Why are kids of color in MN spending days, weeks, and months in hospital ERs that can't treat their problems?

[WhiskeyGrinder]

https://sahanjournal.com/health/minnesota-autism-mental-illness-hospital-boarding/

In order to keep Tyana safe, Hunter sets alarms on her doors and windows to alert her if Tyana tries to leave. But on this day, the alarm wasn’t set, and Tyana jumped from the second-floor apartment window. Tyana wasn’t physically harmed, but Hunter was at a loss for how to keep Tyana safe. Hunter called Tyana’s social worker.

“They told me to take her to the hospital,” Hunter said.

Hospitals don’t offer the type of care Tyana requires: that is, staff trained in helping kids with autism; and safe spaces for bathing and exercise. But Tyana spent five days in the emergency room, nonetheless. And, with nowhere else to go, she’s been back to the emergency room about five times since that event.

One part of Hunter feels relieved when the ambulance shows up. She knows that Tyana will be physically safe in the emergency room, with someone guarding her to make sure she doesn’t run away. But Hunter also knows that the hospital is not equipped to take care of Tyana’s complex needs.

“You have no other choice,” she said.

Tyana’s experience in the hospital is known as “boarding.” The kids in these situations fall into two categories: those with developmental disorders, such as autism and attention deficit hyperactivity disorder (ADHD); and those with mental-health conditions, such as depression and anxiety. When parents or guardians call 911 in response to a child in crisis, an emergency department will admit the child. (It’s a federal law.) But most hospitals do not have the resources or expertise to care for these patients.

(snip)

When kids are boarded, as Tyana was, they’re kept wherever the hospital can find space: in a windowless exam room meant for short-term stays; in a hallway; in a room on the pediatric medical floor; etc. They will receive 24/7 supervision for their physical safety–and perhaps no other treatment.

The number of children and adolescents boarding in Minnesota hospitals has climbed steadily over the past several years and shows no signs of slowing. In 2023, over 1,000 kids in the Twin Cities boarded in emergency rooms operated by the major health systems: Allina, Children’s, Fairview, and Hennepin Healthcare.

Experts say a disproportionate number of these kids are in the foster-care system or county custody, and a disproportionate number are Native American or Black.

[Irish_Dem]

1. Some Children's Hospitals now have behavioral health emergency rooms.

Just for kids with mental health issues.

The kids are evaluated, and sent to appropriate treatment units in the hospital if needed.

[dutch777]

2. This is not unique to kids or people of color . There is simply not enough mental & other behavioral health services.

I retired a few years ago as a hospital administrator in a nationally top rated west coast hospital. Located in a well to do suburb of Seattle, we weren't generally getting homeless and indigent patients prone to substance abuse and other complicating factors of behavioral health problems. But we did get many folks just as the story describes, a family member or foster care person that had issues the family responsible simply could not deal with effectively at home consistently. They tried. But they got worn down. Something goes wrong one day , the person under care hurts themselves or others, gets off their meds or whatever and the closest Emergency Department gets involved. It was not unusual to be boarding up to a dozen of these patients at any one time and some for over a month or more until a proper behavioral health bed could be found. We had one patient that it took over six months to place.

Psychiatrists who would deal with uninsured or Medicare/Medicaid patients were almost non existent and it could takes days to even get one in to consult and come up with a treatment and placement plan. And while we could stabilize and protect them, it was at the cost of precious hospital beds frequently needed for much sicker patients. It was not unusual in the winter flu and pneumonia season that we would, as well all the hospitals in the region, be out of beds. Getting a dozen beds back, over the 8 or so major local hospitals meant helping another 100+ critically ill (usually elderly) patients a day. And we were this overwhelmed frequently from January into April. People died for lack of beds and appropriate care and medical staff gets overwhelmed and demoralized. And that was before Covid!

There are not enough psychiatrists or behavioral health facility beds. The vast majority that exist are for profit and only take cash or rare high end insurance that covers mental health. The states long ago divested themselves of being responsible for public mental health as it was thought home treatment was the way to go rather than institutionalizing people for what was likely to be life. Most of the state hospitals were closed or repurposed. No support was really given to make home treatment workable, no matter how much more humane it was. The staes just took the savings for other uses.
And now in a country where over 60% of people can't cover a $1,000 emergency expense, substance abuse of all types is rampant and complexities of contemporary life push people to a mental brink more and more, there is no real workable system to help the patients, families and communities affected. Pretty sad for one of the richest and supposedly caring countries on the planet.

[OldBaldy1701E]

3. There is no profit in helping the poor and indigent. And that is the only thing that matters to this nation.

They might help the older kids because they will be potential wage slaves in a year or two, but the younger ones? What spend money on something that might not even make it working age? It is disgusting that we can send 8 billion in aid to other countries, but we have the conditions you speak of. It is both horrifying and pathetic.

[stopdiggin]

5. thanks. For a first hand and fairly succinct take.

the short answer is - 'resources are simply not available'
and you can double that score in red state and rural health systems.

[dutch777]

6. You are welcome. It's an issue that largely flies under the radar and is only getting worse by the year.

[slightlv]

7. Back in the late 70's,

when I got out of the AF and found out about the GI bill, I went to college. Psychology was always a love of mine. Helping people. Not experimental psych. Everyone at that time was going for the Business stuff. I hated that. For one thing, I had dyslexia with numbers! (LOL) I'd just gotten divorced because hubby, who was still AF, did NOT want me to go to college. I had other plans for my life. I had a daughter and still pursued my dream. My first job interviews were a bust. Not because of me... but because of what they offered. No way could I survive and raise a child on what they offered! One job I really wanted was a halfway house counselor. Minimum way 3.50/hour at the time, 4 hours minimum... no guarantee beyond that per day! How can you live on that?

So, I could type... fast. That led me to computers and the DoD. Made my life in the DoD, either by contracting or later in GS. And through it all, in a life in computers. As a woman, I was always on the low end of the payscale, but I did find a way to put my training to use, just through non-ordinary ways. For one, as a help desk tech, you had to be able to work with anyone from the most stupid VP to the most insecure newbie... and I could do it. I also branched out into women's spirituality and for years was a spiritual counselor.

Reagan and the Republicans helped start us down such a dark, dark tunnel. I damn them every day. So many lost souls. So many people suffering. Yes, we have drug problems. We have suicides. We also have drug problems where people who need them can't get them because of the people who need them because of their soul-sickness. It didn't start with Reagan, tho. You can trace this back much further than him. Like Trump, he was just a TV host with a "pretty" face. (ha!) He could read a script and make it work for people like Cheney and Feith. What they tried in Iraq that failed horribly and gives us what we have today in the Middle East, they wanted to do (and still want to do) to us here, in America. And they won't stop trying... because their watchwords are "Conservatism can't fail, we can only fail conservatism." This is why they hate trump. He's not conservative. He's a dictator. Not cut from their cloth. Not beholding to them. And they can't control him. Oh, reap the worldwind, Cheney.

[dutch777]

8. I do agree, Reagan, or probably more correctly his enablers and handlers, sent the GOP down a path that...

...got them, and us, here. I do think they thought they'd have a solid and implementable plan at the end of all the blaming and complaining if they got enough power. All they have is more conspiracies and blaming and no implementable plan. Although, some, possibly rightly, believe that the only plan of GOP backers like the Koch Bros really is to make government essentially non-functional so those with capital and power and thereby influence can just do what they want in business and damn the little guy. Given the GOP had the WH, House and Senate the first two years of TFG's term and got basically squat done and that the House under current GOP leadership is at best a shambles, maybe the non-functional government plan is a success.

[slightlv]

9. What's been the GOP's watchword about gov't?

Beyond, "drown it in a bathtub" and "it doesn't work"? It's free market capitalism, which is a euphuism for laisse faire capitalism. I don't have anything against capitalism, per se... it's better than some, worse than other systems, perhaps. But it has to be regulated or all it becomes is greed writ large, people and the planet be damned. And we're seeing that today.

[stopdiggin]

4. good post. But gotta think the answer is also pretty self-evident. -(nt)-