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Florida's severe child psychiatrist shortage keeps one provider up at night

Dr. Howard Pratt is a behavioral health medical director and a child and adolescent psychiatrist at Community Health of South Florida Inc.
Verónica Zaragovia
Dr. Howard Pratt is a behavioral health medical director and a child and adolescent psychiatrist at Community Health of South Florida in Miami.

Dr. Howard Pratt, a child and adolescent psychiatrist in South Florida, worries about all the kids who aren't getting care.

Florida needs pediatric psychiatrists. A map on the website of the American Academy of Child and Adolescent Psychiatry 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 co-workers.

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

"Typically, the people that are coming to see me are doing well," Pratt said. "I’m more worried about the people that aren’t getting help."

All the children and adolescents who can’t get an appointment with a psychiatrist for months worries Pratt, who works at the main campus of Community Health of South Florida. (CHI). The staff of this nonprofit organization is stretched thin trying to meet the demand.

"You had mentioned that if this was a regular day, where I wasn’t here, then you wouldn’t 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 — listen to them, figure out the treatment and write a note. There’s anywhere from 24 to a little more than 30 patients a day, and so that’s consistently moving. Most of the psychiatrists here are not getting lunch."

"There’s anywhere from 24 to a little more than 30 patients a day ... Most of the psychiatrists here are not getting lunch." Dr. Howard Pratt, child and adolescent psychiatrist

Pratt doesn’t take a lunch break, either. One of Pratt's employees — a psychiatric nurse practitioner — calls him to discuss his workload on a recent Tuesday.

The nurse practitioner agreed to let WLRN 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’re done with like five patients, you still have five other notes to do at the end of the day and then you’re 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’t really see it when you leave work. You’re 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 — and he knows he needs to look out for himself, too.

"I’m very cognizant of, 'OK, I need to make sure I’m doing things to take care of my own mental health' because the people that I see leaving, they’re strong people and they’ve done this for years and they’re saying, ‘I’m done,' " Pratt said.

"The people that I see leaving, they’re strong people and they’ve done this for years and they’re saying, ‘I’m done.'" Dr. Howard Pratt, child and adolescent psychiatrist

Pratt seemed professionally rewarded after speaking with a teenager and his mother via video while they’re 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’s 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’s not in school," one woman responded.

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

"I’m 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 sexual abuse came in with her adoptive mother.

"She’s having an emotional meltdown — 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’t speak English. Pratt doesn’t speak 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’s 72-hour involuntary hold for someone who’s 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’re going.

"This is where a child will sit for as long as it takes to find a place," Pratt said. "If they’re local, they’ll get referred back here, hopefully. The thing that’s unfortunate is that when you have a kid that might be sent as far as Fort Lauderdale or Orlando and the parent can’t come see them — now you have a child that is taken from their home, they're suicidal, homicidal, and they’re watching other families come and see other patients. They’re there alone."

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

When it’s finished, a child or adolescent won’t 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 — before starting the cycle again the next day.

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Verónica Zaragovia