The stress of the pandemic is taking a toll on the mental health of Massachusetts residents, young and old. But as more people require in-patient psychiatric treatment, they are often waiting longer for a bed.
In Massachusetts, one of the only points of entry to in-patient psychiatric treatment is through the emergency room. One patient, 11-year-old Claire, spent more than a week in a Boston ER this past October, her mother Lauren said. GBH News is using pseudonyms to protect Claire’s privacy.
“I was feeling bad, and I wasn’t getting help for it," Claire said. "And it wasn’t like I was in the comfort of my own home. I was in this strange place, just sitting there.”
Claire has needed multiple in-patient hospitalizations during the pandemic, her mother said. In her young life, she’s contended with several mental health challenges, including depression and anxiety. She was stable before the shutdowns, Lauren said, but she started spiraling amid the disruptions to her routine caused by COVID-19.
“It wasn’t just the schools shutting down and going virtual,” Lauren said. “It was the lack of social contact. Supports from her peers and mentors and teachers all kind of ground to a halt.”
Boston-based hospital social worker Sophie Hansen said stories like Claire's are not uncommon right now.
“What I tell patients when they’re waiting for their children to find an in-patient bed is it’s kind of a perfect storm,” Hansen said. “I don’t want your kid to be sitting here for a week, either. That’s the last thing I would want for anyone’s child.”
During the pandemic, more people are reporting mental health challenges. In findings made public earlier this month, the Department of Public Health said that 33% of people responding to its COVID-19 Community Impact Survey reported poor mental health. That is up from 11% reported in a state survey from 2019.
As more people experience mental health challenges, a shortage of psychiatric beds is leading to more patients dealing with long waits in emergency rooms, according to data from the state Department of Mental Health.
Under the department's Expedited Psychiatric Inpatient Admission policy, it can intervene to help patients find a psychiatric bed when they end up stuck in the ER for lengthy periods. As the pandemic took hold last spring, the department reduced the amount of time needed to trigger its involvement from 96 hours to 24 hours.
In June 2020, the department intervened for 325 patients. That number grew as the pandemic progressed, peaking at 742 in October. For December, the latest month for which the department has posted data, the number stood at 356. But experts say that emergency rooms are still far more crowded with people seeking in-patient psychiatric care than they had been before the pandemic.
Mental health professionals and policy advocates said that long waits for psychiatric beds is a longstanding issue that’s been exacerbated by the pandemic. COVID-19 restrictions have forced facilities to limit rooms that would normally house at least two patients to one person only, drastically reducing the number of available beds.
Another factor is where to discharge people who don’t have somewhere to live when they leave in-patient treatment. Danna Mauch, president and CEO of the Massachusetts Association for Mental Health, said patients in psychiatric beds are often kept in facilities beyond their needed treatment times.
"They have several hundred people in the different state beds around the commonwealth who could live in the community but can’t be discharged for the lack of housing and support services," Mauch said.
One relatively quick fix that could reduce ER waits would be more funding to help those lingering in in-patient care who might otherwise be discharged, she said.
"There is housing, if we’re willing to subsidize it, available in the commonwealth,” Mauch said. “I’m not saying there’s lot of it, but it’s there. You just have to be willing to step up and pay for it. And people could move pretty quickly. That would free up some bed space.”
A broad set of long-term policy solutions, many crafted in part by the Massachusetts Association for Mental Health, are being considered on Beacon Hill. Some of those efforts could ease the bed shortage, Mauch said. She credits the Baker administration and the legislature for taking steps during the pandemic to make it easier for patients to connect with and afford various forms of treatment. But given the scope and complexity of the issues at hand, relief won’t come overnight.
“There are so many dimensions of this problem that have solutions [but] that take time, talent and treasure,” Mauch said.
In the meantime, psychiatric beds are in short supply, and the long route through the emergency room is causing pain for patients and their loved ones. That’s been true for one Boston woman, Caroline. GBH News is using a pseudonym to protect her privacy, as well.
This past summer, Caroline watched as her mother, who has a long history of anxiety and OCD, was overwhelmed by symptoms brought on by the pandemic. Among them was a persistent fear that her food could be contaminated by the virus. She stopped eating, eventually losing what Caroline estimated to be roughly 20 pounds.
“It was like watching a slow-motion train crash,” Caroline said. “We began to realize that she really needed psychiatric intervention.”
Caroline's mother ended up in the emergency room on three separate occasions during the pandemic. Each was a harrowing experience, she said, with an ER visit stoking her mom’s fears that she’d catch COVID-19.
“It was a very emotional day for me,” Caroline said, reflecting on one of the visits. “She was having constant anxiety attacks, she was crying.”
Caroline said her mother’s mental health has stabilized following her most recent in-patient stay. But she doesn’t think it’s fair that people have to run a gauntlet to get the care that they need.
“Right now, when we have so many people who are understandably terrified of COVID, to ask them to go into this environment — literally the belly of the beast — to get the psychiatric care they need is so hard,” Caroline said.
Claire feels similarly. A psychiatric bed opened up after her long ER wait in October, and she spent two months getting in-patient care. It helped immensely, and Claire said that she’s now thriving. But she doesn’t want others to deal with the same long waits when the need for help is urgent.
“I just feel like there are wrongs in this world that aren’t fair and can be changed if people put effort into it,” she said.
