New Behavioral Health Center Offers Hope for Children in Crisis
Pediatric psychiatry program expands as need hits all-time high
On the top floor of the brand new South Tower building at Cook Children’s Medical Center sits a facility most people will never see. The doors are locked from inside and out. The only access granted comes with the swipe of a badge. Visitors must sign in while security cameras follow their every move. And the patients receiving care for severe psychological disorders here are under constant supervision.
This is the Rees-Jones Behavioral Health Center, one of the few places in North Texas that offers inpatient psychiatric care for children between the ages of 2 and 12. The kids who end up here are among the sickest of the sick. They are often suicidal or have tried to hurt someone else. Eight out of 10 have had something traumatic happen to them. They have either been abused physically or sexually, or they have experienced some sort of neglect.
“The issues our patients face run the whole gamut,” said Hari Kumaresan, M.D., medical director of Psychiatry at Cook Children’s. “We treat common problems like depression, anxiety, mood disorders and ADHD (attention-deficit/hyperactivity disorder) along with issues like autism and schizophrenia.”
The Rees-Jones Center opened its doors in March of 2017, but its mission began nearly three decades ago when Cook Children’s first launched a psychiatric program in 1990. Today, that program sees more than 800 children a year through inpatient hospitalization and the Partial Hospitalization Program (PHP), which treats children during the day while allowing them to return home to their families at night.
While Cook Children’s capacity to help kids with behavioral health disorders has grown to an all-time high, so has the number of patients in need of such services.
When children attempt suicide
For decades, those most at risk of attempting suicide have been teenagers and young adults. But something strange and downright scary is happening now. Young children, still learning the basics of reading and writing, are increasingly ending up at Cook Children’s Medical Center after attempting to kill themselves.
“This is a nationwide phenomenon. If we look back, even 10 years ago, suicide attempts were common in teenage years,” said Dr. Kumaresan. “What we are seeing over the past few years is an increase in preteens, some as young as 7 and 8 years old, having persistent suicidal thoughts and attempting suicide.”
Since 2015, the number of patients who have ended up in medical/surgery units or the intensive care unit at Cook Children’s for injuries related to a suicide attempt has increased significantly. There’s no data available yet to say for certain how many more of these cases there have been, but it’s safe to say the percentage is in the double digits.
It’s not just happening here either. According to research recently released by the Pediatric Academic Society, the number of children admitted to 32 children’s hospitals for suicidal thoughts and actions has doubled over the past decade. The children in the study range in age from 5 to 17. The largest uptick was seen among girls.
“There have been studies that looked at the role of electronics and social media. There also have been studies that looked at changes in family structures over the past few decades. They have all come back negative,” said Dr. Kumaresan. “We’re still trying to understand what’s driving the increases we are seeing, but we do know there is a need for the kind of integrated care we offer at Cook Children’s.”
What affects the mind, affects the body
For years, mental and physical health were widely considered to be two separate entities, posing separate issues for patients. Today, many hospitals are turning their backs on that notion and offering ‘integrated care,’ where behavioral and medical providers work together.
“The artificial divide between mind and body was done for learning purposes. It doesn’t work in real life,” said Dr. Kumaresan.
At Cook Children’s, integrated care often begins in the Emergency Department (ED) where staff can expect to perform about 10 behavioral health assessments each day. The assessments take place in specially-designed rooms free of anything a patient could use to harm themselves or someone else, including standard medical equipment. Physicians are trained to ask critical questions and to make sure the patient is medically stable. Then, if the patient is not medically ill, a psychiatry intake coordinator is brought in to do an in-depth interview and exam. If the child or teen is in imminent danger of harming themselves or others, or is actively psychotic, they will be admitted to inpatient psychiatry.
“Ninety-eight percent of the children admitted to the inpatient program come in through the emergency department,” said Lisa Farmer, director of the Psychiatry Department at Cook Children’s. “Most suffer from sort of mood disorder such as depressive disorder, major depression or disruptive mood dysregulation disorder.”
Much like suicidal patients, the number of children and teens arriving at the ED in need at psychiatric evaluations is at an all-time high, and continues to rise. The good news is, relief should come soon. These types of cases tend to decrease in the summer months while kids are out of school and away from common stress factors.
The haunting role of trauma
Nearly 82 percent of patients who end up receiving inpatient psychiatric care at Cook Children’s have experienced some type of significant trauma such as abuse or neglect, witnessing domestic violence, living with a caregiver with severe mental illness or substance abuse issues, or many other adverse childhood experiences. Often, these children suffer from some type of mood disorder such as Disruptive Mood Dysregulation Disorder (DMDD), anxiety or depression.
But there’s also an increased risk of these children being misdiagnosed.
“Traumatized children do not always exhibit the internalizing behaviors such as withdrawal, depression and anxiety. Instead, they may exhibit aggressive behavior,” said Dr. Kumaresan.
He says reactions to trauma may be confused with attention deficit hyperactivity disorder (ADHD) when kids act out in combative and impulsive ways.
Trauma can also play a role in overall health well beyond childhood.
“We know that trauma impacts physical health,” said Dr. Kumaresan. “It affects blood pressure and blood sugars as well as increases the chances of using substances such as cigarettes, drugs and alcohol.”
Further evidence of this can be found in the Adverse Childhood Experiences study conducted by Kaiser Permanente and the Centers for Diseases Control and Prevention (CDC). In 1995, researchers began collecting information via questionnaires about participants’ childhood experiences. Since then, the CDC has tracked the medical status of those surveyed. The results show that experiencing things like abuse, neglect, divorce or having a parent addicted to drugs or alcohol increase the risk of experiencing health problems later in life.
There is hope and help
Helping children overcome the symptoms of behavioral health disorders is not an easy task. It takes a village and there aren’t enough people enlisted in the fight.
“This isn’t a problem that can be solved by someone sitting in an office writing prescriptions,” said Dr. Kumaresan. “It requires a lot of collaboration with schools, families, legal systems and physicians. Across the country, we need more child psychiatrists, more child psychologists and more patient beds.”
With the opening of the new Rees-Jones Center, the number of beds available to psychiatric patients at Cook Children’s increased from 11 to 15. It’s a 45-percent increase in capacity and could result in nearly 600 admissions a year.
“We strongly believe kids will do well if they can,” said Dr. Kumaresan. “But we have to give them the tools and support they need.”
For parents, this means talking to your primary care provider if you are concerned about your child’s behavior. You can also contact Cook Children’s Psychiatry Intake department at 682-885-3917. They can do an assessment over the phone and recommend resources. Parents should go to the ED if their child is at risk of hurting themselves, others or is actively psychotic.
“Families should know that 1 in 5 children struggle with behavioral health issues and there is hope,” said Farmer. “Mental illness is treatable and there are things we can do to help their children.”
Get to know Hari Kumaresan, M.D.
I was drawn to child psychiatry by a desire for staying in the present moment, which seems to be a natural ability in most children. Moving to the U.S. from India, I did my psychiatry residency at SUNY Upstate Medical University, Syracuse NY. I followed up with Child and Adolescent Psychiatry Fellowship training at University of Medicine and Dentistry, Piscataway, NJ.
I have worked with the most vulnerable families in community mental health systems in Staunton, Virginia and more recently in Dallas, TX. I believe in learning by sharing our experience, which has led me to mentor residents and fellows in child psychiatry at the University of Virginia and more recently at the University of Texas Southwestern in their clinical rotations. Experiences as Chief Resident as well as Regional Medical Director in a busy non-profit clinic have helped me understand and navigate health care systems.
When I’m not working, my two kids, family and friends help me stay in the present moment.
Click to learn more about the Rees-Jones Behavioral Health Center.