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Children's Mental Health
THE CHILD IN THE COMMUNITY: NURSING MAKES A DIFFERENCE Column Editor: Rita Black Monsen, DSN, MPH, RN, FAAN
Children’s Mental Health Debra Thomas, BSN, RN
ENTAL ILLNESS COUNTS for 15% of the overall burden of illness in the developed world, exceeding the toll of all cancers combined, and major depression alone ranks second in the world next to ischemic heart disease in terms of burden on society (National Institute of Mental Health, 2006a). Nearly every family is touched in some way by mental illness in our nation, with one in four adults aged 18 and over affected with diagnosable abnormal behavior patterns each year (National Institute of Mental Health, 2006b). In some families, the degree of anguish is critical and emotional pain, chronic. According to Cassidy and Jellinek (1998), even when families call for help with mental health problems, only 40% of pediatricians responded appropriately, and fewer responded to parents with less education. In the case of bipolar disorders, referrals for treatment are often delayed because many clinicians are uninformed about patterns of behavior that are recognized as diagnostic in children (Craney & Geller, 2003; National Institute of Mental Health, 2001). In a valuable prospective comparison of adolescents and adults hospitalized with bipolar disorders, McElroy, Strakowski, West, Keck, and McConville (1997) demonstrated that adolescents display distinct behaviors different from those usually seen in older individuals. They found that teens were more likely to have depressive symptoms (including suicidality) and less psychotic thinking than adults. Also, first-degree relatives (parents, siblings) of adolescents were more likely to have mood disorders and problems with drug abuse than was found among adult patients, affirming that bipolar illness in adolescence may have a different inheritance pattern than that seen for those diagnosed later in life.
M
Journal of Pediatric Nursing, Vol 21, No 6 (December), 2006
Son and Kirchner (2000) examined depression in children and adolescents, noting that 2% of children and 5–8% of adolescents display signs of depression spanning from sadness to persistent depressed mood, fatigue, withdrawal from peers and social interaction, developmental regression, and school failure. They summarize the recommendations for screening, including use of the Pediatric Symptom Checklist, referral, and treatment to help the child and family. They stress the importance of giving children and youth appropriate treatment that could prevent self-destructive behaviors and violence toward others, promote healthy social relationships, and give opportunities for academic achievement. Caring for children who have mental health problems is challenging and often difficult for families and school personnel to understand, much less tolerate. A young nurse came to me recently with a story of her older daughter. Her words are compelling and inspired me with her courage and determination to find help. My daughter was diagnosed with childhood-onset bipolar disorder (COBPD) at the age of 9 years even though her symptoms began in infancy. The journey of finding help for my daughter has been a very long and difficult one, taking us from Arkansas to Texas to New York, requiring patience, determination, and strength I never knew I could possess. My hopes and dreams for educators and health care personnel is that they become aware of COBPD, familiarize themselves with the signs and symptoms, and become a frontline intervention for these children so that they can receive treatment at an early age. The longer COBPD goes untreated the more difficult it is
0882-5963/$ - see front matter n 2006 Published by Elsevier Inc. doi:10.1016/j.pedn.2006.10.001
443
444
DEBRA THOMAS
for these children to experience stability, which can take years of numerous failed medication trials before the bright mixQ of medications are discovered.
There are two worlds that exist for these children and their families—the bipolar world and the outside world. The following incident is only a small glimpse of the bipolar world in which we live when our children have not yet gained stability or more sadly, have lost it, and experience devastating rages in which they have no control over. These rages can begin anytime and anywhere without warning. During a routine shopping trip to Wal-Mart, my 11-year-old daughter wanted to purchase lipgloss with birthday money she had just received. The rage began inside the store over the cost of the lipgloss even though we were standing at the scanner with the price displayed on the screen. The bmeltdownQ began out of nowhere. I was not expecting it; I thought everything was going so well. However, I left my cart in the middle of the aisle and attempted to remove my bipolar daughter, my younger daughter, and myself safely and swiftly from the store. We made it to the car with my daughter screaming and crying uncontrollably all the way. The rage was so intense and so loud that I could not tolerate being inside the car with
her. So I drove to an empty part of the parking lot and stepped out of the car for a moment to gain my composure and strength to deal with the much unexpected rage that reeked havoc on our seemingly happy and fun outing. A parent cannot ask, bWhy are you doing this?,Q but instead, let the rage pass. Once home, I sedated her and the rage still continued for one and one half hours. All a parent can do is to make sure the child does not hurt themselves or others, hold them at the rage’s end, love them, try to give them hope. I have learned that I can reassure her and tell her that I will fight for her and will fight for the right mix of meds so that maybe, just maybe, there will be a pot of gold at the end of the rainbow, and this madness will end.
One of the messages we attend to in this story and in reviewing the evidence for attending to mental health issues in children is our obligation to inform ourselves first, then seek ways of providing education to our colleagues, to leaders in our schools, and finally to those with power to change policies in our communities. Nurses have access to mental health care information and can repackage it so that families and community leaders can understand and act on the pressing needs for better mental health programming for youth in our society.
REFERENCES Cassidy I. J., & Jellinek M. S. (1998). Approaches to recognition and management of childhood psychiatric disorders in pediatric primary care. Pediatric Clinics of North America 45, 1037 – 1052. Craney J. L., & Geller B. (2003). Child and adolescent bipolar disorder: A review of the past 10 years. Bipolar Disorders 5, 243 – 256. McElroy S. L., Strakowski S. M., West S. A., Keck P. E., & McConville B. J. (1997). Phenomenology of adolescent and adult mania in hospitalized patients with bipolar disorder. American Journal of Psychiatry 154, 44 – 49.
National Institute of Mental Health. (2001). Research roundtable on prepubertal bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 40, 871 – 878. National Institute of Mental Health. (2006a). Fact sheet: The impact of mental illness on society. Retrieved 12 June 2006 from http://www.nimh.nih.gov/publicat/burden.cfm? National Institute of Mental Health. (2006b). The numbers count: Mental disorders in America. Retrieved 12 June 2006 from http://www.nimh.nih.gov/publicat/numbers. Son S. E., & Kirchner J. T. (2000). Depression in children and adolescents. American Family Physician 62, 2297 – 2308.
Children’s Mental Health Debra Thomas, BSN, RN
ENTAL ILLNESS COUNTS for 15% of the overall burden of illness in the developed world, exceeding the toll of all cancers combined, and major depression alone ranks second in the world next to ischemic heart disease in terms of burden on society (National Institute of Mental Health, 2006a). Nearly every family is touched in some way by mental illness in our nation, with one in four adults aged 18 and over affected with diagnosable abnormal behavior patterns each year (National Institute of Mental Health, 2006b). In some families, the degree of anguish is critical and emotional pain, chronic. According to Cassidy and Jellinek (1998), even when families call for help with mental health problems, only 40% of pediatricians responded appropriately, and fewer responded to parents with less education. In the case of bipolar disorders, referrals for treatment are often delayed because many clinicians are uninformed about patterns of behavior that are recognized as diagnostic in children (Craney & Geller, 2003; National Institute of Mental Health, 2001). In a valuable prospective comparison of adolescents and adults hospitalized with bipolar disorders, McElroy, Strakowski, West, Keck, and McConville (1997) demonstrated that adolescents display distinct behaviors different from those usually seen in older individuals. They found that teens were more likely to have depressive symptoms (including suicidality) and less psychotic thinking than adults. Also, first-degree relatives (parents, siblings) of adolescents were more likely to have mood disorders and problems with drug abuse than was found among adult patients, affirming that bipolar illness in adolescence may have a different inheritance pattern than that seen for those diagnosed later in life.
M
Journal of Pediatric Nursing, Vol 21, No 6 (December), 2006
Son and Kirchner (2000) examined depression in children and adolescents, noting that 2% of children and 5–8% of adolescents display signs of depression spanning from sadness to persistent depressed mood, fatigue, withdrawal from peers and social interaction, developmental regression, and school failure. They summarize the recommendations for screening, including use of the Pediatric Symptom Checklist, referral, and treatment to help the child and family. They stress the importance of giving children and youth appropriate treatment that could prevent self-destructive behaviors and violence toward others, promote healthy social relationships, and give opportunities for academic achievement. Caring for children who have mental health problems is challenging and often difficult for families and school personnel to understand, much less tolerate. A young nurse came to me recently with a story of her older daughter. Her words are compelling and inspired me with her courage and determination to find help. My daughter was diagnosed with childhood-onset bipolar disorder (COBPD) at the age of 9 years even though her symptoms began in infancy. The journey of finding help for my daughter has been a very long and difficult one, taking us from Arkansas to Texas to New York, requiring patience, determination, and strength I never knew I could possess. My hopes and dreams for educators and health care personnel is that they become aware of COBPD, familiarize themselves with the signs and symptoms, and become a frontline intervention for these children so that they can receive treatment at an early age. The longer COBPD goes untreated the more difficult it is
0882-5963/$ - see front matter n 2006 Published by Elsevier Inc. doi:10.1016/j.pedn.2006.10.001
443
444
DEBRA THOMAS
for these children to experience stability, which can take years of numerous failed medication trials before the bright mixQ of medications are discovered.
There are two worlds that exist for these children and their families—the bipolar world and the outside world. The following incident is only a small glimpse of the bipolar world in which we live when our children have not yet gained stability or more sadly, have lost it, and experience devastating rages in which they have no control over. These rages can begin anytime and anywhere without warning. During a routine shopping trip to Wal-Mart, my 11-year-old daughter wanted to purchase lipgloss with birthday money she had just received. The rage began inside the store over the cost of the lipgloss even though we were standing at the scanner with the price displayed on the screen. The bmeltdownQ began out of nowhere. I was not expecting it; I thought everything was going so well. However, I left my cart in the middle of the aisle and attempted to remove my bipolar daughter, my younger daughter, and myself safely and swiftly from the store. We made it to the car with my daughter screaming and crying uncontrollably all the way. The rage was so intense and so loud that I could not tolerate being inside the car with
her. So I drove to an empty part of the parking lot and stepped out of the car for a moment to gain my composure and strength to deal with the much unexpected rage that reeked havoc on our seemingly happy and fun outing. A parent cannot ask, bWhy are you doing this?,Q but instead, let the rage pass. Once home, I sedated her and the rage still continued for one and one half hours. All a parent can do is to make sure the child does not hurt themselves or others, hold them at the rage’s end, love them, try to give them hope. I have learned that I can reassure her and tell her that I will fight for her and will fight for the right mix of meds so that maybe, just maybe, there will be a pot of gold at the end of the rainbow, and this madness will end.
One of the messages we attend to in this story and in reviewing the evidence for attending to mental health issues in children is our obligation to inform ourselves first, then seek ways of providing education to our colleagues, to leaders in our schools, and finally to those with power to change policies in our communities. Nurses have access to mental health care information and can repackage it so that families and community leaders can understand and act on the pressing needs for better mental health programming for youth in our society.
REFERENCES Cassidy I. J., & Jellinek M. S. (1998). Approaches to recognition and management of childhood psychiatric disorders in pediatric primary care. Pediatric Clinics of North America 45, 1037 – 1052. Craney J. L., & Geller B. (2003). Child and adolescent bipolar disorder: A review of the past 10 years. Bipolar Disorders 5, 243 – 256. McElroy S. L., Strakowski S. M., West S. A., Keck P. E., & McConville B. J. (1997). Phenomenology of adolescent and adult mania in hospitalized patients with bipolar disorder. American Journal of Psychiatry 154, 44 – 49.
National Institute of Mental Health. (2001). Research roundtable on prepubertal bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 40, 871 – 878. National Institute of Mental Health. (2006a). Fact sheet: The impact of mental illness on society. Retrieved 12 June 2006 from http://www.nimh.nih.gov/publicat/burden.cfm? National Institute of Mental Health. (2006b). The numbers count: Mental disorders in America. Retrieved 12 June 2006 from http://www.nimh.nih.gov/publicat/numbers. Son S. E., & Kirchner J. T. (2000). Depression in children and adolescents. American Family Physician 62, 2297 – 2308.