Safe haven
Inpatient psychiatric unit specializes
in acute care
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Robert Lobis, MD
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For patients, families and clinicians, treatment
of psychiatric illnesses can be much more difficult than simply
addressing the illness by itself. Few other diagnoses are as heavily
dependent upon family involvement in treatment, and even fewer
are as misunderstood and stigmatized. These challenges are even
more pronounced when the patient has a comorbid medical illness,
such as diabetes, that complicates or reduces the child’s
ability to care for him or herself.
For those times when young patients can’t be managed in
outpatient settings, have significant medical risks or severe
psychiatric symptomatology, or are aggressive or dangerous—either
to themselves or others—Children’s Hospital Boston offers
the Richmond
Psychiatry Inpatient Service, also known as Bader 5. This
18-bed unit specializes in caring for children and adolescents,
age 3 to 18, with depression, anxiety, eating disorders, complex
somatoform disorders and chronic medical conditions that can be
exacerbated by psychiatric illnesses.
Bader 5 is staffed by nearly 60 full- and part-time staff, including
three attending physicians, nearly 40 nurses, a staff psychologist,
five social workers, a nutritionist and several residents. In
addition, there are two recreational therapists that help patients
interact socially, and two teachers who help them keep up with
school work.
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Sally Nelson, RN, MEd
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The unit is broken into two areas, one for school-age children
age 6 to 12 and one for adolescents age 13 to 18. Children younger
than 6 have individualized programs. In all age groups, patients’
schedules include time for individual, group, and family therapy,
as well as psychopharmacology consultation and school work. Time
is also included for patients to interact socially where they
see—many for the first time—that they are not the only
ones with a specific problem.
The concentration of individualized services available on Bader
5 allows staff to accomplish things that others can’t, but
the focus is always on the patient and family and how they have
to work together to address the issues that led the hospitalization.
“When children have to be hospitalized for a psychiatric
illness, they feel things are out of control, and the parents
feel helpless,” says Robert
Lobis, MD, medical director of Bader 5. “We address
those feelings in a few ways. First we work with the family as
a whole to define the focal problem, or what we’ll be working
on while the child is in the hospital. We make it very clear that
we’re treating the acute reason the patient was admitted
to the hospital; offering the front end of a longer program that
will take place in an outpatient setting. Then we educate both
the patient and parents about the illness and help them draw a
distinction between a child who has a problem and a child who
is a problem. Finally we work closely with the whole family to
design a treatment program that helps them control that problem.”
Often, however, parents’ expectations of what the Bader
5 staff can accomplish are unrealistic. “Many of them feel
that their child’s psychiatric illness will be ‘cured’
by the time they leave the hospital,” says
Sally Nelson, RN, MEd, program director of Bader 5. “They
want us to fix things. So we try to make it clear that we’re
the first step in a long process and that their involvement is
key.”
In addition to working with staff to design a treatment plan
and set shared goals, parents are expected to spend significant
time with their children at the hospital and are asked to come
to two or three meetings each week.
“We tell parents that their child is not in isolation here,
and try to empower them to help their child manage the illness,”
says Nelson. “There are family meetings and a parents group,
and we plan time for parents and children to leave the unit together
before discharge so they can test some new behaviors. When they
come back we evaluate how things went so we can solve problems
before they get out of the safe hospital environment.”
Once the child is released from the hospital (a typical stay
is usually about two weeks), the family is given an extensive
treatment plan that is shared with the child’s primary care
physician. In addition, schools and agencies like the Department
of Social Services are educated about the illness and how to help
the child follow the plan.
Insurance
concerns often make psychiatric hospitalizations more difficult
than they already are. Nelson and Lobis note that the services
provided on Bader 5 are out of network for most insurance carriers
and that it is important for parents to check whether their insurance
will pay for the hospitalization.
The Department of Psychiatry at Children’s developed “Helping
with Your Child’s Psychiatric Hospitalization: A Practical
Guide for Parents” to answer questions patients and
families have about inpatient psychiatric hospitalizations.
