Washington youth facing mental health crises are stuck living in hospitals, waiting for care

Charlie Edgmon missed huge milestones the year he spent locked inside Seattle Children’s Hospital in Seattle. He didn’t celebrate his 18th birthday. He missed his high school graduation. Nearly every holiday was spent alone.

But for all those months inside Seattle Children’s, Charlie wasn’t receiving the psychiatric care he needed. Instead, he was waiting in limbo, unable to be safely discharged until he could secure proper outpatient services to support him at home.

I came across Charlie and his family while reporting a series of stories on a particularly grim corner of the youth mental health crisis. His predicament — living for weeks or months in a hospital setting that lacks psychiatric staff or the specialty care they need — is referred to as “boarding.” When I met him, he’d spent 330 days languishing inside a psychiatric stabilization unit meant for short, 7- to 14-day stays.

Through the course of my reporting, I learned there were hundreds of Washington youth like Charlie. Every day, about 30 youth are living in Washington emergency rooms or hospital wards as they wait for an inpatient psychiatric bed or other long-term care, according to the Washington State Health Care Authority. Washington has only 94 inpatient beds to serve the state’s 1.1 million children, and waitlists for these beds are 6 to 9 months long. Some families are so desperate for care that they look outside the state’s borders. So far this year, at least 89 youth have been sent out of state to specialty schools or residential programs, according to the state’s Office of Developmental Disability Ombuds.

Access to youth psychiatric care became even more dire during the pandemic. A serious staffing shortage forced two of the state’s four youth residential facilities to cut the number of available psychiatric beds. And even though Washington youth have a legal right to care that allows them to live at home instead of an institution, my reporting found that state psychiatric outpatient teams served far below their service targets for the past four years. As need for psychiatric care increased during pandemic times, these outpatient providers fell further and further behind their treatment goals.

Charlie and his family were luckier than many others I met. He couldn’t leave the hospital grounds — not even for a walk around the block — but he was living in a unit staffed by therapists and psychiatrists.

Seattle Children’s is one of few hospitals statewide with a dedicated psychiatric stabilization unit. Many children who board are living inside windowless emergency rooms or on a busy medical/surgical floor — units that typically lack staff who specialize in psychiatry. Medical professionals who work on these units say they’re ill equipped to handle the often-complex needs of youth with serious psychiatric symptoms. And these units are overstretched and under resourced: some lack the basics, like showers, and others are so over capacity that they’ve set up cots in staff offices and other overflow rooms for youth who are boarding.

The series of stories I produced on this boarding crisis, called “Housed at the Hospital,” drew the attention of lawmakers, hospital officials and outpatient providers responsible for improving care. With the spotlight on this issue — and with support from the USC 2022 Data Fellowship — I intend to dig more deeply into how the boarding crisis is playing out in various corners of the state.

To do this, I plan to analyze data from the state’s Department of Health to better understand how children in need of intense psychiatric care are being served across Washington’s many mental health deserts — regions without a dedicated children’s hospital, youth psychiatric unit or other specialty care.

I want to better understand inequities in access to care, such as how geography, race and age relate to how long youth spend boarding. I intend to estimate the annual cost of boarding — both to taxpayers and more generally. And I want to understand which diagnoses are most likely to result in boarding — information that could inform policymakers as they consider which patient populations to focus on.

Boarding is a signal of serious, deeply ingrained holes in Washington’s pediatric mental health system. I hope that this data-driven project will help add heft and clarity to the picture of this crisis, and compel elected officials and the medical system to build investments and strengthen public policies to better serve the state’s most vulnerable youth.