Ermolovich-Galenkamp-Taylor: child psychiatry services abolished again, despite a crying need

This commentary is by Jake Ermolovich, Amanda Galenkamp, ​​and Sean Taylor, third-year medical students at Larner College of Medicine at the University of Vermont. They have just completed their rotation with the University of Vermont Health Network’s Department of Psychiatry, with time spent at UVM Medical Center, Central Vermont Medical Center and Champlain Valley Physicians Hospital.

Every day in Vermont, children wait in windowless emergency department rooms for a bed at one of the region’s few pediatric psychiatric facilities.

As medical students at Larner College of Medicine, we spent six weeks in the field of psychiatry to learn more about their practices and to familiarize ourselves with a field that we might wish to pursue. The intensity and intimacy of hearing people’s stories every day is a privilege and an honor, but when it comes to finding access to treatment options, it can be nearly impossible.

On April 18, VTDigger reported that the UVM Health Network suspends its project for a pediatric psychiatry unit. In the article, UVM Health also vaguely threatened to suspend or cut plans to expand the adult psychiatric unit in Berlin. This article mentioned the lack of beds available for adults with psychiatric needs while leaving aside the crying need for pediatric beds.

Imagine some of the new challenges facing young people today. In recent years, many have suffered from the isolation associated with the pandemic at a stage when social development is essential, which has led to an increased use of social media to compensate – social media which has notably become the spearhead bullying and abuse.

These new factors add to the gauntlet of growing pains that adolescents have to deal with, as well as other psychosocial stressors that are not immediately apparent. Maybe the mystifying rise in child suicide is not so mystical.

For some, these problems come to a head, the corridor narrows and the only solution seems to be to get it over with. They come to the emergency room. Their clothes are taken and they are given thin paper scrubs for safety. Then they are isolated in a room in a closed wing of the department, often away from their parents. They are seen briefly by a doctor and told that someone else will come to see them. An hour passes. Nothing. Then another. However, no one comes to talk to them.

A day passes. Then another. They hear noise outside their room. Alas, it’s a new patient. An adult in crisis. The new patient is scared and sees things others don’t — and they let it be known. They scream words the child has never heard; however, their violent tone hints at the meaning of the words.

As the child watches, this adult undresses and urinates in the hallway outside the child’s bedroom. The adult attacks the door as urine accumulates below on the floor. Terrified, the child hides under their sheets, storing her fear in the farthest corners of her thoughts, holding her there for years until she reappears explosively – a cicada of the mind, waiting to sing the trauma she slept with. Who will hear this song? Apparently not the administration of the UVM Health Network, judging by its recent actions.

When it takes days or even weeks to be placed in a dedicated psychiatric unit, these children often cry out to leave, get help and feel safe again. They beg to get out of the emergency department every time we stop in the room. When we walk out of their rooms, we still often hear moans echoing from behind the scenes in the emergency department.

When such distressing situations occur on a daily basis, we as students feel helpless and angry because the medical system failed to help them when they needed it most. We find ourselves contemplating how our “care” affects the emotional and physical well-being of these children as they grow into adults.

Although doctors, social workers and emergency clinicians are doing all they can, patients remain in the emergency department for up to a week or more because there are no beds available. The emergency department is the best place to bring someone in crisis, but it is designed for acute remedies. Every day they become more helpless, desperate and isolated.

Many of these children are alone and only have the medical system to care for them, and yet it has failed them as well.

Although inpatient units are not perfect, they are better able to provide longitudinal care than the emergency department. Patients can work through their problems in group therapy sessions, share their experiences, and hear how others would react to them. They also have access to individual therapy, stimulating activities, coping skills building and even windows. Most of the time, they are validated. They are told that their thoughts and feelings are valuable and deserve to be shared, heard and worked on.

This system must change. How many more children will have to sit alone in an emergency room for weeks, waiting for treatment? How will this experience affect their future health? How can we expect providers and staff to effectively help patients in a system that is not designed to be therapeutic?

Right now, it feels like UVM Health Network doesn’t care about us or the kids stuck in the ER and instead interprets Walter Cronkite’s statement that “the American healthcare system is neither healthy nor caring, nor a system”.

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Keywords: Amanda Galenkamp, child psychiatry services, Jake Ermolovitch, Larner College of Medicine, Sean Taylor, UVM Health Network, waiting in the emergency room


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