In the spring of 2013, a 15-year-old girl was taken by her parents to the emergency room of Boston Children’s Hospital on a wet Thursday evening. She had bruises on both of her wrists from self-harm and a previous suicide attempt, and she had told her physician earlier that day that she intended to try again.
“However, I must be forthright with you about what is likely to transpire,” the doctor said. The most appropriate environment for troubled teenagers was not a hospital, but rather an inpatient treatment facility, where individual and group therapy could be delivered in a more tranquil and communal atmosphere, allowing the youngsters to be stabilised and eased back into their normal lives. The doctor, on the other hand, said that there were no vacancies in any of the treatment institutions in the area.
The child and her family accepted the fact that they would have to spend the night at the emergency department as she waited. However, it took almost a month before an inpatient bed became available.
A “psycho-safe” area at the emergency department was where the girl spent the first week of her wait, which is why she is only being recognised by her middle initial, G, to preserve her privacy. Any device that may be used to cause damage has been removed from the premises. Teens before her have done things like search the internet for methods to commit suicide or ask a buddy to bring in a sharp item, so she was barred from using technology in order to protect her from doing things like that. Her door was left open 24 hours a day, seven days a week so that she could be watched.
Adolescents are seeing an increase in mental health disorders: Teenagers reported experiencing a severe depressive episode in 13 percent of cases in 2019, a 60 percent rise from 2007 figures. According to the Centers for Disease Control and Prevention, suicide rates had remained steady from 2000 to 2007, but had increased by over 60 percent by 2018.
G’s narrative depicts one of the most dramatic expressions of the issue to yet. Across the nation, hospital emergency rooms have been converted into boarding facilities for youths who are deemed a danger to themselves or others to be allowed to return home. They have nowhere else to turn since, even as the problem has become worse, the medical system has been unable to keep up, and the number of choices for inpatient and intense outpatient psychiatric care has been drastically reduced in recent years.
According to the most recent federal government survey, the number of residential treatment institutions for persons under the age of 18 decreased to 592 in 2020 from 848 in 2012, representing a 30 percent decrease. The reduction is partially due to well-intentioned policy reforms that were implemented without anticipating a spike in mental-health issues. According to experts, social-distancing restrictions and labour shortages during the epidemic have resulted in the closure of further treatment institutions and beds.
When that is not an option, emergency rooms have stepped in to fill the void. The findings of a recent survey of 88 paediatric hospitals throughout the nation revealed that 87 of them routinely board children and adolescents in the emergency room overnight. Every day, on average, four boarders were admitted to a single hospital, with an average stay of 48 hours.
This method is in direct conflict with the Joint Commission’s suggested best practises, which are developed by a nonprofit organisation that assists in the formulation of national health-care policy. According to the guideline, adolescents who present to the emergency department for mental health concerns should not be kept there for more than four hours, since a lengthy stay might jeopardise patient safety, cause treatment to be delayed, and take resources away from other urgent care situations.
Nonetheless, in 2021, the average adolescent boarding in the emergency department at Boston Children’s Hospital spent nine days waiting for an inpatient bed, an increase from three and a half days in 2019. In the same year, the average wait at Children’s Hospital Colorado in Aurora was eight days, and the average wait at Connecticut Children’s Medical Center in Hartford was six days.