Public Safety Net: Maintain Children’s Mental Health Beds
By Bella Sood
Richmond Times-Dispatch, Feb 15, 2010
Children are our future. No one disagrees with that. We were children once and how effectively someone tended to our needs contributed to our developing into constructive members of society.
Intuition supported by research confirms that unmet physical or mental health needs of children are likely to lead to marginalized adults who cannot contribute meaningfully to society. Despite the implicit truth in these statements, children have very few voices who plead with lawmakers for resources on their behalf.
This is excruciatingly true for children with mental health needs who are at the low end of the totem pole of fiscal priority. With the current economic climate, there is a dire need to find savings. Fiscal discipline is necessary, we all agree. Fairness and equity can make cuts palatable.
In the state of Virginia, of the 1,600 public mental health beds, there are only 64 beds allocated to children. These beds are what we consider the “public safety net.” They are meant to admit and treat young children with serious emotional problems who will not be admitted to other facilities because they are seen as too high-risk or because they are either uninsured or underinsured. These are children who are chronically ill and cannot remain at home — and there is no mechanism for them to be stabilized other than within an inpatient setting.
To eliminate the beds for these children, as is being considered by the legislators, would have drastic consequences for the safety of families and the children of this state.
Why should the state bear the cost of the Commonwealth Center for Children and Adolescents (CCCA) in Staunton and Marion, you ask? Proponents of the cuts may argue that child beds could still exist but the solution is the privatization of these beds. Legislators may affirm this solution: “Why not? That’s the sector that still has money!”
I would argue that privatization is no solution for a public safety net for children. The privatization of child mental health beds seems viable on the surface but ignores the diverging missions of safety-net hospitals and private-sector hospitals.
The planning team convened at the direction of the General Assembly to study this issue concluded that the private sector cannot support the needs of children hospitalized in public beds. When the rubber meets the road, private hospitals will refuse to admit these patients as they are either too dangerous for them to handle or there is no mandate for them to do so. For these reasons, I believe this is a dangerous road to take.
The commonwealth will be forced to allow dangerously ill children to remain at home with inadequate or no services or to purchase costly out-of-state placements when crises erupt, forcing the children of Virginia to be carted off far away from their families at a high cost. If not out of state, they may end up in the only other system that will take them: the juvenile justice system, an obvious but costly and inappropriate fix.
If one has to look for cuts and keep a portion of the child safety beds open, the cuts should be spread proportionally among the adult mental health beds across the state. Children should not be bearing the burden. This is short-sighted and targets the most vulnerable portion of our population.
The Virginia Tech massacre is erroneously cited as the reason adult mental health beds should not be cut. As one of the eight members of the governor’s Virginia Tech panel, I can say with conviction that the panel recommendations clearly did not suggest this course. The report emphasized the need to improve access to outpatient services and case management.
The tragedy unfortunately has focused attention on commitment laws and adult inpatient services. Seung-Hui Cho was able to find an inpatient psychiatric bed with relative ease; what he did not get were important follow-up outpatient services because of a variety of different reasons that this column cannot address. It is an error to assume that the report suggests that adult inpatient beds should be preserved at their current number at the cost of eliminating public child beds.
Anyone who understands the larger picture has to appreciate how important parity for both these populations is: children and adults. Children grow up to be adults. Cho’s history is a poignant illustration of the fact that when he received services as a child he was successful enough to enroll in Virginia Tech. Adequate treatment of children allows them to grow into productive adults.
The most disenfranchised and vulnerable population of our commonwealth needs a voice. This is an attempt to speak on their behalf. Lawmakers, please don’t penalize children because they cannot lobby for their needs. This is not a euphemism: They really are our future. Invest in them. Keep our safety-net beds open.
Aradhana Bela Sood, M.D., MSHA, is professor and division chair of Child and Adolescent Psychiatry at Virginia Commonwealth University, and president of the regional organization, American Academy of Child and Adolescent Psychiatry. Contact her at bsood@mcvh-vcu.edu or (804) 828-4058.
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