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Saturday, November 27, 2021

Children in crisis: ‘Bottlenecked’ mental health system leaves kids untreated

Providers say they’re seeing an increasing number of children with severe mental health issues

Originally published by Oregon Capital Chronicle. For more coverage related to Oregon state government, politics and policy, visit the Oregon Capital Chronicle website.

The pandemic has been especially challenging for Rainy Williams.

She’s a single mother with three children. Her middle child, an 8-year-old boy, was sexually abused in daycare as a toddler.

The resulting trauma left him needing medical care. A Polk County coordinator helps Williams arrange some treatment but when her son turns violent, she is on her own.

In September, he shattered a window, cut his lip, broke a glass lamp and hurled dishes at her. She said 9-1-1 refused to dispatch anyone to transport him to a hospital emergency room.

PART 2
EDITOR’S NOTE:This is the second of a four-part series on the problems facing children’s mental health care providers in Oregon. Deputy Editor Lynne Terry interviewed more than a dozen providers, parents and state officials and reviewed state records. For anyone needing immediate help, call the Lines for Life for youth at 877-968-8491 or seek help in a nearby emergency room.

The next day, with her son in another crisis, she took him to Good Samaritan Regional Medical Center in Corvallis. She needed the help of police to get him inside.

The hospital offered to keep him until a psychiatric treatment bed opened up. But he was already on two wait lists, and she couldn’t stay at the hospital with him as she would have liked. She had to tend to two other children, including a toddler.

So he came home.

Williams’ story is typical of families in Oregon struggling to get help for their mentally ill children. They end up in emergency care during a crisis but have trouble finding sustained, intensive care where their children could learn life skills to help them succeed.

A few days after the hospital visit, the 8-year-old tried to light himself and his mother on fire in her car. She got him to Salem Health’s emergency room where he stayed for 24 hours.

After he returned home, he attacked his mother again. That led to another overnight stay at the hospital.

While there, he threw a chair at a National Guard member on duty helping at the hospital.

Despite the outburst, Wiliams said, hospital staff did not provide an evaluator to assess his mental health state and they did not give him any medication.

She took him home and now waits for an opening at a residential facility with the ability to treat her son’s mental condition.

In response to a request for comment, Salem Health released a statement saying it is dedicated to caring for young people in a mental health crisis.

“Salem Health’s attempts to refer patients to outside residential psychiatric treatment facilities are typically unsuccessful for the simple reason that these facilities are full,” the statement said. “This is a sad reality, and we often see the repercussions in the emergency room, where patients who can’t access to appropriate treatment in the community are forced to return in moments of crisis. We follow careful protocols of assessment, and will continue to treat patients in crisis, sometimes requiring ED stays of several days, until they are deemed safe to discharge. This however does not mean they are well, as that requires long-term treatment in an appropriate facility.”

At home, Williams worries when there will be another crisis.

“It’s hard knowing that what he’s needing is out there but toknock on doors and be told to wait is stressful,” Williams said. “I have two other kids and have to maintain safety at home. That puts a lot of pressure on me to make sure everyone is safe at all times.”

‘That’s no help at all’

Her experience is not uncommon, according to Sandy Bumpus, executive director of Oregon Family Support Network, a Salem organization that advocates for families.

“The system is currently bottlenecked because there’s nowhere to go,” Bumpus said.

Children without a psychiatric diagnosis in desperate need of help have difficulty getting into psychiatric residential care, and there’s also a six-month wait for intensive outpatient services.

“Even kids with a mental health diagnosis are struggling to get into services right now,” Bumpus said.

She knows from experience. She has a child with mental health issues. Bumpus couldn’t get help until her daughter had a plan to kill herself.

Since the pandemic hit more than a year ago, more children in Oregon need a high level of care, providers say, requiring more staff and 24-hour supervision.

Some large providers no longer take children with severe symptoms because they don’t have enough employees to care for them.

“In many cases, we are not able to accept the severe level of acuity that is coming to us,” said Miki Herman, interim CEO of Albertina Kerr in Portland, which has a group home and a psychiatric residential facility for children. “There are no options for these families and the kids to get the care that they need.”

Providers also have seen an increased need for addiction treatment.

Herman said Albertina Kerr has temporarily shut five group homes for developmentally and intellectually disabled children that it couldn’t staff.

Some mental health facilities have closed for good.

Yes House in Corvallis, which treated about 25 children with addiction issues, shut down in June, and in September, Kairos Northwest, based in Grants Pass, closed its youth psychiatric residential treatment programs, which cared for about 15 kids.

Another residential facility, Rimrock Trails in Prineville, which is licensed for 24 teenagers struggling with addiction and mental health problems, is temporarily closed while looking for employees.

Graphic illustrating Children's residential behavioral health care

State data show that Oregon has just over 255 licensed residential beds for children with mental health issues but about 150 are being used. The data include one facility which is temporarily closed due to staffing.

The state has another 129 licensed beds for residential substance abuse treatment for children. Just over 70 are being used.

One facility, Jasper Mountain’s Crystal Creek east of Springfield, which opened last December, is now temporarily closed for lack of staffing. It is licensed for 15 beds for behavioral health treatment but never served more than nine, said Beau Garner, Jasper Mountain’s executive director.

“In March and April, the applications for people who want to do this work dried up,” Garner said. “That was our first hint that we might be facing a staffing crisis.”

More losses because of closures or shortage of staff will be devastating, providers and state officials say.

“Any beds closing, any programs closing, even the reduction in capacity could impact the entire continuum of care from community-based providers to the emergency department,” said Chelsea Holcomb, the Oregon Health Authority’s child and family behavioral health director.

Children's Farm Home
Self-portraits in the cafeteria at the Children’s Farm Home run by Trillium Family Services in Corvallis. (Amanda Loman/Oregon Capital Chronicle)

The lack of bedsand out-patient servicesnot only keep children from getting the care they need but it hurts them in another way: They end up stuck at the wrong level of care.

“What happens when kids stay too long is that they begin to experience a degree of hopelessness that causes increasing behavioral outbursts and challenges, or depression, which becomes a syndrome in and of itself and is very hard to treat,” said Dr. Ajit Jetmalani, director of child and adolescent psychiatry education at Oregon Health & Science University.

Despair can lead to self harm, a problem that’s plagued the Weirich family.

Angela Weirich said her family moved from Oregon to Pennsylvania after years of trying to get her daughter the right treatment. Her daughter would try to kill herself, be taken to Salem Health emergency room, and then released home after a few hours, Weirich said.

“We had to fight and advocate for them to put a referral in for a residential treatment so that she could go and she can get stabilized,” Weirich said.

The family wanted her to be in group therapy and a safe environment.

She was admitted to two Portland-area facilities but kept relapsing, trying again to kill herself.

“She just progressively got worse,” Weirich said.

Exasperated, Weirich gave up on Oregon.


PART 1: CHILDREN IN CRISIS:Mental health, addiction care falling short for distressed children

NEXT IN PART 3:The chronic workforce shortage for mental health facilities for children worsened after the pandemic hit, making it difficult to staff facilities.

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