2013 News

RNs become activists when kids’ mental health unit comes under attack


From the Massachusetts Nurse Newsletter
July/August 2013 Edition

In April, the Cambridge Health Alliance made a stunning and unexpected announcement: it would be eliminating 11 of its 27 inpatient beds for child psychiatric care and ceasing services for children under age 8.

The CHA, a hospital system with three campuses in cities just north of Boston, had long been dedicated to caring for the emotional, mental and behavioral health needs of the commonwealth’s children. Through the unique in-patient programs and services offered at its Child Assessment Unit (CAU) and Adolescent Assessment Unit (AAU), the CHA had earned a reputation as an innovator and leader in psychiatric care for the young. In fact, the CAU has been an award-winning facility entirely focused on helping children ages 3 to 12 who are in acute emotional or behavioral distress.

That’s when the dedicated nurses who work with these troubled children decided to become advocates and worked to stop the closure.

“These are the sickest children in the state,” said Kerry McCalister, RN. “Some are suicidal or homicidal, some are experiencing auditory or visual hallucinations, and some are so aggressive they can’t make it through a school day. From an advocacy point of view, it’s very concerning because this is a time when children and families need more access to care.”

The unit’s nurses began a petition signing and button campaign to bring public attention to the issue and building a team of supporters who were dedicated to saving the CAU. Next on the agenda: putting on a show of force at a public hearing on the proposed closing.

As part of the legal process to close the unit, the state Department of Public Health invited testimony at a May hearing. Well over 100 family members, nurses, care providers, legislators and mental health advocates packed the seats and signed up to have their chance to explain why the CAU’s services are essential to the community.

“The children in the CAU come to us with some of the most challenging and d i f f i c u l t d iagnos e s that a child could ever face,” testified Gina Galarza, an MNA nurse who has worked on the unit for 13 years. “And the CAU is one of the only facilities in the state that can help them by providing age appropriate services in an age-specific environment. Where will they go if this unit is closed?”

“If the proposed reduction and subsequent closure move forward,” testified Paula Robicheau, an RN on the CAU, “the message to our very youngest patients will be this: ‘Sorry, someone else will have to take care of you, we can’t.’ For many of these young children, that is a message they have heard too many times already in their young lives: from families, from foster families, from schools, and from various placement programs. By decreasing the overall services and beds available to these children, CHA is saying that these stressed and troubled children and their families are not a priority.”

“There is no clinical justification for this closing,” testified Donna Kelly-Williams, a pediatric nurse at Cambridge Hospital and president of the MNA. “If it happens, children who are suffering from serious mental health conditions will wait longer for care, they will travel long distances for care, or they will go without care altogether. We are here today to urge the Department of Public Health to prevent this closure from happening.”

Double dose of success
Following the public hearing, the DPH reviewed the various testimonies, details and statistics with one goal in mind: to make a recommendation as to whether or not the services the CAU offers are, in fact, essential. It took less than three weeks for the DPH to decide that the unit provides essential services to vulnerable children from throughout Eastern Massachusetts and that it should be maintained.

A week later, management at Cambridge Hospital released the following statement: “We are pleased to let CHA staff know that Cambridge Health Alliance will continue operations at both the Child Assessment Unit and Adolescent Assessment Unit during the next fiscal year … we [have] received an overwhelming outpouring of support from elected officials, advocates, patient families, and local residents, who rallied in support of the award-winning, top-quality care provided at both units. Our decision to withdraw our unit integration notice was informed by this support …”

This is just the latest example of MNA nurses stepping up to support their patients, using a phrase they have said too many times in recents years: “You’re balancing the hospital’s budget on the backs of those who are most vulnerable!”

After the announcements, MNA President Kelly-Williams said, “We will forge ahead and work with all stakeholders and the recently established Mental Health Commission to address the growing mental health crisis in the commonwealth.”