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Emergency Logjam Still Acute

May 6, 2007
Editorial By Courant

Eight years ago, a series of editorials in The Courant chronicled a breakdown in children's mental health services that had reached crisis proportions. Children with psychiatric, emotional and behavioral problems were stacked up in emergency rooms like cordwood because there was no appropriate place to send them for treatment. The promise of a network of community care that would keep children out of emergency rooms and long-term psychiatric institutions hadn't materialized.

Since then, many positive steps have been taken to alleviate that debilitating logjam and ensure that sick children get the care they need in a timely manner. Most notably, the state contracted last year with a Norfolk, Va., behavioral health management agency to handle its $200 million responsibility to children with behavioral health issues. The idea was to streamline treatment and avert crises before they reached the emergency room or expensive in-patient care.

So it is upsetting that a study by the Child Health and Development Institute of Connecticut shows the emergency room crisis still exists and may even be worse. In the period between 2001 and 2005, emergency room visits by children with psychiatric problems increased by 11 percent. Recently, the Connecticut Children's Medical Center reported that 17 of 23 emergency beds were filled with such children.

This is not to say that the innovations over the past several years have failed. There just aren't enough of them. While the number of children with diagnosable mental health problems hasn't changed - it's about one in five - more are being referred by schools and courts. Access to services has shrunk, particularly for Medicaid patients.

There's optimism that some additional measures will help. An important one is to expand mobile crisis intervention teams that could respond to mental health emergencies or be posted in hospital emergency rooms when necessary. The state Department of Children and Families is adding 29 enhanced care clinics designed to increase access. A proposal to provide an emergency overflow unit where children could go while awaiting psychiatric treatment would free hospital beds for children with physical emergencies.

Equally important is an increase in state payments to regional outpatient clinics. This would allow them to hire additional staff and reduce the waiting time for children in crisis to be seen. It can take weeks to get appointments, leaving acutely ill children in limbo when they might benefit from earlier intervention.

Legislators need not look further for reasons to support these initiatives than the sad story of Alexandra Clouse-Desmond, 18, who was beaten to death late last month after running away from a state psychiatric hospital. Ms. Clouse-Desmond and the four suspects in her grisly killing all had troubled histories in the state mental health system.

It's not possible to prevent all tragedies, but Connecticut can, and must, do better.