More psych hospital beds are needed for kids, but neighbors say not here

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting "988.”

In January, a teenager in suburban St. Louis informed his high school counselor that a classmate said he planned to kill himself later that day.

The 14-year-old classmate denied it, but his mother, Marie, tore through his room and found a suicide note in his nightstand. (She asked KFF Health News to publish only her middle name because she does not want people to misjudge or label her son.)

His parents took him to Mercy Hospital St. Louis. According to his mother, providers told them they didn't have beds available at their behavioral health center, so the teen spent three days in a room in a secured area of the emergency department and saw a doctor twice, one time virtually.

Joe Poelker, a Mercy hospital spokesperson, declined to answer questions from KFF Health News. Leaders of Mercy and other local hospitals have described the shortage of beds for inpatient pediatric psychiatric care in the St. Louis area as a crisis for years.

Nationwide, psychiatric "boarding" — when a patient waits in the emergency room after providers decide to admit the person — has increased because of a rise in suicide attempts, among other mental health issues, and a shortage of inpatient psychiatric beds, according to a study of 40 hospitals in the journal Pediatrics. It found the number of cases in which children spent at least two days in pediatric hospitals before being transferred for psychiatric care also increased 66% from 2017 through 2023 to reach 16,962 instances.

St. Louis Children's Hospital leaders aim to address that problem by opening a 77-bed pediatric mental health hospital in the suburb of Webster Groves. But as often happens with such proposals, neighbors objected. They worry it would worsen safety and lower property values.

Over the past decade, proposed psychiatric facilities for minors in California, Colorado, Iowa, Nebraska, and New York have also faced local resistance.

Behavioral health care advocates counter that such concerns are largely unfounded and rooted in stigma. Locating such facilities in remote areas — as neighbors sometimes suggest — reinforces the misconception that people with mental illness are dangerous and makes it harder to help them without their support system nearby, doctors say.

"We wouldn’t take children with cancer and say they need to be two hours away, where there is no one around them," said Cynthia Rogers, a pediatric psychiatrist at St. Louis Children's. "These are still children with illnesses, and they want to be in their home city, where their family can visit them."

In the United States, the number of suicides among minors increased 62% from 2002 to 2022, according to a KFF analysis of data from the Centers for Disease Control and Prevention.

At St. Louis Children's, the crisis has fueled more emergency room visits, Rogers said, with behavioral health visits nearly quadrupling from 2019 to 2023, jumping from 565 to 2,176. She attributes the increase to factors such as social media engagement, isolation caused by shutdowns during the covid-19 pandemic, and the political climate, which she said has been particularly hard on LGBTQ+ children.

"The pandemic seemed to throw gasoline on the fire," Rogers said.

In the middle- and upper-class suburb of Webster Groves, St. Louis Children's and KVC, a behavioral health provider, want to use a site that served as an orphanage in the 19th century to create 65 inpatient beds for children needing care for about a week and 12 residential beds for people requiring longer stays. KVC now runs a school there for students who struggle in traditional classrooms and offers services to help children in foster care.

"Introducing a hospital into this historically significant residential area disrupts its stability by undermining" its character, one resident testified at a January City Council meeting.

Tim Conway, who has lived across from the site for three decades, told KFF Health News that his opposition is primarily because the facility and its parking would take up more space than the existing structures.

The detailed security plans have not eased his concerns. "It makes me wonder why it needs to be that robust," Conway said.

Samer El Hayek, a psychiatrist at the American Center for Psychiatry and Neurology in the United Arab Emirates, has studied how stigma impacts the locations of psychiatric facilities around the world and said people often don't want the hospitals nearby because they associate them with violence or unpredictable behavior.

"The misconception of increased danger often stems from outdated stereotypes rather than factual evidence," El Hayek said.

Little evidence suggests that people with mental illness are more likely to commit a crime or be violent than the general population, with the exception of people with a severe illness such as schizophrenia, who, while it's still rare, are likelier to commit a violent act.

But residents near mental health hospitals have been rattled by encounters with patients who escaped or reports from law enforcement and local news about missing patients.

In Oklahoma City, Richard Scroggins in 2014 opposed the expansion of Cedar Ridge Behavioral Hospital, which then treated youths and adults, because of its security issues.

Scroggins, who raises horses and cattle on his property, told The Oklahoman newspaper at the time that he once found a stranger raking leaves in his yard. After determining the person was suffering from mental illness and harmless, Scroggins said, he called the police, who retrieved the person.

The Cedar Ridge provider ultimately dropped plans to expand the facility after community opposition.

Scroggins has since encountered other patients from the facility on his property but none in recent years, he told KFF Health News in February. His perspective on the hospital has changed because its staff addressed his security concerns.

"Nobody wants it in their neighborhood, but it's a necessity," Scroggins said. "I’m a Christian, so we are supposed to reach out and help."

Carrie Blumert, CEO of the Mental Health Association Oklahoma, said psychiatric facilities make surrounding areas safer by providing medical care and "treating the root of people’s issues rather than just throwing them in a jail cell."

In Marie's case, her son was ultimately admitted to Mercy-affiliate Hyland Behavioral Health Center and spent a few days there until a physician told the family he probably just needed to speak with a counselor, she said. He was discharged.

A day later, she said, the teen said he still wanted to kill himself, so his parents took him to St. Louis Children's, where he was admitted the same day. After a 15-minute visit, Marie said, a doctor pulled her aside and asked, "Have you ever thought that he might be on the autism spectrum?"

"'Oh my gosh, you’re the first person to validate my feeling,'" Marie told the doctor.

Her son stayed two weeks at the hospital, during which providers diagnosed him with autism and prescribed antidepressants. He returned to the classroom and baseball field, Marie said, but learning he has autism upset him.

"He’s still trying to process that, and he’s very sensitive. And they are teenagers, so when kids are mean to him at school or make fun of him, he takes that to heart way more than a typical teenager would," Marie said. "I have hope for him that he will be OK."

And soon, she knows, kids like her son could have another option in St. Louis if they need acute psychiatric help.

Despite community pushback, the Webster Groves City Council unanimously approved the rezoning needed for the hospital in January. The officials described opponents' concerns as legitimate but said the hospital would benefit children's mental health and the surrounding community.

"This is by far and away one of the easiest votes I've ever had to take," said Councilmember David Franklin, adding that the approval demonstrates that "Webster Groves cares not only about its own citizens but the citizens of this region."