The Register Citizen (Torrington, CT)
With kid psych beds full, mom says daughter had nowhere to go
Jessica Moran’s 10-yearold daughter communicates with the world through an iPad. She types the words, and it speaks for her.
“She’s very good at it, but it’s delayed and it’s difficult to maneuver because with her left hand ... she can’t really hold it by herself,” Moran said.
The other kids at school attempt to engage her in conversation, but the delay makes that difficult.
“The kids are like, ‘What do I do? I can’t communicate. I can’t be part of that,’ ” Moran said. “So she’s always very secluded.”
Moran’s daughter, whose name Hearst Connecticut Media Group is withholding due to her age and sensitive nature of her situation, was born with a traumatic brain injury. She was also diagnosed with cerebral palsy at about 6 months old when she wasn’t developing as expected, Moran said.
“She has, I believe it’s spastic quadriplegia,” Moran said. “So she definitely has difficulty with regulation. Her limbs, like her hands, kind of turn out. She’s ambulatory, which means she doesn’t walk without assistance. And she’s also nonverbal.”
Beyond her physical challenges, the 10-year-old is as intelligent as any other. But that means she is acutely aware that she is not like everyone else in her class.
“She’s not able to actually yell out and say, ‘I’m really mad, I don’t know how to handle this, I can’t get myself off of this crazy train that I’ve just entered,” Moran said. “The only way she knows how is to lash out, and that’s violence, tantrums, namecalling.”
Moran doesn’t know if her daughter’s cerebral palsy and emotional dysregulation are connected with the fetal brain injury.
“She identifies with an age at which she thinks is appropriate for her abilities,” Moran said. “So, I can’t walk, I crawl. I can’t talk, so I scream.”
The situation became untenable when she started acting out violently.
“She’s hurt other students,” Moran said.
Early in October, Moran said her daughter began physically lashing out. Curtains were pulled down in their Greenwich home. Dishes were smashed.
A few weeks later, Moran said she started hurting herself. A crisis hotline was called and the responding social worker advised Moran that her daughter needed immediate mental health care.
“I’ve never seen the self-harm before,” Moran said. “That’s when it really escalated.”
Moran’s daughter ended up in the emergency room at Greenwich Hospital, waiting for a bed in a pediatric psychiatric unit to be available.
There she remained, for more than two weeks.
‘The kids are sicker’
Moran is not alone. Though her child has some very specific needs, the case illustrates what one expert called the most important issue facing children’s hospitals around the nation: A pediatric mental health crisis the scale of which has never been seen.
“Pediatric behavioral health was a major problem before COVID — before the pandemic — but it has really exploded,” said Cynthia Sparer, executive director of Yale-New Haven Children’s Hospital.
The reason for the shortage in beds is due to the ongoing pediatric mental health crisis across the country, Sparer and other experts said.
“The resources at all levels of the system are under extreme stress,” sad Carl Schiessl, senior director of regulatory advocacy at the Connecticut Hospital Association. “The sad fact is, there’s way more demand for services than there are existing facilities in the state.”
Not only are there not nearly enough beds at in-patient psychiatric facilities to accommodate the need, but kids are showing more severe symptoms.
Sparer said it’s “a condition that we have, not only here in Connecticut, but actually across the nation.”
The situation is so dire nationwide that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association in October declared a national state of emergency in child and adolescent mental health.
According to those organizations, between March and October 2020, the percentage of emergency department visits for children with mental health emergencies rose by 24 percent for children ages 5 to 11 and 31 percent for children ages 12 to 17.
Sparer said the pandemic “has taken what was already a problem and exacerbated it tremendously.”
Yale has a total of 40 beds for kids in need of acute psychiatric care, according to Sparer.
“Those 40 beds are filled every day — filled,” she said.
It’s not just that there are more children in need of psychiatric care. “The kids are sicker,” Sparer said.
“It’s not only the numbers, but the numbers of children who are coming in with acute conditions — severe depression, suicidal either ideations or actual attempts,” she said. “Out of the total number of children being seen, fully 40 percent are moderate to high risk for suicide.”
Sparer said she’s worked in children’s hospitals since the 1980s. While the availability of mental health treatment for people of any age has always been a problem, “I’ve never, in all those years, seen it like this,” she said.
The pandemic put children through two difficult transitions. First, they were isolated from their schools and peers. Then, they went back to school.
“They haven’t been with their friends. They may not be adjusting,” Sparer said. “They may not feel like they’re fitting in.”
According to John Santopietro, senior vice president and physician—in—chief of Hartford HealthCare’s behavioral health network, the pandemic “has just been ruinous to mental health across the board.”
“We’re looking at an avalanche of mental health concerns over the next couple years,” he said. “It’s really an allhands-on-deck situation.”
Sparer said the problem is not going to resolve as society reverts to a new normal. “This is not a light switch, this isn’t going to just go away,” she said, using the example of eating disorders.
“Right now, we run seven, eight, nine children in the hospital on any given day with an eating disorder,” she said. “Eating disorders, one of the things about them is they’re long-term. Once a child is at risk, it’s not just the sort of thing, ‘Well here, take this prescription, and you’ll feel better in a week to 10 days.’ It sets them up for longterm needs, long-term therapy.”
‘No one will take her’
Greenwich Hospital, where Moran’s daughter was taken, does not have a pediatric psychiatric unit.
But the hospital is part of the Yale New Haven
Health network, and Sparer said they routinely send children in the midst of a mental health crisis to Yale New Haven Children’s Hospital in New Haven to get the care they need.
According to Moran, that hasn’t happened, perhaps because of her child’s very specific needs.
With nowhere to send her, Moran’s daughter came home and returned to school last week, “without any treatment, medication changes, or even a reentry plan from school,” her mom said.
Longer term, Moran believes her daughter needs inpatient treatment in a facility prepared to handle her specific challenges. She’s involved in a protracted mediation process with Greenwich Public Schools, in an attempt to have the district subsidize the out-of-district placement.
Stacey Heiligenthaler, chief officer of Special Education and Student Supports, declined to comment about Moran’s case, but said out-of-district placements do happen in general.
“Each individual child’s needs are evaluated by the Planning and Placement
Team and appropriate placement recommendations are made through that process,” she said in an emailed statement. “Out-of-district placements are part of the continuum of options that are considered when designing a program to meet individual students’ needs.”
In a letter Moran shared with Hearst Connecticut Media Group, a Yale Pediatric Specialty Center physician, Dr. David Feingold, informed the Greenwich school district that he had been working with this patient for three years.
She has “openly expressed that she wants to be with ‘kids like her,’ and with children who communicate similarly to how she does,” Feingold wrote in the letter.
But Moran worries that her daughter’s propensity to act out physically will make it even more difficult to place her in an appropriate setting.
“A lot of these places will come right out and they have said to me, ‘Our cohorts are calm and peace-loving children,” Moran said. “And, ‘We don’t want to go and add a child with violent behavior into the population.”