Preventing tragedy

The state must increase its commitment to treating mentally ill adolescents

The state is flush with extra revenues. The governor wants to enact a tax cut. In the past few years, politicians such as House Speaker Tom Finneran, Governor Paul Cellucci, and former governor Bill Weld have done a remarkable job convincing the public that everyone is making it in Massachusetts -- and that we don't have to spend extra money on social issues.

Problem is, they're wrong. One example is the state of mental-health services for children in Massachusetts.

One year ago, Massachusetts Department of Mental Health commissioner Marylou Sudders made headlines when an internal memo she wrote was leaked to the media, warning that the demand for psychiatric beds for minors with acute mental illness had reached "near crisis proportions." Despite a flurry of media attention to the issue, things have only gotten worse (see "Disorderly Conduct," News and Features, July 7).

Emergency-room physicians and pediatricians in virtually every Massachusetts hospital treat more and more troubled children -- kids who put their pets in microwaves, attempt suicide, and threaten their parents with weapons. Since 1996, Boston Medical Center has witnessed a 55 percent increase in the number of these children: 60 child psychiatric patients per month. Most stay in the emergency room for hours, long after other patients have left, because no one is on hand to treat them. Half of them are transported to the general pediatric ward, where they wait as long as 10 days for an open bed in a psychiatric ward. While waiting, psychiatric patients displace others with chronic diseases such as leukemia, diabetes, and asthma. This, in turn, disrupts hospital operations and stretches staff resources. Such settings, meanwhile, are inappropriate for child psychiatric patients -- they're frequently seen by pediatricians who may be adept at treating physical ailments, but not mental illnesses. Most are watched round-the-clock by guards to ensure against escape and self-inflicted injury; sometimes, violent kids are restrained.

Even when troubled children get into psychiatric facilities, the problem doesn't end. Though they receive much-needed short-term therapy in a psychiatric hospital, there's no guarantee that these patients will get proper follow-up treatment when they leave. There aren't nearly enough aftercare programs to treat those in acute hospitals who have stabilized and can move into long-term outpatient facilities. So they remain in hospitals, taking valuable beds from others in crisis. State statistics show that 82 kids were "stuck" as of this past May, compared to just 16 kids in May 1998. The irony in all this -- as Fred Stoddard, a child psychiatrist at Mass General Hospital, points out -- is that the field of psychiatry has advanced to the point where doctors can provide real help to disturbed youngsters. Yet this help can't be provided "at the scale we need to" because resources simply aren't available.

This should inspire a sense of urgency among all state officials. Until now, though, the state DMH has been something of a lone voice when it comes to solutions. This year, Sudders and her staff lobbied successfully for a $10 million fiscal 2001 budget item to open 80 new beds at residential homes across the state, thereby moving more stuck kids into aftercare. But that money will do little to effect systemic change. There is only enough staff, for instance, to open 56 of these 80 new beds.

Long-term solutions are required. The state DMH needs money to expand prevention services so troubled children don't have to resort to emergency rooms in the first place. It must increase staff size and clinical capacity at aftercare facilities. And, finally, it must improve coordination among state agencies, insurers, and providers. These solutions cost money. Getting it will mean shifting budget priorities to fund what Sudders calls "the front-door and back-door services."

Right now, mental-health care for children and adolescents isn't a priority because we don't see the problem. But we'd be wise to heed the warnings of those who do. "The situation is scary," says Walter Harrison, a pediatrician at North Shore Medical Center. "I don't want to see another Columbine in Massachusetts."

What do you think? Send an e-mail to letters[a]phx.com.