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Facilities for
children experience bed shortage
(October
2006 Issue)
By Pamela Berard
Psychiatric facilities for children are experiencing a shortage
of beds nationwide, forcing children who need mental health treatment
to board in general hospitals while awaiting the care they need.
Bradley Hospital, a psychiatric hospital for children in East Providence,
R.I., is licensed for 60 beds but was granted a state variance this
spring to exceed capacity for approximately one year to take care
of the growing need.
Gregory K. Fritz, M.D., medical director of Bradley Hospital, says
the hospital has experienced such a space crunch for at least four
years.
"Each year the problem has grown," he says, noting that it's a
seasonal problem, typically worse during the school year with January,
February and March the busiest months.
When beds for children and adolescents are full, children are often
hospitalized on the pediatric ward at Hasbro Children's Hospital
until a bed opens up. "They are called 'boarders,'" Fritz says,
noting that Bradley does everything it can to avoid hospitalizing
psychiatric patients on the pediatric ward. Fritz recalls one day
when nine children were boarders. "I think in the spring we averaged
three or four (per day)," he says.
Dawn Picotte, M.D., chief of child and adolescent treatment units
at Butler Hospital, a psychiatric hospital in Providence, says Butler
has had as many as 10 to 12 boarders at Hasbro.
She says the situation fluctuates and is unpredictable, but "Last
winter seemed to be the worst of my 10 years of experience here
at Butler."
Fritz, who is also director of child and family psychiatry at Hasbro
Children's Hospital and professor and director of child and adolescent
psychiatry in the Brown Medical School, attributes the problem to
a number of factors, including the lack of outpatient and lower
level care available to children and adolescents. For example, because
there are not enough outpatient services for children to deal with
minor problems, the children do not get treatment, the problem worsens
and more children require admittance into a psychiatric facility.
Fritz says he believes poor financial incentives make it difficult
to provide outpatient care. "We do have an outpatient program (at
Bradley), and until recently it's lost money," he said. "Now we
barely break even."
"There's no continuum of care for children and adolescents," Picotte
says. "There are very few day programs, very few outpatient programs.
"I think it's a complex problem."
Picotte says she also believes there's "a greater recognition of
mental illness among children and adolescents," prompting more children
receiving services.
Bradley is planning to build a new hospital building, designed
for more flexible use and with new space for outpatient and preventative
programs.
Fritz also cites the need to increase the number of child psychiatrists.
Recruiting them is the top priority of the national organization,
American Academy of Child and Adolescent Psychiatry. Fritz is chairing
a 10-year recruitment effort for the organization, which has been
underway for a few years. He says the number of new child psychiatrists
has remained flat over the years, but the population has grown,
so the gap is widening.
"There is a national need for mental health professionals … child
psychiatry is the medical specialty most needed. That's nationally,
not just in Rhode Island and Massachusetts. In fact, Rhode Island
and Massachusetts are in relatively good shape (comparative speaking)."
Fritz says organizations are lobbying in support of a bill introduced
by Rep. Patrick Kennedy, (D-RI), called the Child Health Crisis
Relief Act. The legislation provides incentives to increase the
number of well-trained healthcare professionals providing mental
health services to children and adolescents. Support will be provided
through loan forgiveness programs, scholarships, clinical training
grants, as well as Progressive Education Grants for Paraprofessionals
to state-licensed mental health nonprofit and for-profit organizations
and accredited institutions of higher education.
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