I am extremely saddened, although unfortunately not surprised, to read the recent article highlighting the failure to meet the needs of children across Maryland. As a child psychiatrist and as president and CEO of Sheppard Pratt — Maryland’s largest nonprofit provider of behavioral health services, including those provided to children and adolescents — I have too often seen the negative clinical consequences of policy choices that have led to the underfunding of our behavioral health system and a lack of needed programs and services to help our youth.
Mental health effects of the pandemic have heightened distress in young children and teens and worsened the current behavioral health crisis to the point where families have nowhere else to turn except hospital emergency departments — a care setting no one believes is in the best interest of our youth.
Solutions do exist, however, if we prioritize our kids and their mental health and choose to invest in much-needed programs and services. We need to address barriers to care and re-imagine how children and families access mental health services across a comprehensive continuum of care. For children and adolescents suffering from severe psychiatric illness, a long stay within the emergency department is being driven by the lack of available and clinically appropriate psychiatric beds at hospitals such as Sheppard Pratt.
These young people with severe autism, early onset psychosis, or at high risk of self-harm need access to tertiary care at specialized inpatient units. For youths with acute presentations who do not have severe psychiatric illness, we need a statewide solution of hospital diversion programs, including crisis services, intensive outpatient and partial hospital programs.
For those able to get help and move beyond the crisis, the challenge frequently becomes finding a community placement, such as a residential treatment center, or RTC. During the past few years, most RTCs have closed. These types of providers have been similarly affected by youths with more severe illnesses or behavioral problems seeking care and by policy choices made over the years, including those that resulted in chronic underfunding. For those in foster care or the criminal justice system, these extended delays can be even longer, with waits in processing approvals taking days, weeks, or even months.
It doesn’t have to be this way. There are short- and long-term solutions that can be implemented to build a better behavioral health system for Maryland’s children, to meet their needs, and set them up for success in the future.
These solutions include:
- Establishing a statewide care coordination center to lead an efficient process to help young children and teens access appropriate levels of care within Maryland’s behavioral health system. This center would reduce the number of patients stuck in emergency departments and inpatient medical/surgical beds. State agencies would be accountable for their actions through reporting of case progress (or lack thereof) directly to the governor or delegated to the health secretary.
- Providing additional funds to residential treatment centers and other providers to ensure that children and adolescents can successfully transition back into the community after an acute episode has been addressed. This includes building specific programs that do not currently exist in Maryland and often lead to youths being sent out of state.
- Reviewing regulatory barriers that hinder hospitals and behavioral health providers when they try to move patients between levels of care based on clinical needs, allow them to advise appropriate agencies rather than wait at length to get agency approvals.
- Investing in specialized community-based programs to care for complex patients outside of the hospital. This includes programs that support the entire family and allow respite for exhausted parents and guardians.
- Investing in early childhood interventions and preventing exposure to adverse childhood experiences.
- Empowering pediatricians to manage more routine mental health issues and ensuring that insurance companies have adequate provider panels with timely access to psychiatrists and therapists when a referral is needed.
- Establishing a commission to study mental and behavioral health in Maryland, similar to what the Kirwan Commission did for public education, which would require both a legislative charge as well as budgetary authority.
Comprehensive solutions do exist, and we are at a critical junction where we must safeguard the mental health of our youths.
As a parent, my heart breaks seeing what families are experiencing daily. As a physician leader, I know that we can do better. We owe it to our children to do all we can to protect and care for them.
Harsh K. Trivedi, MD, MBA, is president and CEO of Sheppard Pratt and co-author of “Practical Child and Adolescent Psychiatry for Pediatrics and Primary Care.”