The closing of the Providence Behavioral Health Hospital on Tuesday will create an existential mental health crises for children and adolescents.
There is a subset of youth who have not responded to medications and supplemental partial hospitalization and who need in-patient psychiatric care to prevent further de-escalation and possible suicide. These are the youth who, like William Styron in his book “Darkness Visible,” described how he committed himself for two weeks to a Yale in-patient psychiatric unit after being on the verge of suicide.
With the closing of Providence, children and adolescents who live western Massachusetts will need to be transferred to out-of-state facilities in Vermont, Connecticut, or to the eastern part of Massachusetts.
The current COVID-19 pandemic has overshadowed the need for appropriate mental care in the United States. But the disorders of mental health will not go away when a vaccine and a medication to treat COVID-19 is found.
According to a June 26, 2019, U.S. News article, over 44 million adults (18.19%) have a mental health condition; and over 24 million individuals are going untreated. Depression, a primary cause of suicide, resulted in 48,344 deaths last year.
The U.S. Centers for Disease Control has reported that approximately 7.4% (4.5 million children and adolescents) in the United States have a diagnosed behavior problems. Suicide is the second most common cause of death in youth.
Manic depression in children, which I rarely encountered in 50 years of pediatric practice, has increased to 40 times in the past 20 years, according to Susannah Calahan in her book, “Great Pretender.” Also, autism, which was first described in the 1940s, was estimated to be 1 in 2,500 prior to 1985. Now the autism spectrum disorder, that includes Asperger’s Syndrome, is estimated to affect about 1.5 million children, or about 2% of the U.S. population.
Unfortunately, even if the Providence Hospital could hire the necessary psychiatrists, a Mercy Hospital administrator told me that at the rate Providence is being reimbursed, the hospital would continue to lose millions annually.
The only way psychiatric care for children and adolescents who live in western Massachusetts can be effectively provided is that the Massachusetts Department of Mental Health assume the operation of an in-patient child psychiatric unit in this part of the state.
The Massachusetts state government already runs four institutions that provide care for the chronically ill and handicapped children. These institutions include: Western Massachusetts Hospital in Westfield with 100 beds; the Tewkesbury Hospital with 350 bed; The Pappas Rehabilitation Hospital Hospital in Jamaica Plains with 255 beds.
In addition, Massachusetts is currently involved in operating 63 facilities to rehabilitate youth who have committed crimes. Two of these units are in the nearby South Hadley Girls Treatment Center and the Westfield Youth Service Center.
The hallmark of a humane, democratic society is to share the costs (paying taxes) for a multiple of local, state and national service. Public education, the military, police, fire departments and prisons are obvious examples. The state should be responsible for adequately funding the in-hospital treatment for children and adolescents with severe psychiatric problems.
Robert M. Abrams, M.D., is a member (in the 1970s) of the Massachusetts DPH Public Health Council.