Connecticut is dismantling its system of mental health care for children

For the first time in her short life, 16-year-old “Michelle” (some information altered to protect her identity) had begun to thrive. Because of parental abuse and neglect which contributed to her significant psychiatric problems, “Michelle” has been in the care of the Department of Children and Families (DCF) for much of her life.

Her problems led to multiple hospitalizations and foster placements (more than 30 placements in all) and finally a group home where she received intensive treatment. She had finally been stable for more than a year, but this summer she was abruptly moved by DCF to yet another placement, since DCF was closing her group home, one of five closed this summer.

Her new placement was in a different community, it was not equipped to handle her problems, no time was allowed to find proper follow-up treatment, and her treatment team was not consulted in the decision process.

“Michelle” is just one of the victims of DCF’s dismantling of the safety net.  Since 2011 there have been funding cuts of more than $179 million that are undermining all aspects of the mental health care of our children and youth.

This has resulted in less access to acute inpatient and longer term therapeutic settings, such as the group home “Michelle” was living in, as well as community based outpatient services.

Many severely traumatized and psychiatrically ill children must now wait days in hospital Emergency Departments (EDs) with no immediately available treatment options.  Over the past three years, these cuts have coincided with an increase of over 20 percent in expensive psychiatric ED visits, contrasted with a steady decline in psychiatric ED visits from 2001-2011.

Indeed, since these cuts began, the number of children spending more than two nights in the psychiatric ED has skyrocketed, increasing six fold. In 2014 there has already been a 50 percent spike in ED visits over 2013 in New Haven and Hartford alone.

Empty longer-term therapeutic beds exist in Connecticut largely because of the continued denial of the appropriate level of care for many children by DCF. “Michelle” was removed from her successful treatment at her group home creating one of these “empty” beds. Clinical judgment from those treating these very at-risk children – physicians, psychologists, and social workers, and even pleas for help from parents – are often disregarded or ignored.

Recently the federal monitor overseeing DCF admonished the agency for cutting funding for long-term care without reinvesting these funds for alternative community-based care and suggested these cuts be scaled back until such alternative care is in place.

Saving money by eliminating necessary services for children and youth is unwise, short-sighted and dangerous. A child with cancer would not be denied curative treatment because it is too expensive, or because a hospital cancer ward is being closed.  Cost cutting and service restructuring must allow for parallel services so that no child’s care is in jeopardy

In the wake of Sandy Hook, there now is a comprehensive plan in Public Act 13-178 to meet the mental health needs of all children in Connecticut.    Though the plan was enthusiastically endorsed by Commissioner Joette Katz and Gov. Dannel Malloy, it is unclear whether there is a commitment to funding.

In light of these concerns, we urgently recommend the following: a moratorium be placed on eliminating longer term care beds, further mental health funding cuts be halted immediately, and funds saved from previous elimination of services be utilized to bolster community-based services so that the mental health needs of the children and youth of our state can be met.

Furthermore, to deliver the quality of mental health care these children deserve and to have a more efficient system of care delivery, practicing child and adolescent psychiatrists must be involved with DCF’s clinical and policy decision-making and implementation.

This administration’s well-intentioned support of PA 13-178’s plan falls short of what all of Connecticut’s children need for their safety and well-being.  Connecticut’s children and families need to have a safe and healthy future that is not further marred by individual and communal tragedy.

Andrew Lustbader, M.D., is president of the CT Council of Child and Adolescent Psychiatry. Brian Keyes, M.D. is president of the Connecticut Psychiatric Society. Sandra Carbonari, M.D. ,FAAP, is president of the Connecticut Chapter of the American Academy of Pediatrics.