Saturday, January 14, 2012

The Promise of a New Year

Child 1Image by Tony Trần via Flickr
We probably made resolutions that we know we will break. We watched football games and ate too much, maybe drank too much, and laughed a lot but  not enough. The kids have gone back to school and our daily routine  plays out just as it did last year. So far, so good. No big issues. Our kids may see it differently. They have returned to school where they may feel lost and alone. Worse still, they may be frightened. The world of a child with a mental illness is different than ours. They see things, feel things, hear things differently than we do. Kids all hear, see and feel  things differently than adults. Their brains are not ready for the higher cognitive skills we adults have to filter everything that comes in. Kids experience everything  vitally. Hurts are bigger and deeper. Fears are  over whelming and non-ending. Anger is  all encompassing and frightening to the child. It is even worse if the anger that is being expressed is their own. Kids with mental health issues respond differently than we do to the same set of circumstances. Perhaps they are struggling to figure out what they need to be. Who they need to be. Maybe the peer group needs them to be a bully, or the clown, or the one that argues with the teachers. The family needs them to be quiet and  follow the rules. Kids trying to fit in are  changing their behaviors several times a day. A kid with mental health issues may find the stress of these changes too difficult to handle without experiencing a meltdown.  If you have witnessed a meltdown you know it can cause a serious disruption of any routine. These meltdowns are a clear signal the child doesn't have the appropriate coping skills in place to deal with the complexities of his life. This is when  intervention is appropriate, not for the benefit of the family, parent or teacher, but to benefit the child. In a perfect world, the subtle signs of  issues would have been seen in a well child check up by the pediatrician. But largely these signals  are missed and  not addressed until the afor mentioned meltdown occurs, usually at school. Then the wheels start to turn, though slowly, due to the shortage of mental health practitioners for kids. Perhaps there is some fear on the part of the family. Or embarrassment. Or even worse, they may think the child is doing this on purpose and can be punished into being good. These kids will wait until they can be seen by the first available mental health professional on a non-emergent basis Unfortunately, they usually deteriorate into a critical state requiring they be admitted to a hospital. Kids are sometimes seen in emergency rooms along side massive trauma patients, stabbing victims, gun shots and adult psychiatric patients. There is no pediatric psych E.R in our county. There are 133 available beds in San Antonio for children and adolescents, the majority of which are for kids over the age of 6. The State hospital has 36 beds, for kids 12 or older.  There are no child psychiatric beds south of San Antonio, and very few North with the exception of Shoal Creek in Austin and Cedar Crest in Belton. Reportedly Texas has more child psychiatrists than other states, yet Texas kids  are missing the mental health care they need. Child psychiatrists are in great demand, but these specially trained doctors are paid less than other specialties. Pediatricians are trying to pick up some of the needs of their clients, but with one doctor seeing 40-50 kids a day, there is little time for a mental health exam. A diagnosis from a child psychiatrist takes more than a 10 minute visit. It takes interviews with the child, the parents and sometimes the teacher . A good diagnosis may take several weeks or longer. But the difference is the child is getting psychiatric care in the meantime to help control the symptoms that are causing the most trouble for the child. Until the leadership in the cities hear from the rest of us that children's mental health should be the priority in our planning of budgeted items, we will continue with kids in E.R's or in jail until the system breaks down completely. By then it may be too late to save our kids. A call to action might be for parent groups to start conversations about submitting a plan to the city leaders that would support a plan funded by private and state funds to create a Crisis Services Unit that would see kids 24/7 and either stabilize them and release or keep them until a bed can be secured in an appropriate hospital setting. We can get millions for bike paths, and park upgrades, but nothing for what our kids need most, healthy minds.
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