Psyche0248
New Member
- Joined
- Dec 13, 2022
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I’m a CL psychiatrist who sees ED consults also (relatively new, <4 months) and am frequently seeing children presenting to the ED with the following:
- Behavioral issues, for example any combination of: threats at school toward peers, violence at home toward family, self-harming when dysregulated by banging head, hitting self, ingesting objects, etc.
- Most seem to carry diagnoses of ODD or DMDD, ADHD, conduct disorder, or ASD;
- They usually have an outpatient
psychiatrist who is at a loss of what to do and are hoping for inpatient admission for “stabilization”;
- They have had repeated acute hospitalizations that didn’t lead to an appreciable improvement / reduction in frequency or severity of symptoms;
- Inpatient psych hospitals (already limited in this area, especially for those with ASD) are now familiar with many of these children by name and are declining based on not being capable of providing treatment, never mind not having physical capacity;
- Parents “don’t feel safe” with the child at home, and I can’t really blame them;
- These children may sit in the ED for days or weeks without being placed and ultimately are discharged home with maybe a med change or two;
- These are kids too young for juvenile detention (also, police will only bring them to the ED even if parents want to press charges against their 13-18 year old);
- The wait to get into residential programs is over a year or more…
- DSS does little to nothing to help, even if they’ve been involved already;
What do you tend to do with these children, and what is your thought process? I’m sure the answer of whether to admit is “it depends”, but I’d like to know how others approach this. I’ve seen psychiatrists in other systems (I don’t have many colleagues here in psych unfortunately) recommend inpatient and wait until that happens regardless of how long it takes, and I’ve also seen them say this is not behavior that is modifiable by inpatient treatment and discharge regardless of parents’ objections.
These kids are undoubtedly at continued risk of harm to self or others, possibly even imminently, but the risks are chronic. Some of them will even continue to keep endorsing SI to try to stay in the hospital since they seem unhappy with a tumultuous home life, or they make a suicidal gesture at discharge so we will keep them (and these are often very young children who don’t really know about lethal methods and have unrealistic ideas of what can kill them).
I suppose the same question of whether to admit also extends to behavioral disturbances stemming from dementia (with no primary psychiatric disorder and no delirium at play).
- Behavioral issues, for example any combination of: threats at school toward peers, violence at home toward family, self-harming when dysregulated by banging head, hitting self, ingesting objects, etc.
- Most seem to carry diagnoses of ODD or DMDD, ADHD, conduct disorder, or ASD;
- They usually have an outpatient
psychiatrist who is at a loss of what to do and are hoping for inpatient admission for “stabilization”;
- They have had repeated acute hospitalizations that didn’t lead to an appreciable improvement / reduction in frequency or severity of symptoms;
- Inpatient psych hospitals (already limited in this area, especially for those with ASD) are now familiar with many of these children by name and are declining based on not being capable of providing treatment, never mind not having physical capacity;
- Parents “don’t feel safe” with the child at home, and I can’t really blame them;
- These children may sit in the ED for days or weeks without being placed and ultimately are discharged home with maybe a med change or two;
- These are kids too young for juvenile detention (also, police will only bring them to the ED even if parents want to press charges against their 13-18 year old);
- The wait to get into residential programs is over a year or more…
- DSS does little to nothing to help, even if they’ve been involved already;
What do you tend to do with these children, and what is your thought process? I’m sure the answer of whether to admit is “it depends”, but I’d like to know how others approach this. I’ve seen psychiatrists in other systems (I don’t have many colleagues here in psych unfortunately) recommend inpatient and wait until that happens regardless of how long it takes, and I’ve also seen them say this is not behavior that is modifiable by inpatient treatment and discharge regardless of parents’ objections.
These kids are undoubtedly at continued risk of harm to self or others, possibly even imminently, but the risks are chronic. Some of them will even continue to keep endorsing SI to try to stay in the hospital since they seem unhappy with a tumultuous home life, or they make a suicidal gesture at discharge so we will keep them (and these are often very young children who don’t really know about lethal methods and have unrealistic ideas of what can kill them).
I suppose the same question of whether to admit also extends to behavioral disturbances stemming from dementia (with no primary psychiatric disorder and no delirium at play).