Wisconsin childrens' mental health concerns; emergency system strained

MILWAUKEE - A specific crisis is sending more children to the emergency room, and the reason is not always obvious from the outside.

"When kids are in crisis and families have nowhere to go, they come to the emergency department," said Allison McCool, a social work supervisor at Children’s Wisconsin.

Where worry mixes with hope and crisis meets care, the emergency room treats all the obvious ailments, from burns to broken bones. It’s also increasingly host to visits related to traumas less visible.

Dr. Jennifer Zaspel is a psychiatrist on a special team at Children’s Wisconsin -- a crisis response team developed in 2020 specifically for increasing children’s emergencies regarding mental health.

"We’ve all known for quite some time that something’s going on," Zaspel said. "But it’s really, the pandemic kind of like through gasoline on that fire."

Since 2013, data from Children’s shows a general upward trend of visits to the hospital’s Emergency Department and Trauma Center for mental and behavioral health crises. In 2013, there were 722 such visits. That number was 1,399 in 2021 and 1,292 in 2022.

"We have whole spectrum of care," Zaspel said. "The emergency department isn’t always best place to start, but we recognize we’re a safety net and sometimes that is the easiest place to start."

Family feels strain on mental health resources

It’s a place Janelle Flintrop has found herself so many times that she’s lost count.

"In the last week, (we’ve been to the emergency department) three times," Flintrop said. "In the last year, I would probably guess 15 to 20. In the last five years probably over 50."

She’s a proud mother to three children, including 16-year-old Korynne, who she said loves art and K-9s.

"She, most of the time can be pretty much of a jokester. If I could picture her in a classroom, I would say class clown," Flintrop said. "A little bit sassy sometimes, but that’s typical teenager. She’s a fun kid."

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Her daughter’s mental health struggles, including bipolar disorder and suicidal ideation, have put Flintrop in a nearly unimaginable position.

"She said if I go home I’m going to break a glass and slit my neck," Flintrop said, referring to a recent trip to the hospital. "I don’t want to wake up to find my kid dead…There’s many mornings I think about, ‘Is my kid going to be awake or alive when I wake up?’"

Even stronger than that fear is her love, which fuels her perseverance.

"Facilities, especially after the pandemic, are super full," Flintrop said, adding that it can be hard to find a facility that is willing to work with her daughter, who has been labeled aggressive in the past. "We’ve been trying to find a place residential to take her for probably two to three months. (We’ve) probably called over 30 places or filled out applications."

It’s easy to feel stuck, when Flintrop said so many other children struggle with mental health issues as well.

"Now with the crisis of mental health, they can pick and choose who they want to take, and if you have someone who’s a level one needing help versus a level ten, they probably will take the level one. In a sense, I can’t blame them, but my kid still needs help," Flintrop said. "The system is failing these people, not only the kids, but the families who want to help their kids."

"I think the needs are high, and it’s more than the community can handle," McCool said. "There always could be additional resources in the community."

Emergency visits, sign of larger national emergency

All the emergency visits are part of a big national emergency.

The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association have declared children’s mental health a national emergency, with disproportionate impacts on communities of color.

"This worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by COVID-19 and the ongoing struggle for racial justice and represents an acceleration of trends observed prior to 2020," the associations’ joint release from October 2021 said. "Rates of childhood mental health concerns and suicide rose steadily between 2010 and 2020 and by 2018 suicide was the second leading cause of death for youth ages 10-24. The pandemic has intensified this crisis: across the country we have witnessed dramatic increases in Emergency Department visits for all mental health emergencies including suspected suicide attempts."

"It’s a problem that was actually getting worse steadily over the last decade, and all of a sudden, the pandemic hit," said Dr. Allie Hurts, the pediatric emergency department medical director at UW Health.

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UW Health said in 2012, their pediatric emergency department saw about 15 patients a month who required psychiatric care. By 2022, that number jumped to more than 40, with the greatest increase because of overdoses and suicidal thoughts.

Hurst said over the last year alone, they’ve had more than twice as many emergency department visits specifically related to psychiatric complaints and suicidal ideation.

"It’s astonishing, and a lot of the primary care clinics are trying to manage this as well, as are outpatient psychiatrists, and they are so overwhelmed with patients that have these suicidal thoughts that they end up overflowing into the emergency department," Hurst said.

She said one of the most striking things they’ve seen is an "exponential increase" in visits from patients younger than 13.

"We’re seeing an increase overall, but at the same time we were shocked to see those numbers come out," Hurst said.

COVID-19 and its isolating effects worsened an existing problem with many factors, Hurst said, including one at everyone’s fingertips.

"This is a multi-component issue, not just social media, but that I do believe is one of the main components that has exacerbated this so much over the last decade," Hurst said.

"Social media has definitely been a factor," McCool said. "We’re hearing that from kids as well when we’re seeing them, that the bullying has increased."

Crisis Response Team impact

At Children’s Wisconsin, they say they're cautiously optimistic their crisis response team is making a difference, offering a collaborate approach with follow-up care after an emergency department visit. That includes a "navigator" who follows up with every patient and family seen for mental and behavioral health needs who can facilitate connections to resources.

"We are starting to see a decrease in the amount of return visits to the emergency department, which I think speaks volumes to the work we are doing with patients and families," McCool said.

While Flintrop and her daughter have been to the hospital multiple times since Flintrop’s interview with FOX6 News in early February, she won’t stop fighting to get her creative, funny, sassy daughter to a place in life where she’s safe.

"There’s just so much, so I feel like a lot of people are falling through the cracks," Flintrop said. "I have so many health care workers say, ‘You’re so helpful with this.’ What happens to the kids who don’t have moms or dads or grandparents or whoever to advocate a lot for them?"

When should I take my child to the emergency department?

It’s not always easy for a parent to determine the best course of action when their child is experiencing a mental health crisis.

"If you have outpatient team, therapist, counselor, primary care physician, those are great places to start," Zaspel said. "If you’re unsure if the emergency department is the right place for you, there are some pretty hard and fast rules."

She said if a patient has tried to harm themselves, or they have, they are absolutely in need of medical assistance and should come directly to the emergency department.

Zaspel added that Children’s Craig Yabuki Mental Health Walk-In Clinic is another option. It provides same-day care for children and teens ages 5 to 18 experiencing urgent mental health issues, designed to offer an alternative to urgent care and the emergency room.

There are also immediate resources available, including the National Suicide and Crisis Lifeline, which you can reach by calling or texting 988. Trained professionals can help walk families through the next best step.