Our Kids are Not Okay

Gov. Scott powerfully remarked back in February that “our kids are not okay.”
He is right. Social isolation, continued disruption in schools and the ongoing effects of the pandemic have taken a major toll on young people. Over the past many weeks, we have seen this play out in hospital emergency departments where a growing number of young people are waiting for proper mental health care.
Last month, pediatricians, emergency room physicians, advocates and families told the legislature in a clear and resounding voice that they agreed the kids are not okay—that youth and families are under more stress than ever as a result of living in a pandemic while managing social isolation, economic insecurity, and the pervasive threat of COVID-19.
Families and clinicians are correct when they say any child waiting in an emergency department for help is one child too many. The reality is that we now face a public health crisis a decade or more in the making. Vermont teens, for example, described their struggles before the pandemic—31% reported feeling sad or hopeless; 13% had made a suicide plan; and 7% had attempted suicide. All of these rates are higher than they were a decade ago.
With diminished capacity in our schools, community and inpatient settings, and growing need among patients, one result is youth waiting in emergency rooms for days or even weeks to receive the right inpatient care.
We know we have to act quickly and thoughtfully to get our kids and families the help they need. To start, we need to understand the magnitude of the problem. In the last few weeks, VAHHS began collecting data to help inform providers and policy makers. We have also outlined several short-term and long-term actions to address this public health crisis.
As I mentioned, this is not a new problem. Hospitals themselves have been addressing this challenge for many years. They have:
  • Retrofitted spaces, especially emergency departments, to improve safety and privacy.
  • Hired more staff, including one-to-one sitters—a significant feat with our workforce challenges.
  • Increased telepsychiatry services to see more patients and continue care during quarantine and stay-at-home orders.
  • Added beds where possible.
  • Advocated for workforce, physical and financial resources at all levels of the system. 
Patients—both adults and children—waiting for mental health care in hospital emergency rooms is a persistent challenge, not just in Vermont but across the country. It is an intolerable situation that requires our immediate attention and long-term planning and resourcing. Some things can be done quickly while others require much more time. Here is a partial list of needed steps:
  • Continue to look at our admission and transfer processes to help children get the treatment they need faster.
  • Make available more telepsychiatry services. We are working hard to be sure providers can be paid for that care, which does take place now.
  • Obtain state and federal support for the infrastructure and workforce we need
  • Work with the state to determine how and where to increase capacity for both inpatient care, community care, and the intersections of/alternatives to emergency departments. That work will likely take years, especially if new buildings are needed.
This week, the legislature will hear from the Agency of Human Services on their proposed solutions. I know hospitals will be eagerly listening and ready to roll up our sleeves to help Vermont’s kids.
To work through this set of challenges, everyone needs to be at the table and employing a collective, thoughtful approach rather than a piecemeal or finger-pointing one. VAHHS and its member hospitals and clinicians will continue to work closely with state leaders and community partners to improve the outlook in every way we can.
This is children’s mental health awareness week, and May is mental health awareness month. There is no better time to commit to a different and better reality. I am optimistic that if we stay focused on this work and bring the right resources to it, we will make meaningful progress this year on behalf of young and older people alike.