ED Boarding a Struggle for Patients, Hospital Staff

One family’s story of pain and frustration

By Dave Northfield

It was 3 a.m. one early morning in March of 2016. Parent’s intuition made Garth Ellefson bolt upright in bed.

Something was wrong. He followed the thumping noise to his son’s room, where he found 15-year-old Erik bumping into the door jamb over and over. He had taken an entire bottle of Benadryl plus some anti-depressants and cough medicine. Erik survived, but his parents were terrified and struggling to understand what was happening.

“He couldn’t tell us why,” said Ellefson.

That began a frustrating journey deep into Oregon’s system of mental health care for Erik and the Ellefson family.

Erik thrived in school and sports until he was 14, when his father said his son’s behavior “did a full 180, and we didn’t see it coming.”

After the near overdose, Erik’s girlfriend revealed that he had expressed suicidal thoughts. Erik was diagnosed with anxiety and severe PTSD, which his father attributes in part to difficult times in the family during Garth’s recovery from a head injury.
“His perfect life was turned on its ear,” said Garth. “In retrospect it all makes sense. But in the moment, it didn’t compute.”

Erik’s case illustrates a harsh reality: even with a caring family, a good support system, and a nearby hospital (St. Charles Bend), there is not a clear treatment path forward for Erik and other patients moving in and out of mental health crises. That’s especially true for young patients.
“We have a nationwide shortage of pediatric psychiatric care,” said Michelle Brenholdt, Director of Emergency Services at St. Charles’ hospitals in Bend and Redmond.

Brenholdt is an expert in this area, and not by choice. She knows Erik Ellefson’s story is a common one. When the teen has been in a mental health crisis, his parents take him to the emergency department until his condition stabilizes. It’s a safe environment, but all agree that it’s not a therapeutic one.
“It’s busy and chaotic, not the best place for someone suffering from mental illness,” said Brenholdt.

Another problem: the path from crisis to stabilization takes time—often several days. But those patients are not admitted to the hospital unless there is a medical need. Instead, they stay in the emergency department in a kind of limbo that has come to be known as “ED boarding.”

After Erik’s near overdose in 2016, Garth Ellefson said his son had “a couple of suicide attempts” before he spent several days in the ED at St. Charles Bend (Ellefson works in IT at the hospital). Garth said the counselor for the outside agency managing youth mental health cases at St. Charles told them that Erik needed to go home since he was no longer suicidal. His parents did not agree.

“It was a pretty terrible experience,” said Ellefson.

The closest in-patient pediatric psychiatric facility is in the Portland area, and there is often a waiting list for available beds. Erik was admitted to one of the facilities, but “it didn’t go well,” according to his father.

In the meantime, Brenholdt and her St. Charles team have worked hard to improve the patient experience for Erik and others like him.

“We have told him he can stay (in the ED) as long as he needs,” Brenholdt said, and the hospital provides a “safety sitter” for ED boarders. But she knows it’s not the best situation.

“We can have pediatric patients in the ED for 7-10 days,” said Brenholdt. “In rural areas, there is even less access to pediatric psychiatry services. In Redmond, we’ve had a patient in the ED for 19 days. He didn’t meet the criteria for admission.”

When patients are discharged, the hospital now provides a strong network of wraparound services, including diligent follow-up and caring contacts.

Brenholdt said there’s a critical need for beds in the community for crisis stabilization. Ellefson agrees. “We’ve seen an astronomical growth in the number of teenagers suffering from depression and who are suicidal,” said Brenholdt.

With increased awareness of the ED boarding problem, there is now momentum building to search for solutions. OAHHS introduced SB 140 in the current legislative session. The bill seeks to set up a pilot project with stakeholders looking for answers in the community.

Garth Ellefson said his son has attempted suicide eight times and has boarded in the ED several times. Garth praised the changes at St. Charles, calling the improvements “remarkable” for both the hospital staff and the contract counselors who work with Erik. For that they are grateful, as well as to all the people at St. Charles who have worked so hard for them in difficult circumstances.

Even though the family can only hope that one day there will be better in-patient mental health care options for Erik and others facing similar challenges, they do know this: they will never stop fighting for their son.