Children's Wisconsin adds mental health team to ER, responding to rising rates of self-harm

About 70 times per month, a child or teenager arrives at the Children’s Wisconsin emergency department in a mental health crisis. Maybe they have a self-inflicted injury, maybe they attempted suicide, or maybe they just can’t stop thinking about it and their families don’t know where else to turn. 

Regardless, there are no mental health specialists there to greet them.

This summer, responding to a growing need, the hospital plans to change that. For the first time, children in the emergency department will have access to a team of mental health professionals, funded by a three-year $2.5 million grant from the United Health Foundation.

“If you come to Children’s with a broken arm, we make sure those experts are there. We’re going to do the same thing for kids who come to us with a mental health issue,” said Amy Herbst, vice president for mental and behavioral health at Children’s.

The team will include a pediatric psychiatrist from the Medical College of Wisconsin, three social workers specializing in mental health, a supervisor and a navigator to help patients find the next step for their care. They hope to start in August. 

Other children's hospitals throughout the country have already formed similar teams, and officials hope the Wisconsin model will inspire more to follow suit.  

The initiative, which was planned before the coronavirus pandemic, is a response to a long trend in rising numbers of young people and their families seeking help for mental health crises — nationally and locally. 

“We have doctors and nurses that are excellent, but they weren’t mental health experts,” Herbst said. “We thought we could do better.”

Studies have shown such teams have shortened how long patients stay in an emergency room (often just waiting for care), decreased how often patients are physically restrained and cut costs per visit.

RELATED:Children's Wisconsin announces $150 million five-year plan for mental health care

In Wisconsin, the number of children and teenagers visiting emergency departments after self-harm more than quadrupled between 2002 and 2018, according to a Milwaukee Journal Sentinel calculation from state data. 

In 2018, Wisconsin young people under age 18 visited ERs 2,246 times for self-harm injuries, according to state data. Of those, 1,398 involved teens ages 15-17, meaning there were about six visits for every 1,000 teens in that age group. 

The pandemic has only made the need more clear, and mental health professionals are bracing for rising mental health challenges. They are already seeing the impacts of isolation, financial stress, disrupted routines and other traumas related to coronavirus. 

Linda Hall, director of the state Office of Children's Mental Health, said she hopes the team will be able to catch mental health problems that might not be immediately obvious to other clinicians. 

"The idea that they’ll be doing a deeper look, understanding what’s beneath their presenting issues, and helping them and their families plan for after hospitalization, should really help for kids to get some more consistent treatment," Hall said. 

Children’s is able to medically stabilize children after a self-injury, but the hospital hasn’t had mental health professionals to help calm patients down, counsel them, find the best place for them to get help next or follow up and make sure families found ongoing care. 

About a quarter of the children who come to the emergency department with a mental health crisis don’t have an injury at all. But they, or their families, are scared of what will happen without quick assistance or supervision from mental health professionals. 

"They literally do not know where else to turn so they land with us," said Amanda Quesnell, director of mental and behavioral health at Children's. 

Most young people who come to the emergency department in a mental health crisis do not need inpatient psychiatric care, Quesnell said. The mental health team will be able to help them plan for safety and connect with a therapist, psychiatrist or another outpatient program for follow-up care. 

The hospital already has a social worker that helps families connect with such providers, but they haven’t had time to consistently follow up with families to make sure they get what they need. 

About a quarter of emergency mental health patients do need inpatient care, Quesnell said.

Most of these children are transferred to Rogers Behavioral Health, while others go to Ascension or Aurora Health Care, and a declining number go to the county-run hospital.

Children’s does not and will not offer inpatient mental health care, but the new mental health team will help families connect directly with inpatient options. This will reduce the need for families to visit the county-run psychiatric emergency department, which county officials ultimately plan to close. 

Herbst said visits to the Children’s emergency department for mental health crises will be billed the same way as visits for other medical emergencies. She noted that copays for all types of visits are currently waived for those with BadgerCarePlus and Medicaid — and will be through June 30.

Ellen Sexton, CEO of UnitedHealthcare Community Plan of Wisconsin, said she hopes the grant helps catch mental health issues earlier, connect patients with care and reduce return visits to the ER — something that could ultimately save money and be replicated in other hospitals. 

"You could even think about this for adults, she said. "You could look at other children’s hospitals throughout the country. Generally speaking, the concept of medical and behavioral health integration is something that’s been promoted more. Having it right in the emergency department when people have the highest need makes a lot of sense." 

Leah Jepson, director of the Milwaukee Coalition for Children's Mental Health, said she's heard of many situations where patients and parents have been frustrated by how ER staff have responded to mental health crises across the state.

Jepson said she hopes to see Children's Wisconsin involve young people and their families in meaningful discussions about how the team can best respond in various situations. 

"Bringing a group in who are disproportionately impacted by trauma and behavioral health concerns to get feedback on what works and what doesn’t work would be critical," she said. 

Jepson is hopeful the team will be a step in the right direction, and would like to see it expand. 

"There’s a critical need for mental health services in emergency rooms," Jepson said. "There was a need before COVID and I can’t imagine there not being a need as we start the second phase of whatever this will look like next." 

Resources

• National Suicide Prevention Lifeline: 800-273-8255
• HOPELINE: For emotional support, text "Hopeline" to 741-741
• Milwaukee County 24-hour crisis line: 414-257-7222. When needed, a mobile team can meet adults and adolescents anywhere to talk and connect them to resources.
• Milwaukee Coalition for Children's Mental Health: Find resources for mental health support, assistance with other basic needs, and tips for helping children cope with life during coronavirus at mkekids.org. 
• Wisconsin Office of Children's Mental Health: Find resources for accessing health care, hotlines, peer support, child care and more at children.wi.gov.

Rory Linnane reports on public health and works to make information accessible so readers can improve their lives and hold officials accountable. Contact Rory at (414) 801-1525 or rory.linnane@jrn.com. Follow her on Twitter at @RoryLinnane.