'No place for a child': Minnesotans languish in ERs while awaiting mental health services

Alison Yocom sobbed uncontrollably as she stumbled and collapsed on the living room floor of her south Minneapolis home.

For 10 days, Yocom had pleaded with hospital staff to admit her 17-year-old son to a psychiatric unit where he could receive treatment for his suicidal depression and anxiety. But for 10 days, she watched in frustration as he languished on a metal gurney in a windowless room of a hospital emergency room, where his condition worsened to the point that he threatened to kill himself.

Exasperated, Yocom wondered if he would ever receive the psychiatric care he needed.

"I kept asking myself, 'Am I bad mom for taking him to the emergency room?'" Yocom said. "He was getting sicker and sicker with each passing day."

Scores of Minnesota children and adolescents with mental health problems are suffering in hospital emergency rooms for days or even weeks because they have nowhere to go for more intensive care. Parents of children as young as 7 or 8 describe agonizing waits in emergency departments that are not equipped to treat people with serious mental illness and where prolonged stays can be traumatic. In some cases, even the emergency rooms are full, and children experiencing mental health crises are being consigned to stretchers or chairs in crowded ER hallways.

The practice of keeping psychiatric patients in emergency departments while they await hospital beds — known as "boarding" — has existed for decades, but hospital administrators and child psychologists say it has reached a crisis point amid rising levels of anxiety, depression and other stresses brought on by the coronavirus pandemic.

Many ER departments across the state are seeing a surge in mental health-related admissions among children, as disorders that were left untreated over the past year are now boiling over as kids return to school and attempt to re-establish routines and social connections. Mental Health Minnesota, a nonprofit advocacy group, said the number of children under age 18 screened online for mental health problems soared last year to 7,882 screenings, up from 1,664 in 2019.

"The water was already high, and now the dam has broken," said Kristen Wiik, manager for neuropsychology and the Child and Adolescent Psychiatry Clinic at Hennepin Healthcare.

At Minneapolis-based M Health Fairview, one of the state's largest health systems with 10 hospitals, emergency room visits by children and adolescents in mental health crisis have surged 18% this year over pre-COVID levels.

On any given day, as many as 20 children are boarding in its hospital emergency departments or pediatric units while awaiting inpatient beds where they can receive more intensive care. Most children are discharged within days, though one child on the autism spectrum recently had to wait eight months for a bed at a residential treatment center, officials said.

Hospital systems like M Health Fairview have begun deploying multidisciplinary teams of psychologists, counselors and social workers to help children boarded in ERs, but demand can be overwhelming for emergency departments already stretched thin by COVID-19 patients.

"This is unprecedented," said Dr. Allison Holt, physician chief for mental health and addiction for M Health Fairview, which recently launched an internal task force to address the boarding issue. "Whenever you have 20 kids waiting in an emergency department for more than a couple of hours, that's a crisis."

When a crisis hits, many desperate families grapple with the wrenching choice of whether to bring their children to a hospital ER for help, where the indefinite waits for beds amid the often-chaotic atmosphere can aggravate their symptoms. The experience can be so traumatizing that some parents simply give up and bring their children back home after waiting days for a spot to open up in a psychiatric unit or residential treatment center.

"These kids don't know what's happening," said Todd Archbold, chief executive of PrairieCare, which operates a 71-bed child psychiatric hospital in Brooklyn Park. "They might literally be in a different state of mind and suddenly they are in a scary place. ... Oftentimes, it's equally traumatic for parents."

Parents and mental health advocates have expressed concern that prolonged boarding in hospital ERs could have lasting consequences by discouraging young people with mental illnesses from seeking treatment.

Karen Malka, a schoolteacher from St. Louis Park, said her 16-year-old daughter endured a 74-hour wait for treatment in a hospital ER after she became severely depressed and suicidal. While being boarded, the girl heard a male patient yelling profanities and saw another man, who appeared intoxicated, emerge from his ER room naked from the waist down.

"I worry that, if a child's very first experience with the mental health system is traumatic, then will they never go back?" Malka said. "Will they ever seek help again?"

At first, Yocom thought staffers at the University of Minnesota Medical Center in Minneapolis were exaggerating when they said her son might have to stay in the emergency room for a week or more before an inpatient psychiatric bed became available.

The thought of spending even a few days confined to the ER seemed unthinkable to Yocom and her son, George, who has struggled with anxiety and depression since he was a toddler.

That March afternoon, George had written a suicide note and had cut himself so severely that he still was bleeding when they arrived at the ER. Yocom looked around George's mostly bare room in the ER — and the narrow gurney — and feared that her son's condition would deteriorate.

On his first night there, George awoke to the sound of a woman wailing and repeatedly yelling from the room next door, Yocom said. To help their son feel less isolated, Yocom and George's father took turns playing card games and watching over him from a plastic chair next to his gurney. But at times, their visits were disrupted by adults on the ER unit who were experiencing mental health crises. Once, George and his mother watched in shock as security guards chased a panicked patient through the hallways, she said.

"The atmosphere was not therapeutic for a child who was already suffering," said Yocom, a vendor risk analyst at Target Corp.

On the 10th day of George's stay, Yocom broke down and screamed at a doctor on the emergency room floor, threatening to sue if they didn't find a bed for her son. The next day, he was admitted to the hospital's inpatient psychiatric unit where he received one-on-one and group therapy.

To Yocom, the ordeal underscores the striking lack of parity between mental and physical care in the medical system.

"Can you imagine a child sitting in a hospital ER with a broken arm or pneumonia without getting treated? That would be unconscionable," she said. "But a child who is suicidal is left alone — day after day."

Stephanie and Zach Nichols said they never imagined their 8-year-old son, Ronan would be stuck in a hospital ER for a week. Ronan suffers from a complex behavioral disorder that can lead to wild mood swings and severe aggression. During his rages, he has punched holes through the drywall of their Fridley home and turned coat hangers and other items into improvised weapons.

"We love this kid, but his disorder is so severe that it sometimes escalates beyond what we are capable of dealing with safely," his mother said.

Early this month, an ambulance rushed Ronan to an emergency room in Minneapolis after he threatened to kill his sister and attempted to push his mother down the stairs, she said. What followed was a blur of frantic efforts to find their son a psychiatric bed — including calls to facilities as far away as Austin and Duluth — while Ronan sat on a mattress on the floor of a small ER room with bare walls, they said. The Nichols brought in his beloved stuffed animal, a panda, to help ease his anxiety. He was not allowed to go outside, they said.

"It was no place for a child," said Zach Nichols, who works at a creative advertising agency. "The [ER] room felt like a minimum-security prison cell."

Eight days would pass before the Nichols learned that a bed became available at an intensive treatment center for children. Now, they are eagerly preparing for their son's return. This week, they began painting a Star Wars mural in his bedroom to make it more calming.

"We know he's been through a nightmare," said his mother, a schoolteacher. "He needs to know that he's back in a safe and loving environment."

Chris Serres • 612-673-4308

Twitter: @chrisserres