Don’t close Riverview Hospital. Make it better.

In a curious coincidence, the editorial boards of two major Connecticut newspapers recently published articles on the same day calling for the closure of Riverview Hospital, our state’s only publicly-funded mental health hospital for children.

I represent an organization that calls for the improvement and expansion of mental health services in the child’s natural environment – a continuum of care that spans the home, school, and community. However, I cannot ignore the growing rhetoric to close Riverview Hospital.

To start, the numbers published in one of the editorials were not presented clearly. A bed and accompanying treatment at Riverview Hospital costs $816,000 per year; each bed serves four children every year, yielding an average cost of $204,000 per hospital stay. In all, the Hospital serves about 285 children annually.

One editorial board and the proponents of the bill to close Riverview Hospital compared the facility to privately-run hospitals around the state. For anyone who truly understands the subtleties of psychiatric treatment, such comparisons cannot be made. The patient population at Riverview Hospital requires more complex treatment than the patients at private psychiatric hospitals.

Riverview Hospital is a treatment option of last resort for Connecticut families. Here are the criteria that Riverview Hospital uses for accepting children to inpatient treatment:

Both outpatient and inpatient treatment in the child’s community has failed to improve his or her condition, and the child continues to require intensive, hospital-based care;

The child is experiencing an acute behavioral crisis requiring inpatient care, but has limited financial resources or inadequate insurance coverage for treatment at a private hospital.

Proponents of closure argue that closing Riverview would help shrink the gaping budget deficit facing our state.  How much will Connecticut save by closing the Hospital?  There is no evidence that the closure would save any money for Connecticut after contemplating the true cost to taxpayers.

Ultimately, communities from around the state will have to shoulder the public health and financial burden that closing Riverview Hospital will create. Local emergency rooms will have to treat a growing number of behavioral crises. Poorly equipped community hospitals will become revolving doors for persistently mentally ill children. School districts will face rising expenses for special education services and outplacement.

Where do the proponents of closure think this money will come from? Should we just ignore our problem and export our kids to other states? That approach currently keeps 267 children away from their families by sending them out of state, costing Connecticut taxpayers $35 million per year.

Connecticut’s children are facing a mental health crisis. Last year, 1 in 14 high school students attempted suicide and 2,000 children missed school on any given day because they were victims of bullying. About 200,000 Connecticut children struggle with diagnosable mental illness, but only 25% of them receive the care they need and deserve. Our kids and their families struggle to access mental health services, and now some politicians and their public supporters want to make matters worse?

I am stunned. In a world where we are somehow able to find billions of dollars to fight wars and bail out banks or car companies, some people are prepared to strip children and families of much-needed mental health services. Children and families struggling with mental illness often feel disenfranchised, helpless, and can’t afford powerful lobbyists.

I challenge policymakers to work with us to find creative solutions to our child mental health crisis. First, we have to build a robust continuum of mental health care that spans the home, school, and community. The centerpiece of mental health services in Connecticut must be the child’s natural environment. However, we need to continue allocating resources to hospitals that treat children struggling with acute or persistent psychiatric illness when community-based resources just won’t do. We can only begin considering closing facilities after we’ve built a local, community-based system of care that can truly serve our neediest kids.

Second, we need to invest Connecticut taxpayer money in building up our local mental health infrastructure. Let’s bring back those 267 children to Connecticut. Their families miss them, and we’d have $35 million more per year to fund community-based mental health services for children in need.

Finally, we hope the Department of Children and Families becomes a more active and vocal champion for child mental health in Connecticut. For now, most people associate DCF with child protective services or juvenile services; behavioral health must be given equal footing by the agency.

Eric Arzubi is co-chair of the Children’s Committee of the Keep the Promise Coalition and a resident physician in the Department of Psychiatry, Yale School of Medicine.

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