港澳天下彩

Florida needs pediatric psychiatrists. A map on the website of the shows most of the state has a severe shortage. Some counties have no providers at all.

The shortage started before the COVID-19 pandemic and more providers have left their jobs since then. Some left because their caseloads became unmanageable. Others because of the stress of the job, including having to provide telemedicine from home without the support of coworkers.

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Dr. Howard Pratt is a child and adolescent psychiatrist who feels motivated to persevere for his beloved patients. He said he stays up at night 鈥� but not because of his growing number of patients.

"Typically the people that are coming to see me are doing well," Pratt said. "I鈥檓 more worried about the people that aren鈥檛 getting help."

All the children and adolescents who can鈥檛 get an appointment with a psychiatrist for months worries Pratt, who's also the behavioral health medical director
at the main campus of (CHI). It has a full team of child psychiatrists and providers who work hard to meet the demand.

"You had mentioned that if this was a regular day, where I wasn鈥檛 here, then you wouldn鈥檛 have time to speak with me," I said to him.

"Absolutely not," he replied, without hesitation. "We have about 15 minutes to see a person 鈥� listen to them, figure out the treatment and write a note. There鈥檚 anywhere from 24 to a little more than 30 patients a day, and so that鈥檚 consistently moving. Most of the psychiatrists here are not getting lunch."

Pratt doesn鈥檛 take a lunch break, either. One of Pratt's employees 鈥� a psychiatric nurse practitioner 鈥� calls him to discuss his workload on a recent Tuesday.

The nurse practitioner agreed to let 港澳天下彩record their conversation but did not want us to use his name. He said he's concerned about the repercussions of speaking openly about burnout on future jobs.

"By the time you鈥檙e done with like five patients you still have five other notes to do at the end of the day and then you鈥檙e backed up, and then Monday comes and you have 17 patients waiting for you," the nurse practitioner said to Pratt on the phone. "The cycle just repeats itself."

He's had his job for about a year.

"It can be a little stressful," he added. "About the burnout stuff, you don鈥檛 really see it when you leave work. You鈥檙e just like, 'Ugh, what a long day.' But when you come home, conversations you have with your friends, you could be a little snappy, you know?"

Pratt agreed with an emphatic yes.

Pratt takes care of his colleagues 鈥� and he knows he needs to look out for himself, too.

"I鈥檓 very cognizant of, 'OK, I need to make sure I鈥檓 doing things to take care of my own mental health' because the people that I see leaving, they鈥檙e strong people and they鈥檝e done this for years and they鈥檙e saying, 鈥業鈥檓 done,'" Pratt said.

Pratt seemed professionally rewarded after speaking with a teenager and his mother via video while they鈥檙e on a trip in Honduras.

"I want to see pictures when you guys get back," he told them before hanging up. "Always good to talk to you guys."

The mother agreed.

"That just makes my day," Pratt said, after ending the video appointment. "You have to understand, the first time that I saw him was in in-patient psychiatry. He was suicidal, was not getting along with his family, and this is just like a complete turnaround."

Other patients are far from healing.

"There are some days that I come in here and it鈥檚 one punch in the stomach after another," he continued.

Two people come in with a boy.

"What school does he go to?" Pratt asked.

"He鈥檚 not in school," one woman responded.

"Wait, wait. But he is 11. Has he been in school?" Pratt asked again. "He鈥檚 never been in school?"

"I鈥檓 telling you, no," the child's mother said.

After they leave, Pratt called a social worker to take on the case. I checked back later and confirmed that the social worker did contact the family, but the health center could not share any more information.

That day, a girl who was a victim of child sexual abuse came in with her adoptive mother.

"She鈥檚 having an emotional meltdown 鈥� breakdown," the unidentified mother told Pratt. "Every five minutes I can count on the disruptions and the anger."

Pratt also saw a teenager and his mom who are originally from Argentina. They don鈥檛 speak English. Pratt doesn鈥檛 speak fluent Spanish, but he'd rather try than turn them away.

Usually his patients leave with a parent or guardian. Sometimes patients in a crisis come in by force, into their adult stabilization center.

"We have to hold a child there in the crisis unit for adults until we find a space ... in a child adolescent unit," Pratt explained. "That can take days. We have over 1,000 kids per year that come here and they need treatment, in-patient psychiatric treatment."

Pratt and I walked over to the crisis center for adults. Florida鈥檚 72-hour involuntary hold for someone who鈥檚 likely to harm themselves or others is known as the Baker Act.

When kids arrive here, they have to go through a metal detector and they get searched. They go through intake and then wait to find out where they鈥檙e going.

"This is where a child will sit for as long as it takes to find a place," Pratt said. "If they鈥檙e local, they鈥檒l get referred back here, hopefully. The thing that鈥檚 unfortunate is that when you have a kid that might be sent as far as Fort Lauderdale or Orlando and the parent can鈥檛 come see them 鈥� now you have a child that is taken from their home, they're suicidal, homicidal, and they鈥檙e watching other families come and see other patients. They鈥檙e there alone."

Community Health of South Florida has begun plans to build a children鈥檚 crisis center catering to patients 17 and under in south Miami-Dade and Monroe counties.

When it鈥檚 finished, a child or adolescent won鈥檛 have to sit on a black folding chair by themselves in a drab room. Architectural drawings show plans for brightly colored walls, games to play with and couches to relax on.

By late afternoon, Pratt needed to go back inside to his windowless office and finish out his day 鈥� before starting the cycle again the next day.