One Heart at a Time
My heart hurts. It’s how I say my heart is heavy.
Travis’s live-in aide is moving out tomorrow. I am definitely a bit confused by the situation. I can understand why an individual might decide being a live-in aide is not for them. But this aide had just told me that he was committed, that he could see himself being an aide to Travis for five years, maybe even more. And I exhaled.
The aide hung in there through some really tough weeks. Travis is confused too, because even he believes that he is doing so much better. Travis is doing better. He was hurt by the news and blamed himself. But he didn’t become despondent. And he didn’t become enraged.
And you know what? I am doing ok too. Because I am learning to loosen my grip. I can’t control these things. What did I say just last week? Things don’t ever get solved. They come together and they fall apart. Things are always in transition.
I’m learning to relax in the midst of chaos. Strangely enough, I am not feeling panicked.
Even though Travis called me today to talk about a homeless friend that needs a place to stay. He tried to convince me that they have been friends for years. And maybe they have. Only I have never heard of him, so they couldn’t be that close of friends.
This friend was kicked out of his apartment. Only, according to Travis (and the friend), he didn’t do the thing the landlord says he did. Maybe he did, maybe he didn’t. Either way he can’t stay at Travis’s, even temporarily. My responsibility is to Travis, not his friend. The HUD rules don’t allow for this friend to stay with Travis.
I googled the friend’s name. He was arrested a couple of months ago for violating a protection order. I went through his Facebook posts. It sounds like hard times have fallen on him. His friend is struggling. I feel for his situation. I wonder where his family is.
Once again, I am the bad guy. Travis doesn’t understand that he puts his benefits at risk if he breaks the rules. Travis says that I don’t have a heart. Anyone that knows me, knows that is the furthest thing from the truth.
Even one of Travis’s other friends texted me several times today to defend this guy. This friend of Travis’s (that I do know) won’t allow the homeless guy to stay with him. Why? Because it is not allowed on his voucher.
I don’t try to tell Travis who he can be friends with. Again, it is not something that I can control. The guy just can’t stay at his place.
All of that being said, that is not the reason my heart hurts. May is mental health awareness month. I saw an article titled “Mental Health Awareness Needs More than One Month of Attention” and I agree!
Yesterday one of my closest friends forwarded a New York Times article for me to read, “Hundreds of Suicidal Teens Sleep in Emergency Rooms. Every Night.” written by Matt Richtel and published yesterday, May 8, 2022.
Per Richtel, “With inpatient psychiatric services in short supply, adolescents are spending days, even weeks, in hospital emergency departments awaiting the help they desperately need.”
Richtel tells the story of a 15-year-old girl, (G), rushed to a Boston ER. “She had marks on both arms from self-harm and a recent suicide attempt, and earlier that day she had confided to her pediatrician that she planned to try again.”
The ER doctor said that she was not safe to go home, that she needed to be admitted to an inpatient treatment center. But there were no openings in any of the regional treatment centers.
“Indeed, 15 other adolescents - all in precarious mental condition - were already housed in the hospital’s emergency department, sleeping in exam rooms night after night, waiting for an opening.”
The average wait was 10 days, G was in the ER for 29 days before an inpatient bed opened up. The first week of her stay was spent in a “Psych-safe” room. The room looked exactly like the room that Travis stayed in for 30 hours when we brought him to the ER. It contained only a bed and a chair. Only she was in that room for a full week.
Per the article, “In this process of boarding we broke her worse than ever, recalled her mother.”
The following is directly from the article:
Mental health disorders are surging among adolescents: In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. Suicide rates, stable from 2000 to 2007, leaped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention.
G’s story describes one of its starkest manifestations of the crisis. Across the country, hospital emergency departments have become boarding wards for teenagers who pose too great a risk to themselves or others to go home. They have nowhere else to go; even as the crisis has intensified, the medical system has failed to keep up, and options for inpatient and intensive outpatient psychiatric treatment have eroded sharply.
Nationally, the number of residential treatment facilities for people under the age of 18 fell to 592 in 2020 from 848 in 2012, a 30 percent decline, according to the most recent federal government survey. The decline is partly a result of well-intentioned policy changes that did not foresee a surge in mental-health cases. Social-distancing rules and labor shortages during the pandemic have eliminated additional treatment centers and beds, experts say.
Absent that option, emergency rooms have taken up the slack. A recent study of 88 pediatric hospitals around the country found that 87 of them regularly board children and adolescents overnight in the E.R. On average, any given hospital saw four boarders per day, with an average stay of 48 hours.
“There is a pediatric pandemic of mental health boarding,” said Dr. JoAnna K. Leyenaar, a pediatrician at Dartmouth-Hitchcock Medical Center and the study’s lead author. In an interview, she extrapolated from her research and other data to estimate that at least 1,000 young people, and perhaps as many as 5,000, board each night in the nation’s 4,000 emergency departments.
“We have a national crisis,” Dr. Leyenaar said.
In 2021, the average adolescent boarding in the E.R. at Boston Children’s Hospital spent nine days waiting for an inpatient bed, up from three and a half days in 2019; at Children’s Hospital Colorado in Aurora in 2021, the average wait was eight days, and at Connecticut Children’s Medical Center in Hartford, it was six.
One of the adolescents waiting in Aurora, a Denver suburb, was a 16-year-old who had been stabilized after attempting suicide and who needed a residential treatment spot. “But there are no beds,” Jessica Friedman, a social worker, said she had told the family.
“I have eight or nine conversations like this a day,” Ms. Friedman, standing in the hallway, told a reporter; so far that day she had had only two. “This is actually a good day.”
Colorado is struggling with the same shortage of services that has hit hospitals nationwide. The state has lost 1,000 residential beds serving various adolescent populations since 2012, according to Heidi Baskfield, vice president of population health and advocacy for Children’s Hospital Colorado. The state closed one 500-bed facility, Ridgeview, which served at-risk young people, in 2021 because of instances of poor quality and abuse. Another facility, Excelsior, closed its 200 beds in 2017 because reimbursement rates were not high enough to support ongoing operations, the chief executive officer said at the time of the closing.
A major cause, Ms. Baskfield said, was the low reimbursement rates paid by Medicaid, the state insurance program. From 2006 to 2021, the daily Medicaid rate in Colorado allotted roughly $400 for a therapeutic residential bed — “less than some families spend to send their kids for a night to sleepaway camp,” Ms. Baskfield said.
The low rates also accounted for some of the quality issues, she said; it was hard to hire experienced staff. (In the past year, Colorado has raised its reimbursement to $750 per day by using money from the American Rescue Plan, but new beds have yet to open, and that source of money is temporary.)
As you are aware from reading our story, finding an inpatient behavioral health bed is problematic for adults as well.
I am doing a good job of building resilience in dealing with the daily ups and downs of being a caregiver. My heart hurts when I read these types of articles. I feel like I am reading another story about someone dying by suicide on a daily basis.
I want the world to change. I want to change the world. But I am busy changing my son’s world.
What I can do is reach one heart at a time, and hope that it creates a ripple effect. I hope that sharing our story is in some way doing just that.
“You can close your eyes to things you don’t want to see, but you can’t close your heart to things you don’t want to feel.” - Author Unknown
“Empathy feels these thoughts; your hurt is in my heart, your loss is in my prayers, your sorrow is in my soul, and your tears are in my eyes.” - William Arthur Ward
“That moment when you can actually feel the pain in your chest from seeing or hearing something that breaks your heart.” - Author Unknown