By Emma Cotton/VTDigger
RUTLAND — Health care providers hope a new $600,000 pilot program, coming to Rutland this fall, will help reduce mental health crises that send a high number of children and teens to the local hospital.
On average, young people visit Rutland’s emergency room more often than in most other parts of Vermont. Those visits often become extended stays as children and teens wait for treatment, which can be taxing for the child, the family and the hospital.
Those high numbers made Rutland a good fit for the first phase of this program, said Laurel Omland, director of the child, adolescent and family unit at the Vermont Dept. of Mental Health. If it’s successful, Omland said, the department will work to offer similar programs elsewhere in the state.
Looking at data gleaned through all-payer claims, she said Rutland has a high percentage of kids who have repeatedly visited the emergency room for mental health reasons. While the trend dates back to before the pandemic, Omland said Covid-19 exacerbated the problem.
From June to December 2019, 26 kids waited for treatment at Rutland Regional Medical Center. At the beginning of the pandemic, from January to July 2020, that number decreased to 20 kids, as many families likely avoided the emergency room, but during the last six months of 2020, as the pandemic peaked, 56 kids visited the emergency room because of mental health.
“In those moments, it’s putting pressure on emergency departments that were already having capacity challenges,” Omland said. “And from a mental health provider perspective, it’s also frustrating for them because they’re trying to get the right services in place in a timely way to meet the needs of kids and families.”
Officials at the Vermont Dept. of Mental Health identified Rutland Mental Health Services, part of the Community Care Network, to carry out the program. This fall, it will roll out mobile response teams that will respond immediately to calls, arriving at a child or teen’s home to deescalate situations before they become emergencies.
The teams could include a clinician and a case manager, and they’ll respond to calls seven days a week during the day. The exact hours will depend on staffing, but Rutland Mental Health’s existing crisis service is available around the clock.
The new program will offer a different service from the existing crisis team, said Doug Norford, director of child and family services at Rutland Mental Health.
“This is really being positioned as a support service,” he said. “In the continuum of services, it would fall right before emergency services, so we can respond to folks as things are escalating to prevent it from going to a crisis level.”
The team will serve any child up to age 18, and in some cases will continue to serve young adults who, for example, may be in school. An important component of the program, formerly called Mobile Response and Stabilization Services, is that the family — not the provider — can decide whether the incident rises to a level that requires outside support.
There are still some situations, Norford said, where it will be best to refer the child and family to the emergency room — particularly if a child is in immediate danger of conducting self-harm or hurting someone else and needs constant supervision.
“But there’s also plenty of families that have the ability to keep their child supervised and keep them from hurting themselves,” he said. “So we’ll assess situations and really help the family make decisions around preferably the least restrictive, but still safe, way to go about it.”
Norford said the visits will most likely help the families connect to longer-term services and other community resources that can help them.
An alternative to the hospital, Rutland Regional Medical Center typically refers children who need inpatient treatment to the Brattleboro Retreat, but it can take days or even a week before a bed opens, said Sheena Daniell, the hospital’s nurse director of emergency services.
“We’re kind of used to the longer stays,” she said. “We’re just not used to the high volume and longer stays, which has definitely taxed our system and our flow in the emergency department.”
Children who are admitted to the hospital’s psychiatric ward receive one-on-one support from staff members who specialize in mental health, Daniell said, but if there are too many psychiatric patients, the hospital can run into capacity problems with too many beds filled.
“Right now, there’s very limited resources for school counselors, primary care providers — even our mental health clinicians,” Daniell said. “They don’t have the space or capacity to respond in the moment to some of these kids.”
This pilot program, she said, will allow kids to receive treatment in a setting that feels more comfortable to them and where their needs can be addressed more directly.
“If a patient’s having a heart attack, our staff are very well trained,” Daniell said. “They know exactly what to do, and they can actually intervene and help the patient. But it’s frustrating for us — we can support [mental health patients], but we don’t have the resources to treat them.”
Many of the kids admitted to the hospital are at risk of self-harming behaviors, while others have been admitted because of aggressive behaviors, said Matthew Sommons, medical director of psychiatric services at Rutland Regional. He’s seen suicide risks in kids at a younger age than usual.
“Now we’re seeing suicidality dip down into 10, even 8,” he said. “It’s really sad.”
The emergency room, Norford said, is not where a child would receive treatment. “There’s some situations where that might be the best place for them and the safest place for them,” he said. “But if there are alternatives where we can get started on treatment and potentially strengthen the family’s ability to manage that situation — keep their child safe — then we’d rather see them in the community.”