Kids in crisis

COEUR d’ALENE — With limited mental health care options for children available in North Idaho, all too often, families are forced to sit on waitlists or hope a child is able to develop coping tools to guide them away from having a crisis. 

When things hit a critical stage and youth require urgent, inpatient treatment, psychiatrist Lauren Boydston is there to help them at Kootenai Health’s Youth Acute Unit, which provides care on the unit for children ages 10 to 13 and adolescents from 14 to 17. But Boydston knows families are often stuck in limbo wondering if care will become available before a crisis or if their kid is suffering beyond what they can cope with.

“When do you need help?” “And is it going to go away on its own, or is this something more?” are two questions she has found parents of young patients often grappling with. 

“I sometimes wonder when someone identifies the problem to their parents and they first tried to find someone, if they had been able to get into therapy earlier, would it have gotten to this point and level of complexity? Many haven’t been able to find anyone with an opening and here they are in crisis,” Boydston said.

When families of children with mental health conditions wade into the water to connect their child to a counselor, it becomes apparent there’s not much available in the community. Untreated depression or untreated disorders can make people more likely to self-harm. 

For kids coming into the emergency room having a mental health crisis, Boydston said some of them have been on waitlists for months. Among the families who have been able to find youth mental health providers, often those providers don’t take their insurance, which means they’re paying out of pocket. This can create financial hardship for a lot of families. 

One trend that Dr. Hinah Parker, medical director of pediatrics, has noted is that many of the youth coming through the inpatient mental health services at Kootenai Health have had higher acuity cases, meaning severe and imminently dangerous.

“These kids can tell you they’re spiraling and sometimes we can’t do anything about it until they’re acutely spiraling,” Parker said.

Her job is to medically assess them so that they can be cleared for outpatient behavioral health.

Having gone through her residency in Los Angeles before moving to Idaho, she has been surprised to see so many families of patients here stating their immense relief when their child is admitted for emergency care.

“You can tell they’re just going through it. These kiddos have gone so far that when they’re coming in to us they already have suicidal ideation,” Parker said.

Her biggest concern is that the system is leaving children by the wayside because there aren’t enough mental health providers to help everyone in crisis to the degree they need.

“Getting your child into inpatient behavioral health is such a relief for parents and I’m trying so hard, and I feel like I’m not doing everything. It’s an ethical quandary, it weighs on you day after day. My training means nothing if I can’t get them to these other services,” Parker said.

Families need to follow up with outpatient pediatricians and mental health providers for intensive counseling after spending time in the Youth Acute Unit.

“We found it’s become difficult to secure the first therapy appointment after leaving the hospital when they didn’t have a therapist coming in. In those situations, sometimes our only choice is to put them on waitlists and ask that the therapist or agency prioritize them if they can and call them when a spot is available. Our case managers are sometimes calling multiple agencies for a patient and have noticed that it’s hard to find someone who takes Medicaid in particular,” Boydston said.

Mental health and disordered eating

In addition to generalized mental health providers for youth being hard to find in the region, resources for issues like disordered eating are nearly nonexistent.

“We’re very limited, there are very few specific places available. There are some providers in the community who are more comfortable taking patients with eating disorders, but I’m not aware of any specific programs here. If they need a higher level of eating disorder care, they’re sent out of state,” Boydston said.

Disordered eating often comes with a set of mental health problems like anxiety and depression. Parker rues that from a medical standpoint, the system provides little in the way of support until youth become medically ill and qualify for services.

“Disordered eating is challenging because people often try to hide their symptoms. You might not even recognize it until they become medically sick which brings it to light,” Boydston said.

For families with youth wrestling with disordered eating, there is a dedicated outpatient care program in Spokane called the Emily Program Eating Disorder Treatment Center. For residential treatment, kids are often sent out of state, primarily to the Seattle area if families are able to secure payment for it, and if there’s an availability. There are also providers who don't focus exclusively on disordered eating but feel comfortable with guiding families through the outpatient treatment process.

Whether youths with disordered eating receive extended treatment through residential care or outpatient programming, traveling either to visit or to take children to services can have a big impact for families.

“Eating disorder work in adolescents is a lot of family work and it’s hard to do family work when you’re hundreds or thousands of miles away,” Boydston said.

Find a better way for youth

Boydston hopes the state will find ways to provide primary care providers more support, such as the patient call line Washington and other states have implemented to aid pediatricians who have identified mental health crises in their young patients. 

“You go to your primary care providers, who are doing their best but they’re not mental health providers. This wasn’t their specialty training. We need more mental health professionals for people to go to who can make that assessment and waitlists become very overwhelming,” Boydston said.

Boydston envisions a new system that would provide outpatient resources when kids come into the emergency room with mental health crises. In this better system, staff would be able to readily give families a list of providers who would actually have availability in their schedule to see new patients. 

In the face of a scary mental health crisis their child is dealing with, Boydston envisions a better system that would empower them by sending them home with that list of places to receive mental health care with the agency to do it on their own. 

“If we were to have more therapists, more evidenced-based treatments available that aren’t just medication, and also if there were more adolescent psychiatric providers available in the community accessible to all kinds of insurance, Medicaid, private, and you had openings to see new patients when they need to be seen, that would be so ideal,” Boydston said.