Checkup Newsroom

Now Leading Cause of Trauma Death, Child Suicides Spur New Prevention Campaign

Tue, 06 Apr 2021 08:46:00 -0500

One in a series.

One year into COVID-19, it’s clear the pandemic is taking a toll on the mental wellbeing of children and teens.

In March, a record 43 patients were admitted to Cook Children’s Medical Center after attempting suicide. This staggering figure is nearly double the number of suicidal patients seen during the same time period of 2020. Even worse, kids are dying. Last year, Cook Children’s recorded seven suicide deaths, marking the first time suicide was the leading cause of trauma deaths at the hospital, surpassing child abuse and car wrecks.

“The mental health crisis was already happening, then it met a global pandemic and these are the consequences,” said Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s.

“They’re less engaged and have less interaction with others, and instead are spending more time online and in virtual settings. And it’s hard for them to be hopeful about anything because so many things, like prom and graduation parties, are canceled.”

The issue is not unique to North Texas. Doctors and nurses from across the nation are reporting similar statistics. In February, NPR released an article titled “Child Psychiatrists Warn That The Pandemic May Be Driving Up Kids' Suicide Risk.” It found that children’s hospitals across the U.S. are seeing up a 250% increase in suicidal patients in emergency rooms since the pandemic began. While there are no nationwide numbers on child suicides in 2020 available yet, experts agree there is reason to be concerned.

The Impact

More children are suffering from stress, anxiety, depression, and suicidal thoughts than at any time in recent memory. Pediatricians like Kathleen Powderly, M.D. from Cook Children’s Pediatrics Magnolia say children as young as 7 are needing help.

“I’ve had a couple of elementary school students, which you don’t see very often, who are actively suicidal or have already had a suicide attempt. I’ve also managed more kids on antidepressants since the pandemic because it’s hard to get into doctors right now,” Dr. Powderly said. “COVID-19 is not as impactful in terms of volume of cases in pediatrics, but our volume of psychiatric patients has increased quite a bit.”

Previously, Dr. Powderly was the medical director of Cook Children’s Hospitalist Group, the attending physicians who care for children in the hospital. She says her team was seeing an increase in suicidal patients before she transitioned into the office setting five years ago and that the pandemic created a perfect storm. On top of the stressors kids were already dealing with, they’re now struggling with isolation, virtual school, and a loss of activities.

“We’re not going to be able to flip the switch and just go back to normal when this is over,” said Dr. Powderly. “This is going to take some time to come out of. I’ve even had patients tell me they’re struggling with being around people.”

Members of Cook Children’s Youth Advisory Council shared similar experiences in a recent meeting. The teens said they feel more anxious being around their friends in person because they’re so used to only seeing people online now. In addition to new stressors, there is a severe lack of mental health resources across the board.

A Growing Need

“There weren’t enough psychiatric beds to begin with, and then COVID happened and the capacity was reduced because you can’t have patients sharing rooms,” said Dr. Pyrc.

The need for more inpatient psychiatric beds for children and teens has been known for years. In 2017, Cook Children’s opened the Rees-Jones Behavioral Health Center to help address the issue. The unit has 15 inpatient beds available for children between the ages of 2 and 12. As we reported when the center opened, the kids who end up here are patients with complex trauma, medical and social needs. 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.

Teenagers who need inpatient psychiatric care have to be treated elsewhere but often end up waiting on the medical floor of Cook Children’s until a bed opens up in the community, which can take days. With more kids needing these services, it’s not uncommon for Cook Children’s to have a dozen or more patients waiting in a regular hospital room for a transfer to a psychiatric facility that can care for them.

“There are just not enough resources in general,” said Dr. Pyrc. “It’s an awful place to be in. This is a national problem, but it affects us here locally. We need more funding and we need more mental health professionals to care for these patients.”

On the outpatient side, finding a licensed therapist to see a child can take months. The waitlist just to see a counselor at Cook Children’s can be as high as 250 days at any given time. Even with easier access to appointments with virtual visits, there are not enough mental health professionals to meet the need.

Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s, has been a vocal advocate for increased mental health funding. Testifying in front of the Texas Senate’s Committee on Health and Human Services recently, she said early identification, intervention and treatment is essential to preventing further complications from mental illness. But there are roadblocks.

“We get insurances denying a specific level of care saying that a child doesn’t need an inpatient level of care. We also get a lot of pushback about medication,” Dr. Carter said.

She also asked lawmakers for increased support and to consider giving mental health care providers more leverage with insurance companies.

Hoping for JOY

In the meantime, Cook Children’s aims to bring awareness to the mental health crisis affecting children and teens with the launch of a new suicide prevention campaign.

The Joy Campaign is an acronym that stands for:

Just breathe.

Open up.

You matter.

“If we can just get kids to slow down, realize that what they are experiencing is temporary and that they have a long life ahead of them, I think we can make an impact,” said Dr. Powderly.

For the next month, Cook Children’s will be releasing a series of articles on Checkup Newsroom weekly that address many of the issues at play, such as the pandemic, the role of over-the-counter medications, social media, as well as how minorities and LGBTQ+ young people are impacted. We’ll also be speaking with families who have lost a child to suicide to examine the effects on parents and siblings.

If you feel your child might be struggling, here are some of the warning signs to watch for:

Anger
Declining grades
Lack of concern about appearance and hygiene
Changes in eating and/or sleep
Self-injury such as cutting
Less motivation
Alcohol/drug use
Acting highly anxious or agitated
Recklessness
Giving away possessions

If you’re concerned about your child’s mental health, seek help early. Schedule an appointment with a licensed counselor. If your child is actively suicidal, call 911 or take them to the nearest emergency room.

Read this story in Spanish here.

About the Rees-Jones Behavioral Health Center

Our licensed experts provide psychology and psychiatry services for families whose children and adolescents, ages 2 to 18, are experiencing behavioral, neurodevelopmental and emotional challenges such as depression and anxiety to attention deficit disorders (ADD/ADHD) and autism spectrum disorders.

Because we are part of the Cook Children's Health System, we are also uniquely positioned to care for those children coping with mental health as well as chronic physical conditions or diagnoses.

Depending on the severity of a child's condition, we provide inpatient and partial hospitalization programs on the main campus of Cook Children's Medical Center and outpatient services in eight clinic settings across Tarrant and Denton counties.

Our services include:

Diagnostic testing and evaluation
Outpatient therapy and counseling
Inpatient and partial hospitalization programs
Medication management
Family support groups

Visit our website for more information.

Support Cook Children's Rees-Jones Behavioral Health Center

You can help support the work being done through the Rees-Jones Behavioral Health Center at Cook Children’s by making a donation today. Visit our website by clicking here.

7 Signs Your Child May Need Mental Health Help

Tue, 10 Oct 2017 10:47:24 -0500

Lisa Elliott, a licensed psychologist and clinic manager of Cook Children’s Psychology Department in Denton, has heard multiple reasons/explanations/excuses from parents as to why they have not sought mental health help for their child. Some of the most common reasons include parents are worried about their child being labeled and that the label will hurt them further. Other explanations have included not recognizing that their child’s behavior is actually due to a mental health and/or health problem and not solely behavior, while another reason is fear or shame associated with the social stigma of a mental health problem.

Elliott knows it can be difficult for parents to come to grips with mental health issues their child may be experiencing.

“Regardless of the reason for the mental or behavioral health illness, we have to be responsive to our children immediately,” Elliott said. “Parents sometimes wait until it’s too late to seek help before harm comes to the child or someone else, simply hoping the problem resolves itself over time.”

Parents have reported not knowing where to turn for help or having the time and funds to navigate obtaining appropriate care.

Childhood mental illness occurs in about 20 percent of all children in any given year, according to the U.S. Surgeon General. Nearly 5 million children in America have some type of mental illness, yet experts estimate that only 20 percent of them will receive treatment.

“Early identification and treatment is critical and can be a lifesaver for the child,” Elliott said. “In addition, treatment can be beneficial for all of the child’s relationships and success in school.”

Elliott offers these early warning signs:

Significant mood changes, including sadness, depression, withdrawal, irritability or rages
Intense feelings with little ability to manage the feelings, including anxiety, fear and panic symptoms
Behavior changes including aggressiveness, dangerous behavior, and homicidal thoughts or changes in appearance, friends, interests
Physical harm including self-harm and suicidal thoughts/attempts
Substance abuse
Lack of self-care including, lack of cleanliness, not eat or over eating, sleep disturbances, weight changes, pays little attention to physical health, doesn’t care about homework
Change in functioning including inability to concentrate, easily irritated/frustrated, gets into fights/arguments, unable to get along with others, cannot complete projects/work

If parents note any of these changes they are encouraged to speak to their child’s doctor or find a specialist such as a psychiatrist, psychologist, social worker or licensed counselor.

“A proper diagnosis is essential for guiding treatment; and this process may include a health examination and/or psychological testing,” Elliott said. “Treatment may include medications, psychotherapy which includes teaching your child coping tools and how to respond to challenging situation, as well as helping parent training/skills.”

Other resources that provide information to help parents include www.watchdenton.org, National Alliance on Mental Illness (NAMI), National Institute of Mental Health, Mental Health America.

New Behavioral Health Center Offers Hope for Children in Crisis

Tue, 06 Jun 2017 10:16:48 -0500

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.

Dealing with depression

Tue, 01 Jul 2014 08:04:00 -0500

Sooner or later that sweet child in your home will become the moody teenager. Maybe, it’s already happened. Usually, it’s just a phase that he or she will outgrow. But what if it goes beyond moody and is actually depression?

Depression is a biological illness with a strong hereditary link. Generally, 35 to 40 percent of depressed children have inherited their disease. Usually, parents notice that their child is depressed around the teen years.

Teens with chronic illness, such as depression, are no different than any other child and generally want to be treated just like any other kid. But they should receive professional help and be assessed for anxiety and depression.

Parents should watch for any change in mood like sadness, depression, hopelessness, irritability, anger and hostility. You may see more tearfulness and changes in activity level. Watch for more withdrawal from friends and family, change in friends and loss of interest in activities once enjoyed. Other signs include sleep disturbance, change in appetite, restlessness, agitation, fatigue, lack of energy/motivation, feelings of worthlessness and guilt. Depressed kids may have difficulty concentrating, making decisions and may even see a drop in grades.

Always be aware of signs of depression and keep a close eye on your child. Never ignore symptoms. If you see signs of depression, contact your physician and obtain referrals for a psychologist or therapist who is trained in pediatric and adolescent care.

Children threatening suicide may be trying to get attention or may be struggling with depression. But it doesn’t matter. You must take the threat very seriously. If a child is talking about suicide, get help immediately. It is critical not to ignore this cry for help regardless of their reasons.

Know that if your child is struggling with a chronic illness, including depression, it will impact the entire family. Families will require a lot of support: emotional, financial and physical. Most importantly, the support needs to be ongoing. It’s important to allow family members to vent frustration and grieve. Therapy is very helpful. If your teen is struggling with this problem, the entire family will need help to get through it. The good news is it’s available. If you feel your child needs help, please call 682-885-3917 for a referral into Cook Children’s Psychology department.

About the author

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children’s Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appointment, call 940-484-4311. Cook Children’s Psychology provides care focused on children’s behavior, from ages 3 years through 17.