have a child with behavioral needs in. Small, no structure, nothing that’s helpful.”

Throughout Connecticut, experiences like Jaiden’s have only become more common. Between June and September 2023, more than 1,000 children on Medicaid were “stuck” in the emergency room, meaning they remained there at least eight hours past when they no longer needed emergency treatment, according to data from the Connecticut Behavioral Health Partnership, a coalition of state agencies.

This typically happens, providers and advocates say because a child needs services — whether inpatient or outpatient — that are not currently available due to lack of capacity.

“If people could get the care they needed when they need it, you wouldn’t see so many kids stuck in the (emergency department),” said Sarah Eagan, the state’s child advocate. “People can’t get what they need, whatever it is.”

The issue, exacerbated by a pandemic-era spike in children’s mental health issues, has not meaningfully improved as COVID has receded, the data shows. Roughly as many kids were “stuck” in 2023 as during the previous two years, and the average length of stay for behavioral health emergency room visits has declined only slightly since the depths of the pandemic.

Since October 2020, the data shows, more than 2,000 kids on Medicaid spent at least four days in the emergency room for a behavioral health issue and more than 230 spent at least two weeks there.

State officials say continued investment in mental health programs will ease the problem, citing initiatives such as new urgent crisis centers and additional psychiatric beds at a major children’s hospital. Providers, though, fear the backlogs will endure — or even worsen — as they struggle to fund key services.

“There are too many kids that are needing a hospital,” said Victoria Stob, a professor of social work at Yale’s Child Study Center. “Post-pandemic, it’s been more difficult to stabilize kids.”

A lack of services

When kids act up or threaten self-harm beyond a level their parents can manage, they often wind up in the emergency room. When staff there can’t find anywhere else for them to go, they tend to stay there.

“The kids in the ED, there are at least two reasons,” said Howard Sovronsky, chief behavioral health officer at Connecticut Children’s, one of the state’s largest youth hospitals. “You’re either waiting for an in-patient bed somewhere, or there’s a disposition issue and they can’t safely go home.”

In other words, kids get “stuck” when there aren’t enough hospital beds or because they’re not stable enough to go home in the absence of proper outpatient services. This has been a particular problem since the start of the pandemic, which spurred rising depression, anxiety and other mental health issues nationwide — increasing the number of kids who landed in emergency rooms and stressing the programs meant to help them.

During the first half of 2023, fewer than a third of children on Medicaid were connected with services within a week of leaving the emergency department, and only half were connected with services within a month, per the Connecticut Behavioral Health Partnership.

Consider, for example, Intensive In-Home Child and Adolescent Psychiatric Services, or IICAPS, an in-home mental health service offered at 15 sites across the state, where Jaiden was referred after leaving the hospital. The program is a popular choice for families whose children have serious mental health needs that fall short of requiring in-patient psychiatric care.

“IICAPS was the experience that catapulted us into a lot of healing, a lot of recovery, a lot of understanding and a lot of support all around,” said one Middletown-area mother whose son participated in the program. “Three days a week, they were in our home, they gave us an hour a day, they got to witness things as they were.”

The problem? IICAPS currently has a wait list more than 500 children long — more than twice where it stood before the pandemic — and it can take families months to access it. Instead of leaving the emergency room and immediately entering a well-regarded treatment program, kids must wait until they’re stable enough to go home, then hope their issues remain manageable during an extensive wait.

Stob, who is director of model development for IICAPS statewide, says kids waiting for IICAPS or other programs often wind up back in the emergency room, taxing the health system without receiving the services they really need.

“Those families get disconnected from services for a period of time and then pop back up in the emergency room or in the hospital,” Stob said.

Increasingly, Stob says, providers have struggled to staff their IICAPS teams, in part because the Medicaid reimbursement rate for the program is insufficient to sustain it, even after a slight increase in 2023. In recent years, three IICAPS providers have shuttered their programs entirely, while a fourth cut its coverage area in half, Stob said.

Eagan, the state’s child advocate, said she often hears from providers that the mental health system is “collapsing.”

“If that stuck-kid data is not appreciably moving over four years, and our service systems is increasingly inaccessible and the state’s go-to service is fading out, then where are we?” she said. “It’s a disaster for families.”

Efforts at change

This lack of services for children facing mental health emergencies was one inspiration behind a package of legislation passed in 2022 aimed at addressing the broader kids mental health crisis.

Among many other measures, the bills established four urgent crisis centers spread across the state, designed as an alternative to the stress of emergency rooms. The centers opened last year — in Hartford, Waterbury, New Haven and New London — and have begun treating and stabilizing kids who might otherwise have languished at a hospital.

Michelle Yue, a Cheshire mother whose child has struggled with mental health issues, described the urgent crisis center at Wellmore Behavioral Health as a vast improvement on the stress and intimidation of an emergency room.

“You walk in and it’s quiet and welcoming, and you can hear birds chirping and nice music playing, and it’s just a completely different environment,” Yue said. “It’s not sterile or scary in any way.”

Elsewhere, other providers have similarly sought to bolster kids mental health treatment. In late January, Connecticut Children’s held a ribbon-cutting ceremony for a new 12-bed medical-psychiatric unit for children who require mental health support alongside their medical treatment.

The unit at Connecticut Children’s was partially funded with state money, and officials cited it as another example of efforts to fight the children’s mental health crisis.

“We made the biggest commitment to mental health, by far, in the history of the state, because it was needed,” Gov. Ned Lamont said.

In an interview, Dr. Deidre Gifford, executive director of the state’s Office of Health Strategy, said the state has made meaningful progress toward reducing emergency-room stays.

“I know that there are still issues, and they are cyclic, but the second half of 2023 was much better in terms of us hearing about it from providers because a lot of these (programs) really started to come to fruition in the past year,” she said.

Based on the data from the Connecticut Behavioral Health Partnership, it’s too early to say if the problem has truly begun to fade. The number of kids stuck in emergency rooms dipped from the second quarter to the third quarter last year, as it does most summers, but numbers from the final three months of 2023 are not yet available.

On one hand, it’s possible new state-funded programs will ease the stress on emergency departments. On the other, some behavioral health providers fear the state is starting to slip backwards in its efforts around kids mental health, amid budget cuts that have left the future in question for urgent crisis centers and other new initiatives, plus insufficient reimbursement rates for programs that rely on Medicaid.

At the ribbon-cutting for the new medical-psychiatric unit at Connecticut Children’s, Sovronsky said he was excited for the additional beds and optimistic about the difference they would make. Still, he warned against expecting one small unit to ease a problem dating back years or even decades.

“Hopefully it will relieve the pressure on the medical floors and allow us to take some of the kids from the ED,” Sovronsky said. “But you know, we only have 12 beds.”

© 2024 New Haven Register
Distributed by Tribune Content Agency, LLC

Read more stories like this one. Sign up for Disability Scoop's free email newsletter to get the latest developmental disability news sent straight to your inbox.