Beyond-Control Behavior: From Court to Mental Health Institution, and the Challenge of Managing Behavioral Crisis among Children and Adolescents in Trinidad and Tobago

Abstract

There is a noticeable trend in the admission of children and adolescents into the local adult psychiatric hospital in Trinidad (St. Ann’s Hospital). This facility was built in 1900 as an asylum with 400 patients but currently houses 800 patients, among whom are children and adolescents. A brief review showed that many were referred for what parents deem beyond-control behavior. The characteristics of the children and adolescents admitted for inpatient treatment have never been reviewed. The specific aims were to analyze the (1) demographic characteristics; (2) reasons for referral; (3) source of referral, and (4) diagnoses. Methods: This is a retrospective study. The records of children and adolescents admitted between 2009 and 2013 were reviewed. The participants would have been evaluated and diagnosed on the ward by the consultant psychiatrist. A data capture sheet was developed, based on the information contained in the patient intake form. Two nursing staff members were trained on data extraction. The data sheet was pretested with 20 files before a final adjustment was developed. Result: In summary, the findings showed that the major source of referral was from the judiciary (34%), followed by relatives (22%) and private care providers (20%, e.g., general medical practitioners). The least frequent source of referral was the child and adolescent mental health service (child guidance clinic). Based on the data, the results show that there are statistically significant associations between beyond-control behavior and major depression, ADHD and conduct disorder diagnoses. In assessing the strength of the associations based on the phi coefficient, beyond-control behavior has a weak negative association with major depression, but weak positive associations with both ADHD and conduct disorder. Looking at absolute values, the relationship between beyondcontrol behavior and ADHD is the strongest. Conclusions: In this analysis there were significant association between beyond-control behavior and varieties of mental disorders. The behavior displayed by the children and adolescent may be an indication of undiagnosed mental health problems.