The teen years are tough enough for any kid. School, hormones, parents and adulthood coming like a speeding train.
When mental illness is part of the mix, teens, families and their care providers often are outmatched.
“In many cases, their life is at risk,” said Chris Ladish, a pediatric- and neuro-psychologist at Mary Bridge Children’s Hospital.
On Tuesday, the region’s first mental health facility solely focused on teens will open at Tacoma General Hospital. Ladish will be its medical director.
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The 27-bed Mary Bridge Adolescent Behavioral Health at Tacoma General has state-of-the-art safety features and a nontraditional environment for patients ages 13-18. Treatment is geared toward short-term stays, whereas currently many of these patients now seek treatment in the area’s emergency rooms.
“What we’ve really strived to do is make it comfortable, inviting and warm,” Ladish said.
Statistics from a Pierce County mental health assessment show that approximately one in five youths ages 13-18 will experience a mental disorder in a given year. Suicide is the second leading cause of death in people ages 10-24 in Washington state.
The new center, administered by MultiCare Behavorial Health and Mary Bridge Children’s Hospital, will treat conditions such as major depression, anxiety disorders, psychosis, schizophrenia and bipolar disorder.
“The child who comes here is generally not able to function in society,” Ladish said. “They can’t get through a school day. They have probably been in outpatient (treatment). They may have harmed themselves or others. They are not happy with their home life.”
Patients will be admitted voluntarily, involuntarily and of initiated by parents.
“You always try to work with a child to encourage them to come in voluntarily,” Ladish said. “I think the bulk of our kids will come in voluntarily and/or parent-initiated. Usually, one or both is really wanting to seek help.”
Patients, no matter which category they fall into, all need to meet criteria beforebeing accepted into the facility. They must show evidence of an acute behavioral health condition, and they must present a danger to themselves or others. Alternately, they may have severe psychosocial problems.
The three most frequently seen juvenile psychiatric concerns in MultiCare’s emergency departments are suicidal thoughts, acute psychosis and severe behavioral issues.
The center’s work will include psychiatric evaluation and treatment, psychosocial assessment, medication management, counseling and family groups. In addition, the child will be prepared to return to their home and school.
The therapies that will be used in the facility are evidence-based, meaning that studies have proved that they have a positive effect on patients.
NEW AND GLEAMING
The floor where the facility was built was left vacant when the Rainier pavilion was built, a common practice when a hospital adds a new building.
Big but private windows look out onto Wright Park. Comfortable furniture and art give the facility a nonclinical look.
A closer inspection reveals special features.
Anti-ligature hardware — door handles, water fixtures, sprinkler heads — are designed to prevent rope, clothing, belts and anything else from hanging on them in a suicide attempt.
“The bulk of the kids we’re seeing (have a) suicide risk,” Ladish said.
Even the toilet paper rolls are recessed.
“If you take them apart you can unwrap the spring to cut on yourself,” Ladish said. “Anything that has a rough edge has padding so a kid can’t smack their head on a hard edge.”
Door hinges go from floor to ceiling. The door frames themselves can be taken apart in a matter of seconds by staff with a special key in case a patient barricades himself in a room.
Windows are shatterproof. Walls are indestructible. Furniture can’t be thrown.
There is a room with padding, but it reflects the fact that the facility is restraint-free, Ladish said.
“The only time that someone would be laying hands on a child is when they are doing something to themselves physically that is putting themselves at risk,” Ladish said.
A calming room is outfitted with colored LED lights and music that patients can adjust themselves.
“That’s for kids who have unique sensory needs,” Ladish said.
The staff will include psychiatrists, nurses, psychologists, social workers and educators.
“Our staff is going to be out on the floor with the kids all the time,” she said.
FILLING A NEED
Health care providers from top to bottom agree on one thing: The region, state and nation suffer from a lack of facilities to care for people with behavioral health problems.
“People are often languishing, waiting to get the care they need,” said Tim Holmes, president of MultiCare’s Behavioral Health.
Many of those who could benefit from facilities like MultiCare’s end up in emergency departments.
Eight percent to 12 percent of people showing up at MultiCare’s emergency departments are behavioral health patients who meet the medical criteria for inpatient services, Holmes said.
Ladish predicts most of the kids treated at the new facility will be brought in from emergency departments.
“We have seen a steady increase over the past several years of children presenting to the (emergency department) in mental health crisis overall,” Ladish said.
Often intertwined with mental health issues are substance abuse and addiction problems. “We expect some (patients) are going to have problems with substances,” Holmes said.
Holmes oversees a variety of behavioral health outpatient services in south King County and Pierce County, as well as inpatient services in Auburn — a total of about 22,000 patients.
“We’re not addressing the issues as they occur early enough,” Holmes said. “We tend to be reactive, and we don’t have a good, strong inpatient presence.”
THE DIFFERENCE WITH TEENS
Every age group has its needs. But adolescents stand out for the simple fact that they are not yet adults.
“It’s the way you approach a teen, regardless of the mental illness,” Ladish said. “From a mental health perspective, you add the impulsivity, the sense of indestructiveness, hormones. You kind of fuel a psychopathology (with those). It feeds the flame of mental illness.”
Research has shown that the longer it takes to diagnose a teen’s mental illness, the poorer the outcome, she said.
“Early detection is really critical,” Ladish said.
Psychosis and other serious mental health conditions usually manifest in the 16-24 age group.
“There are many precursors,” to severe mental conditions, Holmes said. “Many times you find these things out from a schoolteacher.”
Warning signs can include social withdrawal, missing assignments or classroom outbursts.
“You can see it start to progress from there,” Holmes said. “What we want to do is get ahead of that.”
A complicating factor is that teens with mental illness can present with symptoms that mirror typical teen emotions and behavior.
“One of the first things a parent will preface (a concern with is), ‘I just don’t know if this is just teenage … but, I’m worried about this,” Ladish said.
“When in doubt, seek assistance,” Ladish said. “You can always get reassurance from a provider. And far better to do that than — God forbid — you thought this is typical teen, and you find out the kid is really struggling and did attempt suicide.”
There is some connection between seasons of the year and mental health disorders in children and teenagers, Ladish said.
Fall is associated with school stress and trouble with peers. Spring can bring academic pressures. Prolonged cloudy weather can affect kids with seasonal mood disorders.
Serious psychosis in juveniles remains very rare — less than 1 percent, Ladish said.
Physical health will be taken into account during treatment. People with mental illness have higher rates of physical health problems.
“Healthy body, healthy mind. And vice versa,” Holmes said. “Our treatment plan looks at that and addresses it.”
BEFORE AND AFTER TREATMENT
The new facility is designed for short-term stays, with an emphasis on five- to nine-day stays.
A typical patient plan will include stabilization, diagnosis and getting through the acute phase of mental illness.
“The question is: Where are they going to go from here?” Ladish asked. Some will go to outpatient care in the community. Others will need longer term care, she said.
Though the need is great, it’s hard to tell just how in-demand the facility will be. If beds go empty, the facility will draw from greater distances, Holmes said.
“Our hope is that we can provide more services to a broader population,” he said.
The facility will open in a limited capacity and reach full operation by the end of 2017.
“It takes time to build that infrastructure and foundation to attract (providers) to that environment,” Holmes said.
MultiCare will look to partners as it expands both its range of services and the populations it serves.
Ladish is optimistic that the new facility and its staff will make a difference in the lives of the kids with just a few days of treatment.
“Something is dramatically going to change in seven to nine days,” she said.
Mary Bridge Adolescent Behavioral Health at Tacoma General
Where: Tacoma General Hospital.
Intake number: 253-403-0362.