This article was originally published by Dallas Morning News on September 8, 2022.
A year ago, we celebrated that state officials had partnered with UT Southwestern Medical Center to let the academic institution operate Dallas’ future public psychiatric hospital. We welcomed news about 200 new beds for people suffering severe mental health struggles, recognizing that it was a significant investment by Texas, even if it was only nibbling at a problem too big for one hospital to solve.
Today, we’re cheering on Children’s Health for growing that investment. The private health care system this week signed an agreement with state officials to donate about 100 pediatric beds to the planned Dallas hospital. The beds will be operated by UTSW.
“That is a big deal,” said Scott Schalchlin, the Health and Human Services deputy executive commissioner in Austin who oversees the state’s network of public psychiatric hospitals. “I can’t emphasize enough what the need is up there.”
Schalchlin’s comments at a legislative hearing in June revealing that this donation was in the works elicited gasps from state lawmakers. Officials stayed largely mum about the donation during the summer as they worked out legal aspects of the agreement. And only now, with the deal inked, were they willing to open up about this development in children’s mental health care in North Texas.
The families of Texas children with severe mental health challenges urgently need these beds to exist, along with an array of care options that might divert them from requiring a hospital stay in the first place.
Lindsey Tyra, executive vice president and chief strategy officer for Children’s Health, said hospital leaders have earmarked $200 million for the pediatric psychiatric beds. Children’s Health does not have a dedicated inpatient psychiatric unit, but it has partnerships with two private psychiatric hospitals and works with other community organizations to provide early mental health interventions.
“Children’s Health routinely invests in the pediatric programs and facilities that are critical to deliver care to our patients,” Tyra told us. “Noting this increasing need for pediatric mental health care, we anticipated the need for a significant capital investment in patient beds.”
Our hearts sank when the Centers for Disease Control and Prevention reported that pediatric mental health visits to the emergency room in 2020 increased by at least 24% compared to the previous year. According to recent news reports, children all over the country are “boarding” in emergency departments while they wait for a psychiatric bed to open up somewhere.
This is true even in North Texas, where there are more than a dozen private psychiatric hospitals, most of which admit some children. Dr. Hicham Ibrahim, an associate vice president and professor of psychiatry in the Peter O’Donnell Jr. Brain Institute at UTSW, said it is common for families to wait days or even weeks for a psychiatric bed.
These are families whose children are suicidal, experiencing psychosis or otherwise behaving in dangerous ways.
“Inpatient pediatric psychiatric units are not meant for ongoing care,” said Ibrahim, who also serves as chief medical officer of ambulatory services at UTSW. “They’re really there to address the critical needs when the child’s mental health condition becomes so acute that it requires urgent and intensive interventions to ensure the child’s safety.”
The new state hospital in Dallas will see patients from across the region. The proposed location is at the corner of Harry Hines Boulevard and Medical District Drive in the city’s medical district. Officials say the adult beds will open in the fall of 2025.
“We want this hospital to be first and foremost a community resource and treat the underprivileged patients,” Ibrahim said.
But a trip to this hospital is not supposed to be a long stay. It’s important for children to return home as soon as possible, and the hospital will develop individual treatment plans that make that happen, Ibrahim said.
Many of the details about the pediatric unit have not been determined yet, such as its location relative to the adult facility, the age range that will be served, the services offered or how patients will be able to access a bed. In Texas, the entry point for low-income patients is usually the local mental health authority, which directs people to available beds.
The principles guiding the hospital design, however, are starting to come into focus. Ibrahim said officials are relying on community feedback as well as best practices from modern and award-winning mental health hospitals across the country. For example, Dallas-area residents have said that it’s important for patients to have private rooms and bathrooms.
And patients shouldn’t feel trapped, which is why state and UTSW officials envision gardens and courtyards for access to sunlight and fresh air.
Every health care leader who talked with us about this hospital is thrilled about the additional beds. But these experts also emphasized the need for step-down services and early interventions that help children return to healthy lives sooner and avoid hospitalization altogether. We await details about how the pediatric wing at the Dallas hospital might connect with existing programs or perhaps even inspire new ones.
It’s impossible not to get excited about the promise this hospital holds. Ibrahim said the facility will advance research in the field of psychiatry and become a training hub for behavioral health professionals. This would address an urgent need, as dozens of psychiatric beds in the state are going unused because there is no one to staff them.
“Not only will we be relying on our own training programs, but we are also going to be reaching out to other academic programs, other universities in North Texas to see how we can come together and provide a comprehensive training strategy to all these behavioral health professionals that we need to grow,” Ibrahim said.
Dallas has accomplished mental health care professionals, but it doesn’t have the “critical mass” of people it could have with a facility like the planned state hospital, said Andy Keller, president and CEO of the Meadows Mental Health Policy Institute in Dallas.
“We have some world-class people,” Keller said. “I’m not trying to minimize the expertise we have, but we have a handful. If you have a facility like this, we could have one of the best places in the country.”
One hundred pediatric beds or so still won’t be enough to care for all the children who need the state’s help. Officials will have to figure out how to allocate limited resources among kids in the general population, foster care and the juvenile system.
Yet these 100 beds from Children’s Health are beds that we couldn’t count on yesterday. Every single bed is a ray of hope for a family, and for that we celebrate.
The full article is available online here.