Youth mental health program stalled as children fill emergency departments

  • Terri Clyde and her grandson, John, outside their Merrimack home on Thursday. Clyde said she thinks many of John’s hospitalizations could have been avoided if they just had a trained clinician to talk to them. GEOFF FORESTER / Monitor staff

  • Terri Clyde and her son, John outside their Merrimack home on Thursday, October 1, 2020. Clyde said she thinks many of her son's hospitalizations could have been avoided if they just had a trained clinician to talk to her and her son. GEOFF FORESTER—Monitor staff

Monitor staff
Published: 10/1/2020 4:09:55 PM

John Clyde was seven when he was first sent to the emergency department to wait for a psychiatric bed.

Clyde, who lives with fetal alcohol syndrome, a traumatic brain injury, and autism, tried to jump out of a moving car on the highway on the way to the doctor’s office. He later told his teachers he planned to do it again.

He was sent to the hospital, where he waited for eight hours, to receive psychiatric help. Terri Clyde, John’s grandmother who adopted him, said she felt like the nurses weren’t trained to handle children with mental illness.

When John threw the hospital food on the ground, the nurses told him he had to pick it up or he wasn’t going to get anything else to eat or drink. Though he looked like a second-grader, developmentally, he had the mental capacity of a three-year-old and couldn’t understand the ultimatum.

“It was my first experience with (the emergency department). For us it was a nightmare,” Terri Clyde said. “The staff didn’t understand what was going on.”

As the number of children waiting for psychiatric care reached startling peaks this summer, money allocated last year for revamping the mental health system for children is nowhere to be found.

Senate Bill 14 was proposed to rectify the state’s 10-year mental health plan, passed in 2008, that made little mention of children, despite the fact that the CDC estimates 1 in 5 children lives with mental illness. The bill proposed 12 provisions to improve New Hampshire’s psychiatric system for children.

Most notably, it allocated funding for mobile crisis teams, a 24/7 hour service that dispatches a clinician and a “peer support specialist” – someone recovering from their own mental illness – to the child in need. Whereas typically parents have to send their children to the emergency room to wait for psychiatric help, mobile crisis teams bring help to their doorstep, clearing hospital waiting rooms, and offering children help from the comfort of their homes.

The bill was signed into law in June of 2019 with bipartisan support and about $20 million was allocated from the budget to fund the efforts. The process to seek contracts to build this elaborate network was supposed to start promptly after the bill was signed into law.

Yet more than a year later, the Department of Health and Human Services has not completed the first step in this long process, releasing a request for proposal. After proposals are solicited, there will likely be several more months of negotiating and approving contracts. Dellie Champagne, a children’s behavioral health advocate at New Futures, estimates that it will be another year until the mobile crisis units are operational.

In total, John Clyde, now 17, has been hospitalized six times.

Terri Clyde said she thinks many of them could have been avoided if they just had a trained clinician to talk to her and her son. Often times, his strong emotions stem from a hard day of school. Talking to someone impartial can quickly deescalate the situation.

“A lot of times, all it takes is someone to talk to,” she said. “In a lot of instances where he ended up being hospitalized, all of that could have been avoided if we had mobile crisis.”

Now, New Hampshire is facing high numbers of children waiting in the emergency room for a bed, a situation very similar to the one SB14 was proposed to avoid.

In August, mental health advocates noticed children made up a large portion of the waiting list for psychiatric beds. During the last peak in 2017, there was only one child on a 72-person list. However, last month, children comprised sometimes more than half of the list. On Aug. 14, 26 children were waiting for a bed in a psychiatric facility, about two-thirds of all patients waiting for a bed that day.

Becky Whitley, a candidate for state senator who co-wrote the bill as a policy director for the NH Children’s Behavioral Health, said she has heard from several parents who are frustrated that the state seems to be dragging their feet on this program.

“This is not a lack of funding issue,” she said. “We have a solution here. Where is it?”

Moira O’Neill, the director of the state’s Office of the Child Advocate, worries that waiting in emergency departments is not only a poor course of treatment for children struggling with mental illness but, in the event of another surge of COVID-19, it could put them at risk for contracting the virus.

In early July, her office sent a report to the Division for Children, Youth & Families – a subset of DHHS – recommending that they quickly implement the plans detailed in SB14 to keep children out of the emergency rooms. O’Neill said she did not hear back from DHHS.

O’Neill said she suspects staff shortages at DHHS is at least partly responsible for the delay.

“The development of requests for proposals (RFP) and drafting of contracts for services is extremely slow,” the report read. “There are not enough staff to complete the work in a timely manner causing considerable delays in rolling out expended and redesigned services.”

Jake Leon, a spokesperson for the Department of Health and Human Services, said several factors have delayed the implementation of SB14, such as snags with the approval of the 2020-21 budget and COVID-19.

He said the department hired additional staff in the last six months to support the implementation of SB 14 and the request for proposals will be released in the coming weeks.

Now that there are long lists of children waiting for beds, this gesture feels reactive instead of proactive, as it could have been done more than a year ago, Terri Clyde said.

“Everything needs to wait until we’re in a crisis situation,” she said. “The system is set up so everything is reactive.”

 Editor’s note: This story has been changed to correct Becky Whitley’s title as a candidate for State Senate.




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