A hospital crisis: children in need of psychiatric care

Help: For reasons neither simple nor clear, more and more U.S. children need treatment for mental health problems. Lacking adequate services, in a crisis families resort to the emergency room.

February 13, 2000|By Diana K. Sugg | Diana K. Sugg,Sun Staff

He wrapped a telephone cord around his 2-year-old brother's neck, trying to strangle him. Another time, he dragged him down the stairs. Later, he pulled a knife on him. But what 3-year-old Kalif Johnson-Boyd really wanted was to kill himself.

"I tried to put something around my neck," he declared one night at the Johns Hopkins Children's Center emergency room. "I tried to get killed."

Kalif is among the littlest and most extreme of the troubled children who have been showing up by the thousands in the past few years at emergency rooms in Baltimore and across the country.

It's a crisis with no simple explanation. Some point to changes in welfare and the health care system. Others say that, in the wake of school shootings, Americans have grown scared of their children. But psychiatrists, social workers, experts and parents agree: There aren't enough services to deal with all these sick children.

So they wind up at emergency departments, where they will wait for hours and hours, and often more than a day, for an open bed in a hospital, a group home or a rehabilitation center.

"The system is overwhelmed," says Dr. Irm Raja Bellavia, a resident in child psychiatry at the children's center, "and so are we."

In Philadelphia, where officials designated one hospital as the psychiatric emergency room for children, the facility has reported a 40 percent increase in patients in the past year. At Yale-New Haven Children's Hospital in Connecticut, doctors report a 60 percent increase over the past four years. Other cities, such as Denver and Seattle, are also seeing more patients.

At Johns Hopkins' pediatric emergency department, for all the gashes, broken arms or the urban scourge, asthma, more than half the cases on many nights are children with mental, behavioral or emotional problems. Since 1995, the number of kids going there with such problems has nearly doubled to 730 a year.

The University of Maryland Medical Center's pediatric emergency department is also swamped, so much so that it is considering opening a walk-in clinic for patients with psychiatric problems.

The children come from all over the state, from all types of families, and could make up an encyclopedia of mental health conditions. Some are cursed with genes that predispose them to such mental illnesses as manic depression. One 9-year-old Baltimore boy can't remember the last time he felt good. Some are haunted by nightmares and sadness.

Others are traumatized by neglect and abuse, but still seeking love, run after addicted mothers who are living on the streets. Some hang their heads, kick at the examination table and admit they just want to talk to someone about their parents' divorce. For many children, their world is making them sick.

One 11th-grader, struggling with a mild learning disability, hates that she can't take the SATs like the other students at her Baltimore County high school. She does well in most subjects, and her counselor assures her she'll be able to go to a community college and from there to a university.

But last fall, she was afraid her future was behind a fast-food counter. And the gossip and cliques and taunting at her high school were tearing her up.

"I couldn't take it anymore," said the 16-year-old. One afternoon in November, she got off the bus, walked home, grabbed the first bottle of pills she could find and swallowed every one of them.

Lying on a gurney at 4 a.m. at Hopkins, pulling back her long, thick hair in a ponytail, she asked, "Why did God make me like this?"

Her face was blank. "I wasn't scared to die."

But this teen-ager lived. Night after night, Bellavia and her colleagues are in a battle, trying to save the others.

Dancing 'the jig' all night

The last Wednesday in October is a typical shift at Hopkins' pediatric emergency department. At 5 p.m., another physician hands off the on-call pager to Bellavia. Within minutes, it goes off, trumpeting an annoying melody the residents call "the jig."

Bellavia, 31, quickly surveys an oversized board hanging on the wall, the key to everything that is happening. In the bottom left corner, next to the information about her patients, is the symbol for the Greek letter psi, for psychiatric.

These are the children who will be here long after all the other patients have left, the ones who will survive on graham crackers and Hawaiian Punch from the nurses, the ones who will sleep in chairs and on exam tables.

"It's going to be a really long night," says Bellavia, walking fast down a hallway to rooms near the emergency room used for overflow. As she rounds the corner, she sees that security guards are already posted outside three rooms.

Family members eye her skeptically through the open doors. She braces herself. It has been crowded like this for months, every fifth or sixth night when she rotates on call.

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