No one to turn to

From the Corvallis Gazette Times, December 12, 2010

Ann Weston struggled for close to a year with her son’s mental illness. She fought to make his life as normal as possible, maintaining a close relationship.

Brandon Stone

Brandon Stone

But on Nov. 4, Brandon Stone took his own life, succumbing to the disease that had haunted his family for so long.

“It was a tough road,” Weston said, remembering her 16-year-old son’s diagnosis of severe clinical depression in late 2009.

But at least one part of that road still frustrates Weston — and she’s hoping that by calling attention to the issue, she can help other families facing the same difficult journey.

“There are only two hospitals in the entire state that can take adolescent mental health patients for crisis inpatient care,” Weston said. “That’s 32 beds available.”

Legacy Emanuel Hospital and Providence Medical Center — both in Portland — are the only two care facilities that offer these services, according to the Oregon Department of Human Services. Legacy Emanuel has 17 beds for patients under the age of 18. Providence has 15 beds for adolescents aged 13 to 17, plus 10 beds for children 4 to 12.

“The whole state could use more beds,” said Dr. John Paisley, clinical director of the pediatric inpatient unit at Legacy Emanuel, but funding trends make it hard to pay for them. “It’s very sad to have kids of any age who need psychological help to not have essentially anywhere to go.”

Insisting on inpatient treatment

For Weston, the shortage became apparent last spring, when Brandon twice attempted suicide. On both occasions, Weston said, Brandon went to the emergency room at Good Samaritan Regional Medical Center in Corvallis.

“I was adamant and insistent about inpatient treatment,” said Weston, a Corvallis veterinarian. She said her knowledge of medicine aided her determination to find help for her teenage son.

“Not many parents could have stood their ground like she did,” said Weston’s partner, Rick Humphrey.

Both times, Weston said, she found emergency room doctors and other staff members uncertain about the proper protocol to follow.

On the first trip to the ER, she said, “we were there for 12 hours.” Doctors were at a loss about how to treat Brandon, given that he was only 16. She recalls an ER doctor warning her about the stigma that could follow Brandon, a student at Corvallis High School, if he were to be sent to a mental health unit. “Do you really want to do this to your son?” Weston said the doctor asked her.

He was eventually referred to Emmanuel, where he was admitted.

The second trip lasted 11 hours. She went to Good Samaritan asking for a referral to one of the Portland facilities.

This time, however, the adolescent units at Providence and Legacy Emanuel were full.

Doctors wanted to discharge Brandon, saying there was nothing they could do for him, she said.

Eventually, though, an on-call pediatrician agreed with Weston that Brandon should not be discharged. He stayed at Good Samaritan, where a nurse watched him around the clock until he was stable enough to transfer to a longer-care unit.

“I worry about the parents who wouldn’t be as persistent,” she said.

Weston has another worry as well: What about families who live even farther from Portland than Corvallis? Where do they find treatment?

“I haven’t the foggiest idea,” Paisley said. “It’s sad. It’s very difficult for everyone who has to help these kids.”

Funding issues

The reason why only two Oregon hospitals care for this niche group of patients boils down to funding.

“Everything’s money,” Paisley said. “Funding is squeezed for health care in general; psychological and mental health services get squeezed first, just like social services. It’s difficult to fund mental health services in general.”

Dr. Michael May, medical director of mental health at Good Samaritan, explained that there just aren’t enough acute adolescent mental health patients to support hospital units in other parts of Oregon.

“It’s unfortunate, but if you have somebody, a child or adolescent, that needs to go to an inpatient unit, they would need to go to Portland — which is not the best way, but it’s the only way that it can be done at this point,” he said.

In addition, May said, mental health professionals are restricted by government regulations that produce “gaps or problems in the system that are not patient-centered.”

For example, beds are not as hard to come by in adult mental health wards. But the law doesn’t allow patients under 18 to be admitted to these units.

There are good reasons, May added, why the law makes that distinction: The needs of younger patients are different from those of adults. For example, he said, “school-aged children still need to have somebody to deal with learning issues so school doesn’t completely stop. So you need specialized people there.”

The adult units treat patients from “18 to 100,” May said, with conditions such as dementia, psychosis and anxiety that come with a variety of risks.

“The mix of patients changes every day. Do you want to put a 17- or 18-year-old on a unit like that? Depending on the circumstances, it might be OK — but it might not be OK.”

For Weston, though, the bottom line is not OK: Children throughout Oregon have only limited access to immediate inpatient psychiatric care, especially in remote parts of the state.

She’s in the early stages of taking action to increase awareness of the situation. Her goal, she said, is to “develop something that works.”

“I want Brandon’s life and death to have meaning.”