Mental Health and Pediatric Patients
Elyssa N Handlen
Dakota College at Bottineau
NURS 227: Clinical Application 1
Connie Geyer
September 16, 2018
Mental Health and Pediatric Patients
Social workers in the hospital setting are often forgotten players left on the bench, but when it comes to discharging patients with difficult medical histories and needs, they become the star quarterback of the team that everyone relies on. During my clinical with Kyleigh in social work, I was only able to see a small portion of what social workers do. She was tied up with a patient in the Emergency room who had a medical record ten page long. This patient was a 14-year-old male who had several psychiatric issues and extended acute hospital stays in the psychiatric unit at Trinity Health. A four-hour clinical involved phone calls to 30 plus facilities located in North Dakota and the three neighboring states, many outgoing faxes and even more denials of admission. The Billings acute psychiatric unit agreed to see the patient and evaluate him on a 24-hour hold, but this did not guarantee admission. After the parents declined to transport the patient to Billings, the administration team of Trinity Health agreed to pay for the flight to Billings, so the patient could receive appropriate care for his health issues. After the interactions with this patient and the historic lack of understanding of this topic, I was drawn to do some research on the very foreign and underrepresented issue in healthcare today.
Mental Illnesses and The Pediatric Patient
“Mental illness is quite common in children and occurs in 1 out of 4 children in any given year.” (Dryden-Edwards MD, 2018, p. 1) Although some of the mental illnesses are short lived, some can linger for years or a lifetime significantly affecting the patient and the families of those affected. The most common mental illnesses are anxiety disorders, depression and attention deficit hyperactivity disorder (ADHD). Another psychiatric issue that has made a dramatic increase in pediatric patients is autism spectrum disorder. “It is said that one out of 15 children is affected by this, a 15% increase from 2016-2018.” (Dryden-Edwards MD, 2018, p. 1)
The patients planning that I was involved with suffered from ADHD, depression, schizophrenia and autism spectrum disorder. The combination of these illnesses will have a significant impact of this patient for the remainder of his life. Many of the providers and nurses who cared for this patient expressed that in cases like his, patients end up in the state psychiatric hospital permanently as adults. This is why the patient’s psychiatrist made the suggestion for the patient to be transferred to a acute psychiatric facility and the have a referral made to transition the patient to a long term/residential setting, as he would never be able to function as an reasonable responsible adult alone in society. This either says a lot about his mental illness or the a lot about the lack of care he can receive outside of an institution.
Causes and Risk Factors of Mental Illness in Pediatric Patients
After extensive research there was not one definitive cause to mental health disorders in any age of psychiatric patient. Yet three main factors influenced the mental health of patients. These were biological, physiological and environmental factors. “The biological factors were linked to abnormal levels of neurotransmitters, like serotonin or dopamine in the brain. As well as decreased size of certain parts of the brain and increased levels of activity in others.” (Dryden-Edwards MD, 2018, p. 3) The physiological risk factors for mental illness include many preventable or reversible things. Such as low self-esteem, poor body image and feeling helpless in negative situations. With the youth today, it is easy to get caught up in social media and let these factors leave lasting damage on children. More often than not when I am at work and we have a child come in with psychological issues it often leads back to social media. Often the body image problems and low self-esteem hit patients during puberty where their body is going through the fluctuating hormones of puberty and changes in relationships with parents and peer. It is said in many areas that pediatric patients’ environmental stresses can also trigger mental illness. Patients who are victims of verbal, physical, sexual or mental abuse are at higher risk for mental illness issues. When a person takes a step back and looks, other than the physiological factors many of the risks of pediatric mental issues can be prevented or modified early enough to prevent serious mental health issues.
“Gay teens are at higher risk for developing mental disorders like depression, thought to be because of the bullying by peers and potential rejection by family members. Children in military families are at risk for experiencing an increase in depression. “(Dryden-Edwards MD, 2018, p. 3)
The patient that we worked with experienced many traumas during childhood and after interacting with his mother you could clearly see she was also suffering from some mental illness issues herself. Often the medical professionals are seeing the lack of self-care and willingness of the parents to reach out for help for themselves affecting the children they are raising. This is where the social worker has to dig deep and when necessary fill out the appropriate forms for the appropriate agencies. With the patient in the emergency room the social worker had to fill out a 960 which is the form mandated reports must fill out for any neglect or abuse cases that need to be followed up on by child protective services (CPS). In this case it was filled out for neglect, as the mother didn’t want to take responsibility for her child and transport him to Billings because she stated, “I have too much other stuff going on right now to just worry about him. I will leave him here and he can be your problem.” This was said in front of the patient, which was just one of the many examples of how the child’s environment affected his mental health.
Signs and Symptoms of Mental Illness in the Pediatric Patient
With the hundreds of disorders in the Diagnostic and Statistics Manual of Mental Disorders (DSM-5) a person could write about any of them. But the most important thing to remember is that each diagnosis will have its own signs and symptoms to look for, where many will present themselves as completely different issues instead. “Some of the signs and symptoms of mental illness in the pediatric patient include poor school performance, persistent boredom, frequent complaints of stomach aches and headaches, sleep or appetite problems, non-compliant or aggressive behaviors and risk-taking behaviors.” (Huszti, Ph.D., 2018, p. 1) Examples of risk taking behaviors include running the street, climbing a tree to high, engaging in physical altercations, or playing with unsafe items. “Over half of all adults with persistent mental illness first experienced symptoms before the age of 14, but many waited more than 10 years for a diagnosis and treatment.” (Huszti, Ph.D., 2018, p. 1)
The patient presented to the Emergency room with increased agitation and violence towards himself and his parents. The patient struck two nurses while in the emergency room with no signs of regret for injuring someone who was trying to help him. The patient had a history of abusing family pets, siblings and grandparents. The patient had many different outbursts in the emergency room including uncontrollable laughter, crying and violence against staff and law enforcement. Healthcare providers in the emergency room said this was displayed the classic signs and symptoms of a patient suffering from schizophrenia.
Diagnosing Mental Health Issues in Pediatric Patients
Social workers on a clinical level are among many different healthcare professionals that help make the diagnosis of mental illness in the pediatric patient. The healthcare team that is involved with the diagnosis include pediatricians, licensed mental health therapists, psychiatrist, psychologist, psychiatric nurses, emergency room physicians and social workers. The initial diagnosis referral usually comes from an emergency room physician. This is because the patient has had a behavior issue at home or school, resulting in the parent or police bringing them to the emergency room for treatment. Often with mental illness a emergency room provider has to rule out that it is not a result of medications or an underlying medical condition such as a tumor in the brain or unbalanced chemicals in the body. Many times parent think there child has a mental illness when in fact there blood work comes back abnormal or they have a mass found with a CT scan in there head creating these behavior issues. With the above reasons treatments are often available and the patient is not diagnosed with a mental illness. When all of the medical reasons are ruled out a healthcare provider asks the patient and parents a series of standardized questions and self-test to help further assess symptoms. “The use of screening tools is particularly important for detecting early signs of mental illness in infants and toddlers, due to their being largely preverbal in their communication. “(Dryden-Edwards MD, 2018, p. 2)
With the patient in the Emergency room he has been exhibiting signs of mental illness since he was a toddler. These were displayed by aggression towards other children and family pets, lack of being able to express himself and unhealthy sleep and growing cycles. When the patient presented to the ER he was six feet 4 inches tall and weighed 240 pounds, this made it impossible for his parents and staff to control him without excessive force and restraints. Eventually medication was used to calm the patient and the three restraints were removed. The patient was very “flat” showing no emotions at times, I observed this was when the patient had the most potential to be violent with hospitals staff as they let their guard down trusting that he was calm and in a “normal” frame of mind. This taught me that no matter what the situation is you have to maintain your distance from these patients as they can become violent very quickly.
Treatment of Pediatric Patients with Mental Health Issues
The healthcare team has may interventions they can use when it comes to treating pediatric patients with mental health issues. Some of the therapies include psychotherapy also knows as “talk therapy”. (Dryden-Edwards MD, 2018, p. 6) This is where the patient is involved with a mental health professional and participates in counseling sessions which helps them identify problems, solve problems and be able to cope with them in a healthy manner. “In general, these therapies take several weeks to months to complete. Each has a goal of alleviating symptoms.” (Dryden-Edwards MD, 2018, p. 6) Cognitive behavioral therapy is another option for pediatric patients with mental health issues. This helps the child change his or her way of thinking. This therapy is often credited for reducing the likelihood of the symptoms or bad behaviors returning. It gives the patient life coping skills and they carry the benefits throughout the remaining childhood and adult life. “Most providers will continue treatment of a mental illness for at least six months. Treatment for children with mental illnesses can have a significantly positive effect on the child s functioning with peers, family, and at school.” Medication therapy is often prescribed to patients with mental health issues either for situational issues or for long term treatments of mental health issues. The major types of medications used are antidepressants (Zoloft/Prozac) and anti-anxiety (Lorazepam) medications. They also use stimulants (Ritalin/Adderall) and nonstimulants (Strattera/Catapress), depending on the issues that are affecting the child. It has been found that helping children with medication and nonmedication interventions produce the best results.
The patient in the Emergency room was on many different medications including stimulants, nonstimulants, antidepressants, sleeping medications and everything in-between. He took stimulants in the morning and nonstimulants and sleeping medication at night. I often find myself wondering if a person would “detox” from all of those medications and start fresh if the body would have a chance to do a hard “reset”. When a person’s body is on a roller coaster of medications and hormones from puberty I don’t see how anything could level out the hormones either naturally or chemically. This is a topic that is very interesting to me and I hope to have other reasons to continue the research.
References
Dryden-Edwards MD , R. (2018). Mental Illness in Children . Retrieved from https://www.medicinenet.com/mental_illness_in_children
Huszti, Ph.D., H. (2018, 07/30/2018). Pediatric Mental Health Should Be Everyone's Concern . . Retrieved from https://childrenshospitals.org/newsroom/childrens-hospitals-today/articles/2018/05/pediatric-mental-health-should-be-everyones-concern