One state finds success with ER psych diversion program for kids : Shots - Health News At many U.S. hospitals, children and teens are stuck in the emergency department for days or weeks because psychiatric beds are full. Massachussets has a simple, yet promising solution.

One state looks to get kids in crisis out of the ER — and back home

  • Download
  • <iframe src="https://www.npr.org/player/embed/1154953475/1156166967" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

JUANA SUMMERS, HOST:

Today, thousands of children and teens going through mental health crises are stuck in hospital emergency rooms because psychiatric units are full. But in Massachusetts, some are offered an alternative - intensive therapy at home. From member station WBUR in Boston, Martha Bebinger reports. And a warning - there is a mention of suicide in the story you're about to hear.

MARTHA BEBINGER, BYLINE: Counselor Laura Polizoti lays a worksheet on the table in front of 12-year-old Haley.

LAURA POLIZOTI: Have you ever done an emotional thermometer before?

BEBINGER: Haley shakes her head no. The oversized picture of a thermometer has blank lines for five emotions from the base to the top. Haley labels the bottom chill. In the upper red zone, she writes, infuriated.

POLIZOTI: Infuriated. OK. That's a good word. So when you're infuriated, how do you think you feel, like, physically?

HALEY: Like my palms get sweaty. And I, like, make this face.

BEBINGER: Haley scrunches her nose and frowns.

POLIZOTI: And then what is a coping skill that you could use to calm yourself down?

HALEY: I could go on the trampoline.

POLIZOTI: Oh, yeah, that's a good one. OK. So go on the trampoline. Can we come up with, like, one more?

HALEY: I could, like, talk with my mom.

POLIZOTI: Awesome.

BEBINGER: Awesome because Haley argued with her mom a lot before starting these sessions. Her anger turned into risky behavior that landed Haley in a hospital emergency room. We're only using Haley's first name to protect this 12-year-old's identity. Things all came to a head one night last October. Haley's parents realized she'd snuck out to meet an older boy and posted sexually suggestive pictures. They remembered an earlier suicide suggestion, panicked and drove to a local ER, where Haley had a psychological evaluation.

HALEY: I didn't know if they were just going to send me home or if they were going to, like, put me in a really weird place. It was, like, really nerve-wracking.

BEBINGER: The hospital considered sending Haley to a psychiatric ward, but DeAnna Pedro, who handled Haley's case, worried that would be too intense for a young girl whose only prior mental health care was with her school counselor.

DEANNA PEDRO: And then we put her on an inpatient psych unit with potentially kids who've been experiencing a lot of other things. So we reached out to Youth Villages.

BEBINGER: Youth Villages is 1 of 4 agencies Massachusetts hired to provide an alternative to psychiatric hospitalization. With rising depression and anxiety during the pandemic, there was a big need to help ease emergency room crowding. Youth Villages' counselors meet families in the ER to map a plan for intensive home-based care. Polizoti, Haley's counselor, says the first step is a safety sweep.

POLIZOTI: We look under rugs. We look behind picture frames. We look in the dirt of plants.

BEBINGER: Counselors see clients often with family members at home, three times a week, typically for three months. Haley has stopped sneaking out at night and sending suggestive pictures. More than 80% of youth who've tried home-based counseling in Massachusetts have not returned to the ER. Dr. Chris Kang is president of the American College of Emergency Physicians.

CHRIS KANG: We see more and more mental health patients, unfortunately, often languishing in emergency departments. And I've heard stories not just weeks, but months. And it's anywhere from California to Massachusetts to Alabama to Minnesota and Detroit.

BEBINGER: Kang says few states have programs like the one Haley is in because creating partnerships between hospitals and local mental health agencies is a challenge, as is funding them, even though care at home is much cheaper. Haley's mom, Carmen, choked up talking about why sharing this experience is important.

CARMEN: A lot of parents don't know what the kid's going through because they don't want to accept that your kids really need help.

BEBINGER: Going home, rather than to a psych hospital, won't work for every child in a mental health crisis. Still, some parent advocacy groups say their main complaint is that these programs don't have more openings. For NPR News, I'm Martha Bebinger in Boston.

SUMMERS: If you or someone you know may be considering suicide or is in crisis, call or text 988 to reach the Suicide & Crisis Lifeline. This story was produced in partnership with Kaiser Health News and WBUR.

Copyright © 2023 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.