My son, Ethan, is 11 years old and has always been unique. From his very first days, he faced challenges, including a mysterious bout of sepsis that struck shortly after his birth. As a baby, he was aptly described by his grandfather as “a worm in hot ash.” While he communicated well when calm, his emotional state would often plunge him into what we came to recognize as his Fugue State—an autistic meltdown.
By the time Ethan was 6, he had a little sister and received a diagnosis of autism spectrum disorder, which later evolved to include a mood disorder, anxiety, dysgraphia, and increasingly severe outbursts. Despite the support of medication, an amazing private school, therapy, and countless hours of hard work, everything culminated in a crisis on an otherwise lovely October day in 2017.
My husband, Daniel, called me, his voice trembling with emotion. “Ethan has lost control at school. They can’t manage him. We need to take him to the ER.”
When I arrived, four staff members struggled to keep him from bolting into the street. It had been a tough week; the renewal of his IEP for our North Carolina Disabilities Grant added significant stress to our home. Earlier, Ethan had faced disciplinary action, which, as many parents of children like Ethan know, can sometimes backfire and exacerbate the situation.
Fortunately, we had a good relationship with the school’s mental health director, Alice Thompson, a strong advocate for children’s mental health. In the past, we had nearly called the police on Ethan during severe episodes, but never before had there been issues at school.
Ethan experienced what is termed a psychotic break. It’s a heavy label, but the essence is that, in that state, he poses a risk to himself and others. During these Fugue States, Ethan is unrecognizable; reason and punishment have no effect.
Ethan meets all the criteria for autism. Since he was 18 months old, he has been obsessed with cars, demonstrating extraordinary pattern recognition and an IQ that’s off the charts. Yet, he struggles with social interactions, executive functioning, and understanding others’ perspectives. Although he can appear charming in social settings, he is often trying to manipulate situations to align with his desires. Once he flips into a meltdown, he cannot control his emotions, and various triggers can flip that switch.
But Ethan is also an intelligent and caring person. He adores animals and enjoys figuring out how things work. He stands up for kids who are smaller than he is and, while he connects with others primarily through his love of cars, he genuinely tries to engage. Unfortunately, with each meltdown becoming more prolonged and violent, he is increasingly self-critical, expressing a desire to be “normal” and fearing that we love his sister more than him.
We have read extensively to understand him, but the insights from Ross Greene’s works have been particularly enlightening. I truly believe if Ethan could manage his emotions, he would—his skills just aren’t quite there yet.
What It Means to Wait
For children in Ethan’s situation, the only option is to wait in the ER. In a frightening turn of events, we had to send him to the ER in a police car out of concern for his safety and those around him. Once the on-site psychiatrist confirmed his need for hospitalization, she provided us with a list of around 20 hospitals from Charlotte to Wilmington. Unfortunately, there are very few psychiatric beds, and the psychiatrist warned us that “this process takes time.”
We thought we would hear back within days; we never anticipated such a lengthy wait. We checked him in on a Friday, which meant nothing would happen over the weekend. Now, over 200 hours later—more than a week—we are still waiting.
This waiting has entailed:
- Moving between four different rooms
- Interactions with numerous nurses
- Encountering many other kids in similar situations
- Experiencing panic attacks and meltdowns
- Use of restraints and antipsychotic medication
- Countless calls to facilities and state representatives
And we’re still counting the hours of missed work.
Ethan held on for four days before his emotional state deteriorated, which honestly surprised me. Daniel and I left on a Tuesday night, feeling drained after learning that he had been restrained—information the hospital had not shared with us. We filed a grievance, and they are “looking into it.”
According to the World Health Organization, mental health problems among children and adolescents are on the rise, and this trend is expected to continue. Each time Ethan is moved, he must recalibrate, consuming significant energy. I understand this isn’t what ER staff signed up for either. Some nurses have been compassionate—one named Mark even commented that he had rarely seen a child with as much anxiety as Ethan.
However, not all interactions were supportive; some staff members have been dismissive or even mocking. When I visited Ethan, I found him in tears, a rare sight for my usually stoic boy. He was overwhelmed, shaking, and struggling to breathe during his first panic attack. I mistook it for a seizure—his neck stiffened, he was sweating profusely, and his face turned blotchy. Thankfully, the nurses checked his vitals and managed to calm him down with medication. Yet, he hadn’t seen daylight in nearly a week, trapped in a stuffy room with no windows.
When another panic episode struck that evening, I approached the new nurse, who met my mention of “panic attack” with eye rolls, even though this was a child who had entered the ER expressing suicidal thoughts.
Mental health solutions are not straightforward, especially when non-medical systems lack preparedness to address acute psychiatric issues in children. A study presented at a Senate hearing noted that thousands of children with psychiatric disorders were improperly incarcerated due to a lack of available mental health services.
Every time I leave, something distressing occurs. I spent the night in his room, surrounded by the sounds of creaking doors and moaning children. It’s no wonder he has been unable to sleep. Thankfully, we now have medication to help, but that is not a real solution.
What a Psychiatric Bed Means
Ethan needs further evaluation. Our family is fortunate to have access to private schooling and many resources in Chapel Hill, North Carolina. However, finding a facility that can support him has proven nearly impossible. We had to wait for things to reach this critical point.
Psychiatric beds are not financially profitable, and few want to work with children who display challenging behaviors. Many private institutions lack the best track records, and sadly, the ER has become a temporary holding area for Ethan. He is not trusted with basic items like forks or plastic knives, and the way he is perceived is disheartening.
I recognize the dismissive looks from staff members; the judgments have become palpable. At 11, Ethan is a big kid who often looks older, but he is still just a child—a child who has faced verbal abuse and has been restrained, left with unfulfilled promises.
During this first encounter with mental health care, Ethan has been sheltered until now. I wish I could explain why this wait is necessary, but I am beginning to question it myself. He desperately needs help. He feels miserable, out of control, and yearns to do the right thing, yet he is afraid of his own mind.
The absence of compassion is staggering. Today, I left the hospital early, only to receive a call from Ethan, thrilled that he had been moved from the high-security area to a room with light. My hope is that this positive change will help him cope better. Nevertheless, I must stress that he is not in an environment conducive to his success. He needs kindness, movement, and understanding.
This situation isn’t unique to North Carolina; we may have resources, but the reality is that many children are suffering. I have seen and met others like Ethan—kids who are suicidal, confused, or neglected. Many face repeat visits to the ER with little parental support.
The lack of outpatient services is a critical factor in why kids with psychiatric issues end up in emergency rooms—either due to nonexistent care options or inadequate insurance coverage.
200 Hours
I can’t shake the significance of that number—200 hours. How much can one endure in a sterile hospital setting with constant probing, repetitive questions, and bland food? How much longer must we wait for him to receive the care he needs?
Ethan simply wants to go home.
Summary
Ethan, an 11-year-old boy with autism, has been waiting over 200 hours in the ER for a psychiatric bed after experiencing a severe emotional breakdown at school. Despite the family’s efforts to manage his condition through school support, therapy, and medication, the lack of available resources for mental health care has left them in a desperate situation. The story highlights the urgent need for compassion and better mental health services for children like Ethan as he navigates his challenges in a system that often feels unprepared to help.