Kids at Risk Action (KARA) is a non-profit action tank supporting people, policies, and programs
that improve the lives of at-risk children. We are passionate and unapologetic advocates for the welfare of abused
and neglected kids in Minnesota, the United States, and the world.
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Today’s Boston Globe/ NYTimes articles; “Mental Health Crisis + Emergency Rooms” (below) is just the tip of the iceberg. It shows the exponential increase in chemical restraints and Emergency Room mental health visits by children. Yet it misses the crisis at the heart of the story and what we could do to save the huge costs and terrible failure our policies repeat for at-risk children and our communities every day.
Children’s mental health is not delivered by the stork or subduing them with powerful drugs in emergency rooms. It comes from nourishing parents, skill building and a safe home environment.
Absent this, children of young moms without parenting skills, drug habits and violent boyfriends struggle every day to live with their trauma, abuse and neglect.
Some escape the chaos but most don’t. Only the very worst cases of trauma and abuse make it into Child Protective Services and Foster Care. Between 10 & 12 million children are reported to CPS every year (pre COVID)
Fewer cases were reported during COVID but more stress, domestic violence and trauma occurred. There were 3.9 children per family in MN’s child abuse reports last year. This is about the national average (3.5 million reports nationally per year – pre COVID).
This is a topic that most of us avoid. There is little appetite for knowing the living conditions or mental health of, or how traumatized fostered and adopted State Ward Children succeed or fail.
Child self-harm and attempted suicide are common in child protective services but rarely reported.
Only successful child suicides make the paper.
Abused children have no voice in their homes and little understanding or support in the media or the State House.
Decades of working in the field of Child Protection have made it clear to this CASA volunteer guardian ad Litem that mental health requires a safe, skill building environment. Otherwise, too many children go on to live a life missing important skills, crushing depression and recurring feelings of failure and inadequacy born out of the traumas they have suffered.
Child self-harm and suicide attempts are everywhere in child protective services but nowhere are they transparent or reported.
Suicide now the 2nd leading cause of death among teens
Our ability to avoid and ignore the data and stories has filled our jails, broken our schools and made our communities unsafe and unhappy.
Almost 1/2 of LGBTQ youth have seriously considered suicide this last year
Children raised in homes filled with rape, violence, crime and substance abuse suffer from self-hate, depression. Their trauma induced behaviors often set them apart from their peers and leave them without the skills necessary to succeed in school or society.
ER Physician Dr Anna Cushing (the quoted DR in this article) has no way of knowing how many of her patients are traumatized children come from foster or adopted homes.
Children locked into toxic homes during COVID with no escape or access to mandated reporters that might lessen their need for Emergency Room mental health visits and the behaviors that need medicating.
A striking number from the JAMA study;
308,000 emergency mental health visits in the 38 hospitals reporting in JAMA’s study equates to 8026 emergency health visits per hospital.
This equates to 48,904,342 emergency room mental health visits in the 6,093 hospitals in the U.S. from 2015 to 2020. The COVID lockdown has kept many millions more children locked in toxic homes over long periods without access to safety or healing.
Share this article with your State Rep and let them know how important children’s mental health is to you and your community.
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Caregivers fearful of kids in mental health crises turn to ERs
BY ELLEN BARRY NEW YORK TIMES
For emergency room doctors, they are a dispiriting and familiar sight: Children who return again and
again in the grip of mental health crises, brought in by caregivers who are frightened or overwhelmed.
… surge in pediatric mental health emergency visits in recent years, as
rates of depression and suicidal behavior among teens surged. Patients often spend days or weeks in
exam rooms waiting for a rare psychiatric bed to open up, sharply reducing hospital capacity.
…a large study published Tuesday found a surprising trend among adolescents who repeatedly visited
the hospital. The patients most likely to reappear in ERs were not patients who harmed themselves, but
rather those whose agitation and aggressive behavior proved too much for their caregivers to manage.
In many cases, repeat visitors had previously received sedatives or other drugs to restrain them.
“Families come in with their children who have severe behavioral problems, and the families really just
are at their wit’s end, you know,” said Dr. Anna Cushing, a pediatric emergency room physician at
Children’s Hospital Los Angeles and one of the study’s authors. “Their child’s behavior may be a danger
to themselves, but also to the parents, to the other children in the home.”
The findings, published in the journal JAMA Pediatrics, analyzed more than 308,000 mental health
visits at 38 hospitals between 2015 and 2020.
…The results suggest that researchers should focus more attention on families whose children have
cognitive and behavioral problems, and who may turn to emergency rooms for respite, Cushing said.
“I’m not sure we’ve been spending as much time talking about these agitated and behaviorally
disregulated patients, at least on a national scale,” she said.
The frequency of revisits suggests that the care they receive in emergency rooms “is really not
adequate,” she said.
Guidelines recommend that so-called chemical restraints — benzodiazepines or antipsychotics
administered by injection or through an intravenous drip — be used as a last resort because they can be
traumatizing or cause physical injury to the patient, medical staff or caregivers, said Dr. Ashley Foster,
assistant professor of emergency medicine at the University of California, San Francisco.
The use of these drugs in pediatric emergency rooms has increased in recent years. Between 2009 and
2019, chemical restraint use increased by 370%, while mental health emergency room visits increased
by 268%, according to a study that Foster and her colleagues published last year.
The drugs were used more often on Black patients, as well as on male patients between 18 and 21, the
study found. Foster described those disparities as “concerning, and motivation for thinking about how
to enhance equitable care.”
Dr. Christine Crawford, a child and adolescent psychiatrist at Boston Medical Center, said caregivers for
children with behavioral disorders often turn to ERs when “it gets to the point where someone could get
hurt.”
“They enter sixth, seventh, eighth grades — that’s when we see those families that have been
struggling for a long time,” said Crawford.
Families in this situation, she said, “are quite isolated,” often hiding their struggles from friends and
relatives. ER treatment is comforting to caregivers but offers little long-term benefit, she said.
“Families come in with their children who have severe behavioral problems, and the families really just
are at their wit’s end.”
Dr. Anna Cushing, ER physician at Children’s Hospital Los Angeles and study co-author
