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The child and adolescent mental and behavioral health inpatient care facility at Bergen New Bridge Medical Center has 17 beds and for a long time ran an average census of eight to 10 patients as young as 5 years old and as old as 17. On occasion, the hospital would see an influx of kids, but recently that influx has turned into “a bit of a tsunami,” said CEO Debbie Visconi.

“Over the past year or the past six months, that unit is full to capacity almost all the time,” Visconi said. “We’re seeing a tremendous uptick in the needs of children and adolescent mental and behavioral health services in New Jersey. We’ve seen hospitals in our region not able to handle the children because they don’t have the facilities or the extensive programs we have, and many times these kids might sit in an ER with nowhere to go.”

It’s clear to Visconi that the crisis in children’s mental and behavioral health is closely tied to the pandemic and its implications.

“The isolation, being remote learning for such a long time, certainly drained their mental health. There’s fear–-they’re hearing all these things about infections and getting sick and being contaminated. Their parents being out of work, there’s much more domestic violence than ever before. The parents are experiencing their own mental health issues … all of that put together for the children is really damaging their mental wellbeing,” she said.

“I think the masking is another factor contributing to this as well. They don’t see faces, you don’t get the full feel of the individual, and masks can be frightening to children as well,” said Visconi. “All of that has been contributing factors to what we’ve seen.”

As many hospitals aren’t equipped to deal with mental and behavioral health issues, kids sometimes end up in the ER because their parents don’t know there are other options. Enter Bergen New Bridge’s Hope and Resiliency Center, an adolescent intensive outpatient program the system launched six months ago to address issues that don’t require inpatient care but do require a higher level of care and attention.

The Hope & Resiliency Center is a clinic-based mental health program that enrolls at-risk children and teens in eight-to-10-week programs that aim to initiate change primarily through symptom assessment, individualized planning, interventions, and skill development.

“We call it that because we want to remove stigma from it, and to teach them how to deal with it,” Visconi said. The thrice-weekly programs integrate family group meetings and multi-family skill development to improve outcomes. Thus far, 433 group sessions and 113 individual sessions have taken place in the six months since it opened.

For many, the outpatient program has offered an outlet to address their issues early enough to head off a need for inpatient care. But given how busy the inpatient program has been in recent months, Visconi said the hospital would like to expand its beds if the Department of Health allowed.

“Quite frankly if we doubled it in size, it wouldn’t be an inappropriate bed capacity, and I don’t think we’re seeing all of the kids coming through the doors,” she said. “The parents are embarrassed. When they reach out to me, it’s sort of in the dark of the night. But I always say, if you have a mental health issue, it’s no different than having cardiac arrythmia or high [blood] pressure. Many of those are lifestyle issues, and things that can be fixed or managed.”

Increasing bed capacity requires a hospital to demonstrate need in a particular service line, and it’s historically been a long process. Visconi said that she hopes Commissioner Judy Persichelli understands the desperate need for inpatient mental and behavioral health care in New Jersey.

This year, Bergen New Bridge plans to build a new emergency department to expand access to mental health and behavioral health services alongside an acute care department. The new ER, which Visconi said should be open in 2023, will include a special pod for children to address mental health emergencies away from where adults address theirs, and will also have a “living room” concept space for those who need clinical treatment but warrant a more relaxed, homey environment to get through their crises.

The build-out will happen in an existing space within Bergen New Bridge’s Paramus campus. The new mental and behavioral health emergency room will have 30 available beds.

Much of Bergen New Bridge’s adolescent mental and behavioral health care is covered by insurance, with 42% of patients using private insurance while half using government insurance. The reimbursement, though, isn’t always as consistent as it is for such services as cardiac care.

“I think there’s still an evolution among society and insurance carriers to really understand mental health, behavioral health, and even addiction. I think over the last couple of years, people are becoming more understanding that you can’t have physical health if you don’t have mental health. They go hand in hand,” Visconi said.

Bergen New Bridge isn’t the only system to recognize the need for more beds. In December, Hackensack Meridian Health said it planned to invest $35 million at Perth Amboy’s Raritan Bay Medical Center, in part to expand behavioral health care beds.

At the time, HMH Behavioral Health Care Transformation Services President Donald Parker described the Raritan Bay expansion as vital and timely: “As the COVID-19 pandemic has reminded us, readily available psychiatric services are essential to the overall health and well-being of the citizens of New Jersey.”