Children who lash out at homes and shelters are increasingly being dropped off at M Health Fairview Masonic Children’s Hospital, prompting the creation of a makeshift shelter in an ambulance garage.
While hospitals have always been a place of last resort for children in emotional or behavioral crises, Fairview leaders said counties and social service providers are using their pediatric emergency room at an unprecedented rate. Normally expecting one or two such cases per month, the Minneapolis children’s hospital has seen 145 children since September, most staying about 15 days and one 97 days.
Hospitals are already overwhelmed by children suffering from heightened anxiety, depression and other mental health issues who need hospital care amid the pandemic. Some of the children housed in the ambulance bay fall into that category: They need mental health evaluations and are waiting for open inpatient psychiatric beds. The rest have long-standing behavioral disorders or developmental disabilities, such as autism, but no acute medical problems that need to be treated in the hospital.
“They’re not appropriate for admission. They don’t have medical concerns … but we still can’t safely discharge them because there’s no place to discharge them,” said Lew Zeidner, director of clinical triage and transition services at M Health. Fairview, which operates the University of Minnesota’s West Bank pediatric hospital. “They are too vulnerable to just put them out on the street.”
The result was on display Monday afternoon as eight children sat and watched “Zootopia” in the large ambulance space on concrete floors and narrow garage door windows for natural light. Other children were too unstable to join the group and were kept in separate rooms. Beds lined one wall of the garage along with recliners pulled from hospital rooms.
Violent outbursts or incidents draw alerts from staff on a daily basis. Half of children over the age of 10 are homeless. Most have personalized supervision around the clock and are cared for by nurses and psychiatric assistants.
Many of the children have traumatic histories and attachment issues, which go unresolved when exasperated parents or providers drop them off at the hospital, said Stacy Rivers, clinical manager at M Health Fairview with a supervisory role for the makeshift transition unit.
The classic case “is a child who is no longer a child and is 12, 14, 16 years old, big, now aggressive, with chronic destructive thoughts or behaviors,” he said.
State and county mental health officials described a chain of problems that have ultimately befallen Masonic and other hospitals. They mostly stem from staffing shortages and financial difficulties that have reduced the capacity of Minnesota’s residential treatment programs and other locations that are more therapeutic for children than hospitals.
The number of licensed children’s residential facilities in the state has decreased from 122 in early 2019 to 106 in early 2022, according to the Minnesota Department of Human Services. That total includes detention centers and shelters, as well as psychiatric residential treatment centers. Capacity has shrunk at an even faster rate, meaning fewer beds are being used by existing providers.
The pandemic and related school closures and stay-at-home restrictions have triggered new mental health crises in some children and made it harder to manage others with long-standing behavior problems, said Cynthia Slowiak, manager of human services for troubled children. Hennepin County Mental and Behavioral Health. disorders The county is responsible for a fifth of the 145 children who have been hospitalized at the U hospital since September, according to M Health Fairview.
“Oftentimes, families were left alone to deal with challenges that already existed if their youth had pre-COVID mental health needs,” she said. “But a lot of families were also being asked for the first time to respond to things that were coming from left field in terms of their son. They weren’t ready for it.”
The correct solutions?
Expansion of hospital psychiatric capacity for children could help. Children’s Minnesota is set to open a 22-bed inpatient psychiatric unit on its St. Paul campus this fall and has asked the Legislature to grant a moratorium waiver for hospital expansion. PrairieCare received legislative permission last year to add 30 inpatient beds to its children’s psychiatric hospital in Brooklyn Park.
Bipartisan support for other child mental health solutions has emerged. Governor Tim Walz visited Edison High School in Minneapolis on Wednesday to advocate for using some of the state’s budget surplus to expand school-based mental health and crisis prevention services. State Senator Rich Draheim, R-Madison Lake, has garnered support for legislation expand a range of child mental health services and ensure providers have enough trained staff.
Fairview leaders said many of the solutions address the minority of children in temporary shelter who need mental health care, but that the counties and the state must also address the problem of children with behavioral problems left in the shelters. emergency room doors despite their lack of medical needs.
The Minnesota Department of Human Services first responded to the crisis situation at Masonic in November, diverting $2.5 million in state emergency funds to psychiatric residential treatment facilities to prevent the loss of more beds and staff and expand capacity. . Another $360,000 paid state staff to work with families and social service providers to fix the problems that led to children’s removal from their homes or placement in the first place.
“It’s very sad that our children, who really don’t need to be hospitalized, have to be there,” said Neerja Singh, acting director of the DHS Division of Behavioral Health.
However, the support hasn’t eased problems at Masonic, which turned the ambulance bay into a temporary shelter late last month due to rising demand.
Rivers defended the use of the garage as a temporary shelter. Confining children for weeks in crowded, isolated emergency rooms can add to their agitation. By comparison, the ambulance bay is spacious and allows for group scheduling and more supervision.
The hospital provides psychiatric support for the children and also contacts their families to see if any family issues can be addressed so they can be discharged. It’s a “point of pride” when some of the toughest kids are no longer aggressive and even make improvements despite unusual living conditions, she said.
“In a few days or maybe weeks, we don’t see [emergency] codes or problems,” he said, “and they’re talking about their feelings and making connections with family members they refused to talk to when they first arrived.
Correction:
An earlier version of this story misrepresented Children’s Minnesota’s expansion plan.
