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Connecticut faces an ‘overwhelming’ pandemic-induced crisis in mental health care. Here’s what experts say the legislature should do.

Hartford Courant - 10/14/2021

Behavioral health care providers, child advocates and representatives from state agencies say there is a widespread surge in demand for urgent pediatric behavioral health care across Connecticut, a crisis they say is exacerbated by insufficient staffing levels.

To address the crisis that has left dozens of children waiting for mental health care at Children’s and other hospitals, experts say Connecticut must:

The ongoing surge is “overwhelming,” said Patricia Rehmer, a senior vice president at Hartford HealthCare and a co-chair of the Behavioral Health Partnership Oversight Council, which met this week to address the crisis. The council advises the state Department of Children and Families, the Department of Mental Health and Addiction Services, and the Department of Social Services.

“I don’t know how we dig our way out of this, but it is definitely a systemwide issue and one that is going to take some time to get through and to get out of,” said Heather Gates, the president and CEO of Community Health Resources, which operates a wide range of programs for adults and children impacted by mental illness, substance use disorder or trauma, in Connecticut.

“I don’t think there are any magic bullets here, because this is affecting every provider and every service type that we all operate,’' Gates told the council during a meeting on Wednesday.

At CHR, Gates said, “there’s a level of acuity that is greater than what we typically experience,” as well as “fewer staff to meet those needs.”

Surge at Children’s

Connecticut has seen a dramatic increase in the need for urgent pediatric behavioral health care this fall, driven in part by the psychological and emotional toll that the COVID-19 pandemic has taken on children across the state.

The surge has led to prolonged wait times for families in crisis at hospitals like Connecticut Children’s Medical Center, as the Courant reported last week. In response to the deepening crisis, U.S. Sen Richard Blumenthal visited Children’s on Friday, where he called for deeper investments in federal funding for pediatric hospitals, as well as for suicide prevention efforts.

Members of the council voted unanimously this week to create a list of recommendations for the state legislature about how to address the crisis.

Representatives from state agencies stressed that they were working to tackle the crisis.

At the state Department of Social Services, William Halsey, director of integrated care, said that the state is having “ongoing conversations” with various hospitals about increasing capacity for pediatric beds.

“We know there’s been a lot of attention focused on youth in the [emergency department],” said Dr. Lois Berkowitz, mental health director of psychological services for DCF. “As a department, we’re working with various state agencies and community providers to address this.”

Vincent Russo, legislative program director DCF, noted that though the agency is trying to “open things up as quickly as we can,” staffing issues remain a major challenge.

“With the department, we’re working very hard to try to treat kids at home, we’ve been really trying to really beef up the community networks,” in order to free up space in emergency departments, he added.

Jeff Vanderploeg, president and chief executive officer of the Child Health and Development Institute of Connecticut, emphasized that there are some short-term solutions to the surge in demand that Connecticut could consider adopting. For one, he said, the state needs to “immediately” expand inpatient psychiatric bed capacity.

Vanderploeg also drew attention to a backlog in clinicians who have finished master’s programs but have not been able to take a licensing exam as a potentially untapped workforce. And he emphasized that stronger partnerships between schools and mobile crisis teams could help divert children away from emergency departments.

Many providers described widespread issues in retaining and recruiting staff, which results in reduced capacity for behavioral health care across the state.

Struggling to retain staff

Dr. Frank Fortunati, the medical director of the Yale New Haven Psychiatric Hospital, said that it has become increasingly hard to retain staff, with nursing staff being recruited away to lucrative jobs as traveling nurses in New York City and other areas, while social workers are “burned out.”

“They’re handling higher acuity and we’re losing them to school systems now,” he said of social workers. “And it’s forcing us to close some of our [intensive outpatient program] tracks.”

Fortunati said he did “not see a way out of this” without better compensation for health care workers.

Gates emphasized that much more work must be done to raise the salaries of those who work in mental health care to “sustainable” levels.

“Compensation for individuals working in our field has been stagnant for so long, and now we are in a real crisis with it, and that’s really from all levels of staffing. We can’t hire staff for our residential programs because they could make $3, $4, $5 an hour more working for a big box store.”

Families bear burden

Laura Nesta, director of behavioral health at Hartford HealthCare, who manages part of the psychiatric emergency department at St. Vincent’s as well as inpatient side at Westport and Bridgeport, said that ultimately, families bear the brunt of staffing crises.

“What we can’t forget about is that as much as we’re talking about staffing challenges and staff being burnt out, our parents and our families are having an even more difficult time,” she said.

In one recent incident, Nesta said, a clinician was working with a child in the emergency department who required behavioral health support but did not need to be in the hospital.

“The mom refused to pick him up. She’s like, ‘I’m done,’” Nesta said, adding that it took about 12 hours to resolve the situation.

On the inpatient side of care, she said, as children return again and again for treatment, parents are often in need of support themselves.

“They’re frightened, they’re scared, they’re burnt out, they’re overwhelmed themselves,” she said. “They’re afraid to take their kids back home.”

A crisis in adult care, too

Fortunati also emphasized that there is an intense need for expanded urgent behavioral health care not only among children in Connecticut, but also among adults. He described the situation as “beyond a crisis.”

On Tuesday morning, he said, there were 121 adults in emergency departments throughout the state, waiting for an available bed.

“It’s just a staggering number,” he said. “121 folks waiting in the emergency department.”

Many providers noted during the meeting that the current crisis has deep roots — and will require more than an easy fix to solve.

“We need to start grappling with the fact that the pandemic may be waning, but the impact on the service system is, I think, in some ways just starting,” Gates, of CHR, said. “So we may see this continue for potentially another two, if not three years, given the workforce issues.”

Eliza Fawcett can be reached at elfawcett@courant.com.

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