Moving Upstream from the ED: How the Network Creates Infrastructure for Improving Behavioral Health Care
By Henry T. Sachs III MD, President Bradley Hospital, Jim Shmerling, President, Connecticut Children’s
“Every child who shows up in the Emergency Department
in crisis is a sign that we, as a society, have not done enough to
support them at other points in their journey.”
The Beginning
Back in 2021, in the middle of the pandemic, Bradley Hospital and Connecticut Children’s met to discuss a shared problem. Our emergency departments were overflowing with children and teenagers in crisis. Beds were full in our inpatient psychiatric units. Acutely ill behavioral health patients were boarding in the EDs or in medical-surgical wards for days or even weeks with nowhere to go – itself a traumatic experience.
What we saw in our hospitals in New England reflects a national trend – in the early months of 2021 there was a 51% increase in ED visits for suspected suicide attempts. COVID-19 shone a light on more than a decade of decline in children’s mental health. Supports for families and communities have frayed, and teenagers themselves have faced a toxic combination of stress from social media compounded by the isolation and uncertainty of the pandemic.
As acute hospitals we witnessed the depths of the crisis in children’s behavioral health. Half of children who seek behavioral health care do so for the first time in the ED. That’s neither a humane nor an efficient way of delivering care. Every child who shows up in the ED in crisis is a sign that we, as a society, have not done enough to support them at other points in their journey. We need to move care away from crowded emergency departments and into homes, schools and communities, with a focus on prevention.
Rising to the Challenge
The problems we face are clearly bigger than any hospital, or sector, or state, can address singlehandedly. Given that demand for behavioral health care is likely to outstrip the supply of qualified psychiatrists, psychologists and social workers for a generation, it’s clear that we have to move away from a purely clinical model of how we provide care. In effect, to address a challenge of this scale, people across society will have to rise to the challenge of becoming the workforce for behavioral health.
We created the New England Children’s Behavioral Health Network to provide an infrastructure to bring stakeholders together at a regional level to share learning and meet our common challenges. We want the Network to be a forum for health care providers, educators, policy makers and community organizations to engage on our common challenges and collaborate to find solutions.
As a Network, we envision a radically different model of care; one that is centered on families and communities. We want New England to become, as our logo suggests, a beacon for providing behavioral health care that is equitable, innovative, preventative, high-quality and sustainable, and where we can measure the impact on children’s lives.
We’re excited that our new website will provide a forum for sharing expertise across states and sectors, sparking collaboration and advocating for change. We’d very much like you to join us on this journey to improve care for children and families across our region. Join the network here, contact us with your ideas, and join our events.
