More psychiatric hospital beds are needed for children, but the neighbors say not here

More psychiatric hospital beds are needed for children, but the neighbors say not here

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988” or texting “.

In January, a teenager in suburban St. Louis informed his high school counselor that a classmate said he planned to kill himself later that day.

The 14-year-old classmate denied it, but his mother, Marie, tore through his room and found a suicide note in his bedside table. (She asked KFF Health News to only publish her middle name because she doesn't want people to misjudge or label her son.)

His parents took him to Mercy Hospital St. Louis. According to his mother, providers told them they had no beds available at their behavioral health center, so the teen spent three days in a room in a secure area of ​​the emergency room and saw a doctor twice, once virtually.

Mercy Hospital spokesman Joe Poelker declined to answer questions from KFF Health News. Executives at Mercy and other local hospitals have described the shortage of inpatient pediatric psychiatric care beds in the St. Louis area as a crisis for years.

Nationwide, psychiatric "boarding" - when a patient waits in the emergency room after providers have decided to admit the person - has increased due to a rise in suicide attempts, among other things, and a shortage of inpatient psychiatric beds, according to a study of 40 hospitals in the journal PediaTrics. The number of cases in which children spent at least two days in pediatric hospitals before being transferred for psychiatric care also increased by 66% from 2017 to 2023, reaching 16,962 cases.

St. Louis Children’s Hospital leaders plan to solve this problem by opening a 77-bed pediatric mental health hospital in suburban Webster Groves. But as often happens with such proposals, neighbors objected. They fear it would worsen security and lower property values.

Over the past decade, on-site psychiatric facilities for minors in California, Colorado, Iowa, Nebraska and New York have also been suspended.

Behavioral health care addresses these concerns that these concerns are largely unfounded and rooted in stigma. Finding such facilities in remote areas - as neighbors sometimes suspect - reinforces the misconception that people with mental illness are dangerous and makes it more difficult to help them without their support system nearby, doctors say.

“We wouldn't take cancer with cancer and say they have to be two hours away where there's no one around them,” said Cynthia Rogers, a pediatric psychiatrist at St. Louis Children's. “These are still children with illnesses, and they want to be in their hometown where their family can visit them.”

In the United States, the number of suicides among minors increased from 2002 to 2022, according to a KFF analysis of data from the Centers for Disease Control and Prevention.

At St. Louis Children's, the crisis has increased emergency room visits, Rogers said, with behavioral health visits nearly quadrupling from 2019 to 2023, increasing from 565 to 2,176. She attributes the increase to factors such as social media, the isolation caused by shutdowns during the Covid-19 pandemic and the political climate that has made it particularly difficult for LGBTQ+ children.

“The pandemic seemed to throw gasoline on the fire,” Rogers said.

In the middle- and upper-class suburb of Webster Groves, St. Louis Children's and KVC, a behavioral health provider, want to use a site that served as an orphanage in the 19th century to create 65 inpatient beds for children who need care for about a week and 12 residential beds for longer stays. KVC now runs a school for students who struggle in traditional classrooms and provides services to help children in care.

“The introduction of a hospital into this historically significant residential area disrupts its stability by undermining its character.”

Tim Conway, who has lived across the street from the site for three decades, told KFF Health News that his opposition is primarily because the facility and its parking lots would take up more space than the existing structures.

The detailed security plans have not eased his concerns. “I wonder why it has to be so sturdy,” Conway said.

Samer El Hayek, a psychiatrist at the American Center for Psychiatry and Neurology in the United Arab Emirates, has studied how stigma affects the locations of mental health facilities around the world and said people often don't want hospitals around them because they associate them with violence or erratic behavior.

“The misunderstanding of increased danger is often based on outdated stereotypes rather than factual evidence,” said El Hayek.

Little evidence suggests that people with mental illness are more likely to commit a crime or be violent than the general population, with the exception of people with serious illnesses such as schizophrenia, who, while still less likely, are likely to commit a violent act.

However, residents near mental health hospitals have been alerted to encounters with patients who escaped or reports from law enforcement and local news of missing patients.

In Oklahoma City, Richard Scroggins in 2014 opposed the expansion of Cedar Ridge Behavioral Hospital, which then treated teenagers and adults because of its safety problems.

Scroggins, who raises horses and livestock on his property, told the Oklahoman newspaper at the time that he once found a stranger browsing in his yard. After determining the person suffered from mental illness and was harmless, Scroggins said, he called police, who called the person away.

The Cedar Ridge provider ultimately planned to expand the facility after community opposition.

Scroggins has since encountered other patients from the facility on his property, but in recent years, he told KFF Health News in February. His perspective on the hospital has changed because his co-workers have listened to his safety concerns.

“Nobody wants it in their neighborhood, but it’s a necessity,” Scroggins said. “I’m a Christian, so we should reach out and help.”

Carrie Blumert, CEO of the Mental Health Association Oklahoma, said mental health facilities are safer by providing medical care and "treating the root of people's problems rather than just throwing them in a jail cell."

In Marie's case, her son was ultimately admitted to Mercy-affiliate Hyland Behavioral Health Center and spent a few days there until a doctor told the family he probably just needed to talk to a counselor, she said. He was fired.

A day later, she said, the teen said he still wanted to kill himself, so his parents took him to St. Louis Children's, where he was admitted that same day. After a 15-minute visit, Marie said, a doctor pulled her aside and asked, "Did you ever think he might be on the autism spectrum?"

"Oh my God, you're the first person to confirm my feeling,'" Marie told the doctor.

Her son remained in the hospital for two weeks, during which providers diagnosed him with autism and prescribed antidepressants. He returned to the classroom and baseball field, Marie said, but he learned that his autism upset him.

"He's still trying to process it and he's very sensitive. And they're teenagers. When kids at school are mean to him or make fun of him, he takes it a lot more than a typical teenager," Marie said. “I have hope for him that he will be okay.”

And soon, she knows, children like her son may have another option in St. Louis when they need acute psychiatric help.

Despite community pushback, the Webster Groves City Council unanimously approved the rezoning needed for the hospital in January. Officials called opponents' concerns legitimate but said the hospital would benefit children's mental health and the surrounding community.

“This is by far one of the easiest votes I have ever received,” said Councilman David Franklin, adding that the approval shows that “Webster Groves cares not only about their own citizens, but about the citizens of this region.”

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