Pediatric Mental Illness Crisis: Barriers to Pediatric Mental Health Services in Our Current EMS System

Imagine you are a pediatrician working in an emergency department when a young female patient who was recently diagnosed as bipolar is brought in by her mother. She is visibly angry upon arrival, and her mother looks tired and distressed. When you enter the room, the young girl begins the interaction with foul language. She not only threatens to hit you and the hospital staff but actually succeeds. Her mother sits quietly in the back of the room and does not say a word. Security is called into the room for the safety of the patient and the health staff. She begins to yell, kick and spit as security places her in restraints. Soon, she is given a shot of haloperidal, a powerful antipsychotic medication. In a few short minutes, she zones out. She is only 9 years old.

white profile of a child with a red heart over the headAcross the hall is a young teenager who wants to take his own life. Although he is a straight-A, honor roll student at a prestigious school and a skilled athlete who helped his team to the lacrosse state championship, he is overwhelmed by sadness and feels as if he is drowning. He has already come up with a plan for how to end his life. His parents are visibly distraught, tears welling up in their eyes.

These are two very real types of encounters I have had with children and their families when they came to the emergency department for care. Unfortunately in both cases, because there were no local psychiatric beds available within the region, they were forced to remain in the emergency department for days on end without access to the specialized mental health services each of them required.

As a pediatric emergency doctor in Maryland, this is an all too common occurrence when trying to give the best possible care to patients. As such, it’s an issue that warrants urgent attention in our state.

Emergency department overcrowding threatens access to medical services for patients who need care the most. Patients who need mental health services usually require a significant amount of resources and stretch our capacity to accommodate their unique needs while balancing the flow of new patients coming in. The high-stimulation environment of the emergency department is also not conducive to healing or calming patients in mental duress.

So what can we do to fix this problem and ensure timely and age-appropriate access to mental health services for patients in our state? One place to start is to establish more pediatric psychiatric inpatient beds within the Baltimore metro region.

Children with mental illness eventually become adults with mental illness. The costs of leaving their mental health needs unaddressed in childhood have dire ripple effects on society, the health care system and their own potential to live long, healthy and fulfilling lives. If we address mental illness early in life by strengthening the pediatric workforce and providing more resources to emergency departments through inpatient units specialized for children, we will start to take meaningful action to improve the lives of children in our state. This, in turn, will help improve the health of our community and our children.

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