CHKD seeks state approval for a $50 million mental health facility
Virginian-PilotMar 15, 2018
The hospital must get state approval before moving forward, but president and CEO
Three to five children a day arrive in the hospital's emergency room in need of a mental health evaluation, a number that has increased by 40 percent during the past four years, according to CHKD.
If the children have both a medical and psychiatric condition, they can be admitted for inpatient care. But if their sole diagnosis is psychiatric, they need to be referred to a psychiatric facility. In some situations, such as eating disorders, that means traveling out of state.
The hospital submitted paperwork to the
The expanded mental health program would employ about 250 health care providers and support staff, and treat children 2 to 18 years of age.
The request for a "certificate of public need" would also include 12 beds in the current hospital for inpatient psychiatric treatment. The proposal will be reviewed by the state health officials to make sure the need for services is justified. A public hearing also will be conducted, likely in May or June. The state health commissioner is expected to make a final decision by early August.
"Everyone from parents to social workers to government agencies to school systems are telling us that mental health services for children are the No. 1 priority," Dahling said in an interview Tuesday.
National statistics are showing that 1-in-5 children need mental health services.
"The tipping point was the frequency of children coming into the ER in crisis," Dahling said. "Parents are saying, 'Please help.' There are simply not enough localities to place them. They stay in the ER sometimes for a day. You roll all of that together, and we cannot walk away."
A five-day snapshot of 14 mental health patients seen in the ER included:
* A 5-year-old with a history of setting fires, and being violent to animals and adults.
* A 16-year-old who took his parent's diabetes medication after experiencing suicidal thoughts. His brother died by suicide at 13.
* A 13-year-old who experienced sexual assault and later overdosed on Benadryl.
* An 8-year-old who expressed suicidal and homicidal thoughts and tried to jump out of a second-story window.
Currently, the system receives 15 to 20 mental health referrals a day from primary and specialty care providers. One day in February, 153 children were on the waiting list, with waits as long as six weeks.
The hospital has one psychiatrist and is now recruiting for more, but a national shortage has made that challenging.
But there have been times when those facilities have been full or the situation would not be good for the child. For instance, if it's a young child or someone with autism, or a child who is gay, lesbian or transgender, sharing a room, or even a unit, would be difficult. Parents and caregivers often have to travel to
Osler said it's particularly hard to find appropriate programs for children with eating disorders. The system has also struggled to find treatment for children as young as 3 or 4 getting kicked out of day-care and preschool settings because of behavior problems.
"When you are at the point of needing acute care for your child, neither of you are in a place you want to be. If you have done it more than once, a bad experience at a previous placement can also cause anxiety for both of you, and sometimes as a parent, you can delay getting needed help because of the options available."
Another woman, a 59-year-old
She and her husband were foster parents of the two children, who were severely abused when they were young, and they have since adopted them. "She was 4 years old when she was traumatized, but it's like it was yesterday," said the mother, who asked not to have their names used to keep private their background of abuse and mental illness.
They are both in and out of the hospital. At times, her daughter has had to wait more than a day at CHKD before a psychiatric bed was found for her.
"It's a shame to have to go so far to get help," she said. "
One pediatrician made the observation that diagnoses were shifting from typical ear infections to attention deficits, depression and obsessive-compulsive disorders: "I am stymied here and have little to no assistance. It is like fighting a battle and I am not armed."
In 2014, the health system assigned six licensed clinical social workers to do mental health assessments and interventions. The first year, the system's mental health team did 3,500 visits. Since then the number of mental health therapists assigned to that duty has grown to 25 and they are on track for 18,000 visits at nine different CHKD locations this year.
That was the first step in bolstering mental health services, along with getting mental health training for pediatricians.
"We want to give children a gliding path, post-discharge, so they don't end up back in the ER two weeks later," Dahling said.
If the system gets state approval, it would take two years to get the 12 beds in use in the current hospital and four years for the new facility to be built.
The King's Daughters, founding organization of CHKD, has pledged
Dahling said the move will eclipse the most recent shift in strategy, which was when they began building medical centers and urgent care clinics in other parts of the region 15 years ago.
"It's extremely exciting," he said. "And a little terrifying."
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