Kids desperate for inpatient psych care have few options in WA

There are only 84 publicly funded psychiatric beds for over 1.6 million kids in Washington, and the waitlist can span half a year or more.

A woman sits in a chair looking at the camera

Penny Quist, in her Ephrata home in Grant County on Jan. 3, 2020, has driven all over the state to get psychiatric care for her son. They had been to Seattle Children's behavioral care unit twice, driving almost three hours across the state, until he was finally given a bed in a highly coveted inpatient facility in Lakewood. (Dorothy Edwards/Crosscut)

They’ve made numerous trips to pediatric emergency departments. They’ve called law enforcement and engaged crisis teams. They’ve used the state’s wraparound services, often an insurance requirement before receiving further care. They’ve driven hours across the state to get to Seattle Children’s hospital. They’ve been on the waiting list for months to receive the most precious commodity of all, an inpatient psychiatric bed.

And they’re at wits’ end.

They are Washington families who have youth with severe behavioral health needs. The children might be homicidal, suicidal, violent, intellectually disabled or chronically mentally ill. Every child is unique, but they all need one thing: long-term inpatient psychiatric care.

Unless a family can afford private services or are approved for out-of-state care, they need a CLIP bed — Children's Long-term Inpatient Program — the only publicly funded long-term inpatient psychiatric care for youth in Washington. While it’s labeled “long-term,” stays are usually less than 12 months, and not long enough for some children who need continued behavioral health resources. 

Thirty-two children are currently on the official waitlist for a CLIP bed at one of five facilities, according to Sean Murphy, assistant secretary of the Department of Social and Health Services’ behavioral health administration. And the number of people wanting a bed is even higher. Those on the waitlist are families who have already gone through a myriad of other required services, been given referrals, filed the paperwork, presented their case before a committee and, finally, been approved.

After all of that, they then typically spend three to six months or more of waiting for the bed, depending on how quickly children are discharged and beds are made available. 

In the meantime, some are going to the Psychiatry and Behavioral Medicine Unit, Seattle Children’s hospital’s specialized psychiatric facility for children.

While there are some other acute care hospitals for youth — Smokey Point in Marysville, Fairfax in King and Snohomish counties, Sacred Heart Children’s and Inland Northwest Behavioral Health in Spokane — nothing compares with Seattle Children’s, considered the gold standard for acute care youth hospitals by many families and behavioral health teams in Washington.

Seattle Children’s accepts referrals only from emergency rooms, which means ERs across the state are calling the unit for help. Maureen O’Brien, director of the psychiatric unit, said over half of the youth they serve are from outside of King County. The unit maintains a computer database with a queue of all the youth waiting for one of its 41 beds.

This means the unit can run out of beds — O’Brien said sometimes it’s “packed to the gills” — so it works closely with social workers and mental health evaluators. Last year, Seattle Children’s created six new ICU beds for those who need more intense care or have violent behaviors. 

Children’s is one of only two acute care hospitals for youth under 13 in Washington. The other, Kitsap Inpatient Youth Services, sometimes accepts younger children, but has been closed since March because of COVID-19.

According to Washington State's 2018 "Healthy Youth Survey," one in 10 high schoolers say they have attempted suicide in the past year, and one in five have seriously considered it, with even higher rates among LGBTQ youth. 

With that high of a need, youth psychiatric beds are in high demand. Yet for the over 1.6 million youth in Washington, there are only 84 publicly funded psychiatric inpatient beds for youth: 37 are split among four community-based CLIP facilities contracted by DSHS and 47 at the only DSHS-run facility, the Child Study and Treatment Center in Lakewood.

This summer, 12 to 14 more beds will be added to one of those community-based facilities, Pearl Street Center in Tacoma, according to Elizabeth Venuto of the Healthcare Authority’s Division of Behavioral Health and Recovery. DSHS’s Murphy said 18 more beds will be made available at the Child Study and Treatment Center in 2021 — 10 civil and eight forensic (those involved in the court system) — thanks to funding from the Legislature. 

One of the largest gaps in care is the dearth of a centralized resource system to help families navigate the youth psychiatric system in Washington: “Knowing how to find things is a really big problem,” O’Brien said. 

More partial hospitalization programs and intensive outpatient programs, which would reduce the need for emergency rooms, is greatly needed, said Alysha Thompson, a Seattle Children’s  psychologist. The hospital’s psychiatric unit is meant only for short-term behavioral stabilization, meaning most stays are around a week, although some youth can stay for months, if safety is deemed a risk factor.

Although more outpatient care, such as seeing a therapist, would be helpful, that system is also overburdened, although Seattle Children’s has created a “crisis service program,” which allows next day appointments through telehealth.

Its team of psychiatrists will also provide referrals, which is required to receive a CLIP bed. If a child’s behaviors and needs are deemed extreme enough — harm to themselves or others is a large factor — that makes a difference on how fast the child can be placed.

Richelle Madigan holds a picture of her son Christian at their Moses Lake home on May 28, 2020, on one of his old toy cars. Christian was finally was given an inpatient bed at the Child Study and Treatment Center in Lakewood, which will be his second time there, after staying in the Sacred Heart pediatric emergency department for over a month. (Emily McCarty/Crosscut)

Richelle Madigan holds a picture of her son Christian at their Moses Lake home on May 28, 2020, on one of his old toy cars. Christian was finally was given an inpatient bed at the Child Study and Treatment Center in Lakewood, which will be his second time there, after staying in the Sacred Heart pediatric emergency department for over a month. (Emily McCarty/Crosscut)

Dina Solman, who lives an hour south of Seattle in Graham in Pierce County, is awaiting one of those Child Study and Treatment Center beds in Lakewood for her adopted 11-year-old daughter, Jasmine, who will be admitted in September. 

Solman legally adopted Jasmine and her sister, technically her grandchildren, after her daughter died in 2011. Jasmine has been diagnosed with ADHD, autism, oppositional defiant disorder, disruptive mood disorder and reactive attachment disorder, among others.

She’s also been in the Seattle Children’s unit three times since May. Because Jasmine is under 12, that is Solman’s only inpatient option for now.

Solman applied for a CLIP bed in December of last year, but was denied until she worked with the Healthcare Authority’s WISe program (Wraparound with Intensive Services) for several more months. In March, she applied again. Now, Jasmine has a bed secured in Lakewood in September. Until then, Solman is scrambling to find a place for Jasmine, who is violent toward Solman, her sister and herself.

“There's nothing. Places are booked. They have too many kids already, or they're not placing kids,” Solman said, adding that she thought there was a possibility of a bed at Twin Rivers in Yakima but because of COVID-19 they’re not taking children. “I feel like I go down this road, and somebody gives me a gleam of hope, and I follow that gleam of hope. … Then when I get there, there's a brick wall.”

Solman said they’ve tried outpatient services but Jasmine desperately needs that inpatient help. Jasmine has run away, started fires, kicked holes in the wall, choked her sister as well as Solman and has been suicidal and homicidal.

“I have to walk on eggshells, because I don't know how she's going to react,” Solman said. “When I say something, when I do anything that makes her mad, you don't know [what she’ll do].”

Now, she just calls the police. And waits.

Richelle Madigan, a mother of seven in Moses Lake, has used Spokane’s Sacred Heart Hospital pediatric emergency room since June 12, when her son, Christian, was discharged from an inpatient facility in Spokane. Christian also has violent behaviors and has put his family’s safety at risk many times. He is autistic, with disruptive mood dysregulation disorder, ADHD, oppositional defiant disorder and other diagnoses.

Christian’s ER room had no windows, no way to exercise, no access to the outdoors because he would run away, said Madigan. He can have crayons, because they aren’t sharp, can watch TV and listen to music. While the Madigans feel safe with Christian there, Christian has been highly distressed in the hospital, Madigan said, and they were eager to get him into CLIP.

Christian finally entered the Lakewood facility last week. This will be his second time in the CLIP program. He was last discharged in 2018. 

“I’m grateful. This is an unbelievable situation no family should have to endure, let alone multiple families,” Madigan said. “There needs to be some contingency planning for people who enter crisis situations, because I’ve been contacted by families who are going into other ERs and getting sent away because they’re full past capacity … and we’re talking about children who are beating up their parents at home or putting siblings at risk.”

Another mother, Penny Quist, currently has a son at the Child Study and Treatment Center. Quist, a long-time advocate for youth behavioral health and mother of a teenage son with intense behavioral health needs, has taken her son to Seattle Children’s twice. Quist lives in Ephrata, a small town in Grant County that’s almost a three-hour drive from Seattle, but it was her only option. Grant County’s services weren’t enough for her son, who had threatened to hurt himself and others. She has five other kids and sits on numerous boards of behavioral health and other youth programs. She’s busy. But she has no other options. 

On her second visit to the Seattle hospital, she was told it would be three to six months before he would get his CLIP bed, which is a normal wait time. When she was told it was time for her son to be discharged, because 13 children were waiting for his bed, Quist disagreed, saying her son was still suicidal and she couldn’t risk taking him home. 

Her only option after discharge was to walk right back into the ER and readmit him. That was her plan, but the night before his discharge, he punched another youth in the head and caused brain trauma. Seattle Children's Hospital denied that the injury happened in their hospital, but Quist said it absolutely did, and their denial may be due to a lawsuit by the assaulted child's parents.

“After [my son] did that, he had a CLIP bed in six days. Why did it take my child almost killing another child and giving him a brain injury to get that clip bed?” Quist asked. 

Quist is extremely grateful for the placement in Lakewood, which she said has been the best in-state option for her son.

The Child Study and Treatment Center, run by the Department of Social and Health Services, is the only one of the five CLIP facilities with high acuity beds — beds for youth who need higher levels of attention — which makes the beds highly sought after. 

But the facility in Lakewood is by no means the end of the road for Quist, or Solman, or the Madigans. 

While their children’s short term psychiatric needs will be met in CLIP, they will eventually be discharged. A lot of families want therapeutic treatment at a residential facility, which currently only exist out of state. Madigan said the reason Washington won’t bring these facilities in-state is mostly because the age of consent in Washington is 13, which means teens can sign themselves out of treatment. They also want more options like the unit at Seattle Children’s, better community wraparound services, more pediatric emergency rooms, easier systems to navigate and, most importantly, more CLIP beds.

“We aren't at the finish line yet. We still have to make it to a place where chronically violent disabled kids in Washington state can receive treatment in Washington state, while keeping our families in one piece,” Madigan said. “I will be doing everything in my power to advocate that we bring those necessary and very needed treatments to Washington state.”

This article has been updated to include a reaction from Seattle Children's Hospital regarding Penny Quist's son assaulting another child.

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