Update on Seattle Children’s Mental Health ED Patient Surge

As shared in the Oct. 7 Provider News article, Seattle Children’s Emergency Department continues to see significant numbers of pediatric patients with mental and behavioral health emergencies who require inpatient admission or an appropriate discharge plan.

Please continue to advise families that if a child is experiencing an emergency, they should go to the nearest appropriate emergency department without hesitation. Youth in crisis shouldn’t travel farther than they need to. Dr. Tony Woodward, medical director, Emergency Medicine, stresses that Seattle Children’s prioritizes ED care for all patients based on assessed patient acuity and level of illness.

This surge is exacerbated by statewide capacity challenges in access to pediatric inpatient psychiatric care and long-term inpatient or residential treatment:

• Very few facilities in Washington treat children and adolescents in need of inpatient psychiatric care; two of those inpatient psychiatric units are currently closed, only one of which plans to reopen. Because Washington does not have a statewide psychiatric bed tracker, Seattle Children’s did not have visibility into inpatient psychiatric unit closures until attempting to refer patients during this surge.
• Washington state is losing 25% of its Children’s Long-Term Inpatient Program (CLIP) beds due to the planned closure of Pearl Youth Residence. CLIP was already a resource with limited capacity, having only 109 beds to serve the entire state and often running a waitlist of 60 to 90 days. This loss of capacity for pediatric treatment is already impacting access to both long-term and short-term inpatient psychiatric treatment.
• Loss of long- and short-term inpatient psychiatric capacity directly impacts Seattle Children's: high volumes of patients in the inpatient Psychiatry and Behavioral Medicine Unit (PBMU) are stuck waiting for residential treatment placement, which forces pediatric patients who need inpatient treatment to wait longer in emergency departments for an inpatient bed to become available.

How Community Providers Can Help 

• Continue to identify and manage lower-acuity complaints in outpatient settings to help maintain ED capacity for higher-acuity concerns. Please see Seattle Children’s Healthcare Professionals site for Resources for Community Providers. 
  • For urgent mental and behavioral health concerns not needing the care of an emergency department, encourage families to visit Psychiatric Urgent Care to make an in-person or virtual (video) appointment. If today’s appointments are full, tomorrow’s appointments will open at midnight tonight. 
  • Share this list of Mental Health Crisis Supports and Seattle Children’s Mental Health Resource Hub with families. 
  • Remind families that the Washington Mental Health Referral Service for Children and Teens is a free service that connects families with mental health providers in their community. 
• Before sending a patient to the ED, contact Seattle Children’s Mission Control team with as much notice as possible at 206-987-8899. This helps with planning for the patient’s arrival. In appropriate instances, Seattle Children’s may be able to directly admit a patient to the hospital or arrange an urgent ambulatory clinic visit in lieu of an ED visit. 
  • Please be aware that Seattle Children’s inpatient PBMU has limited capacity. Patients seen in Seattle Children’s ED who need inpatient psychiatric admission will be referred to appropriate inpatient pediatric psychiatric facilities in Washington. Patients will be re-evaluated daily and may discharge directly from the ED once clinical stability is reached.  
• Help set realistic expectations about an ED visit and/or inpatient admission with children, families and partners. 
  • Patients and families should be prepared for potentially longer wait times. 
  • An ED visit for mental or behavioral health typically involves an evaluation to determine if the child needs an inpatient psychiatric admission or is appropriate to discharge home.  
  • As noted earlier, referrals to the PBMU could experience significant wait times and may not result in admission; Seattle Children’s is asking all external partners to consider referring patients who need inpatient admission to all appropriate inpatient pediatric psychiatric facilities in Washington and consistently reassess need for inpatient admission. 
  • An inpatient psychiatric admission is typically 5 to 10 days and focused on acute crisis stabilization. It is not a long-term placement.  
• Advocate: Join Seattle Children’s advocacy list to stay in touch on advocacy work to support legislative and policy solutions to support youth mental health facilities.

“As our region faces these evolving challenges, we know that lasting solutions rely on strong, aligned partnerships across all levels of care delivery and government,” notes Dr. Ray Hsiao, chief of Psychiatry and Mental and Behavioral Health Services. “Seattle Children’s is advocating with community partners to convene key decision-makers – including representatives from all pediatric inpatient psychiatric facilities in Washington – to meet daily and work with us to transition these patients into appropriate care settings.”