Integrating Mental Health Care for Medically Complex Children.

Abstract

An adolescent girl requiring admission for complications of cystic fibrosis was concurrently experiencing suicidal ideation and engaging in self-harming behavior. Because the local children’s hospital did not offer inpatient psychiatric care, she was transferred to the closest pediatric hospital able to provide both concurrent medical and inpatient psychiatric care. Although the patient presented at a large urban medical center, the “nearby” facility was 250 miles away. Unfortunately, because of limited household resources, her parents were unable to visit and directly participate in her medical or psychiatric treatments. Illustrated in this case is a situation that it is not uncommon for health providers at children’s hospitals: how to manage acute mental health crises in medically complex youth given a lack of available inpatient pediatric psychiatric units within many medical centers. Her providers were faced with the challenge of balancing what was in her best interest, treatment of her pneumonia, cutting behaviors, and suicidal ideation, with the reality that in their community no facility could provide standard of care for both medical and mental health concurrently. How then to minimize harms in attempting to meet both her psychiatric and medical needs? A burgeoning literature indicates that depression is increasing in children and adolescents, and suicide is now the second leading cause of death in children, adolescents, and young adults (ages 10–24).1 Youth with chronic illness are at an increased risk for depression and suicidal ideation.2 Pediatric emergency department encounters for suicidal ideation and self-harm have doubled for children ages 5 to 17 years, and more than half of these encounters resulted in inpatient hospital admissions. … Address correspondence to Kristin Canavera, PhD, Department of Psychology, St Jude Children’s Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105. E-mail: kristin.canavera{at}stjude.org