A hospital doctor’s view from the frontlines of the adolescent mental health crisis
This article is part of an ongoing series in The Recorder focusing on the child and adolescent mental health crisis. This in-depth series will examine the barriers and difficulties teens and children face in receiving care, as well as a ground-breaking local initiative to address the problem. Future articles will share the perspectives of students, parents, mental health providers and emergency practitioners, among others. Articles will contain material that some readers may find disturbing.
By MELISSA WHITWORTH
Dr. Richard Catanzaro is the head of psychiatry at Northern Westchester Hospital. This means that he sees children and adolescents in their deepest moments of need in the emergency room. He is the point of contact when the situation for children and their parents has become life or death, and, he said, this shouldn’t be the case.
“When I am seeing kids, they are being brought into the emergency room in a crisis,” Catanzaro said. “And when they come in in that crisis, my available solutions to that crisis — they are binary solutions.”
By binary, he means the choices are either to admit a child who is considered suicidal or to send them home. A child or teen who is considered to be in danger of self-harm is held at the hospital until inpatient care can be found, he said. There is no inpatient psychiatric unit at Northern Westchester Hospital. If the child is released, the parents are handed a list of local, and not so local, mental health professionals to call and navigate alone. Most of those providers will have long waiting lists. (Parents have told The Recorder the waiting time can be anything from six months to a year in some cases).
As a senior local mental health practitioner, Catanzaro is on the frontlines of a growing national problem. The Centers for Disease Control and Prevention has found that our youth are experiencing unprecedented mental health struggles, with sharp increases in depression and suicidal thoughts.
Prior to the pandemic, screen use and the proliferation of social media were thought to be the chief instigators in the rapid decline of young people’s mental health. But research has confirmed that the downturn in mental health began before the advent of widespread social media use. Between 2009 and 2019 there was more than a 40 percent increase in suicidal behaviors among high school students, the CDC found.
What does the local hospital’s head of psychiatry think about the current way of treating children and teens who are experiencing depression and suicidality? “I think it’s terrible,” said Catanzaro. “It pains me not only as a professional but as a parent and a human being,” he said. “Because many times someone is coming in and they’ve just had an awful day, an awful week and something may have set off a crisis. They really just need a safe space and structure to get themselves back on track. But I feel many times it’s like using a sledgehammer to kill a fly.”
The ER experience is traumatic and dehumanizing and rife with bureaucracy, Catanzaro said.
Every mental health professional The Recorder interviewed for this series reiterated their view that the ER of a hospital is not the right place for any child with mental health concerns to be treated. “And I think it’s really not very sincere of us as a society to be imploring kids to speak out about their mental health, and then rushing them to the hospital,” said Catanzaro. “You have to know what you are going to do with that information. And if then the answer is, well, I’m going to incarcerate you and terrify you — this is not the answer.”
Catanzaro has been practicing at NWH for 10 years. The current treatment solutions locally and nationally for children and teens struggling with mental health amount to systemic failure, he said. Does he feel that the system is failing him as a practitioner and his ability for him and his team to do his job?
“Yes, I do. I think there’s a tendency then to kind of pathologize typical human responses. I have, and my team has, made an effort to do community programs and outreach to schools, but by and large, when I am seeing kids, it is when they are being brought into the emergency room.”
There are many reasons why we have reached this failure of treatment. Firstly, there is a severe national shortage of child and adolescent psychiatrists according to data published by the American Academy of Child and Adolescent Psychiatry in 2022.
When Catanzaro was applying to medical school, he was warned away from psychiatry by the doctors interviewing him, he recalled. “An ophthalmologist said to me in the interview, ‘Why would you want to do psychiatry? Those people don’t get better.’ So I said to her, which I still believe, first of all, people do get better. They do.”
Secondly, he said, is the problem of money. Psychiatrists and psychologists generally don’t want to work in hospitals because they don’t make as much money as they can working outside of the hospital. Psychiatrists in particular do not want to take insurance because insurance companies pay “next to nothing — pennies on the dollar” Catanzaro said, compared to what they cover for other areas of medicine. “Psychiatrists are getting short-changed for their work,” he said.
Psychiatrists who do take insurance are likely seeing 50 patients a day to make their practice financially viable. There simply isn’t enough time in the day to sit with each patient for 45 minutes to an hour.
Additionally, he said, “There aren’t a ton of providers who want to take on the risk when a patient is discharged and they aren’t able to see them for two months or three months.”
Still, Catanzaro powers forward.
“Why do I do it?” he repeated an interviewer’s question. “This is a story I tell a lot. My mom is a social worker. She’s 79 and she’s still practicing. She has worked for 30 years in a public high school where she will pick truant kids up from their beds, literally go to their bedside and pull the sheets off of them and put them in her car and get them to school so they will graduate.”
“She is passionate about these kids who don’t have a voice and who maybe didn’t have the parents who had the wherewithal or the means to advocate for their kids. She would be their voice. And I saw that when I was this little. My mom is 5-foot nothing and weighs a hundred pounds soaking wet and she was a force and she saved kids’ lives. And she told me — she calls me ‘Richie’ — she said, ‘Richie, whatever you do, don’t be a social worker. You get no respect.’”
And so Catanzaro turned to psychiatry instead.
‘The current treatment solutions for children and teens struggling with mental health amount to systemic failure, according to Dr. Richard Catanzaro, head of psychiatry at Northern Westchester Hospital.’
Catanzaro and his team have managed to make some positive changes for the children who wait at NWH for inpatient help.
“When there is a lack of beds, it becomes a logistical and potentially legal nightmare,” he said. “There are rare occasions where we know there are no beds because we’ve started early on a Friday morning. We know that in the world of psychiatry, unlike the world of general medicine, you don’t get discharged on the weekends. Everything shuts down. So in those cases, depending on the severity of the case here, locally we’ve decided that it is slightly more humane to move those kids that are going to be here for two or three or four days to the pediatric medical unit.”
“It’s still medicalized,” he continued, “but they have a TV and they have windows. We’ve had kids stay for five days, I will tell you that. That sounds outrageous. And it is. It is a nightmare, absolutely.”
Coming next: Child psychologists and social workers will speak about what they are experiencing in their outpatient practices.