Friday, February 26, 2016

Anna Philbrook Center

I spent a week covering on the children's unit for the first time in my career. The flow of work is different, but I don't imagine folks are much interested in that.  You want to know about the kiddos.

Most of it isn't horrifying, just sad.

Only about half of them were seriously ill, which surprised me. The rest were mostly just sad cases, of things not working right. They had parents who expected them to smarten up and do their chores and not give any lip.  The phrase "doing this for attention" came out of those parents' mouths a lot more than you'd like.  These are generally kids who have too much anxiety, or too little central nervous system control, or are depressed, or obsessional, and just can't quite manage to do what the other kids in the family or at school do. They aren't horribly out of control, but it all winds into a deteriorating pattern of a kid who can't meet expectations, and a moderately stupid or unsympathetic or bullheaded parent who thinks They Could Do It If They Just Tried, leading to yelling, rejection, tantrums, and eventually, a parent who wants their child gone somewhere else, overwhelmed in the same way that the progeny are.  No serious pathology at any given point, just everyone dragging each other under the water, until the child does something dramatic like tie a cord around his neck or get suspended for fighting.

Those are never intact families, but chaotic, boundaryless ones.

There are also mean kids, that everyone hopes are just ill in some treatable way or will respond to a more structured environment. We are often the last stop before juvenile detention, as the last team of experts shakes their heads and say she's got some anxiety or mood disregulation that we can reduce, but that's not the main problem. The main problem is that she doesn't care anything for others. They are just objects to her. Sometimes those parents are just fine, so that you wonder if it's some genetic quirk or undiscovered prenatal or early childhood disease that just leads to dead conscience in some biological way.

The kids with the more serious illnesses are in a different world, even there. The sad, mostly healthy kids interact with them less.  They often come from "placements" and are going through an especially bad patch, with everyone hoping that some medication change will do at least minor magic. Sometimes it does, but mostly it's just tweaking and trading off side effects. Those parents are often bewildered or at their wits' end, but they seem like you and me.  Or more precisely, the percentage of pathological parents seems about the same as in the general population. The others are much like those I used to see at Little League or youth group.

Underneath it all is the chronic shortage of child psychiatrists (and even greater shortage of good ones, of course).  Less dramatically but still seriously, a shortage of child psychologists, psych nurses.  Maybe social workers - you'd think I'd know that about my own field, but I don't. Not enough well-trained people, so we rely on people we can pay very little and hope they have natural kindness and intuitive ability to deal with strange children.  Some can, quite remarkably. But most of the psych techs dread being sent to the kids' unit to cover.

6 comments:

Boxty said...

Why do the psych techs dread the kids unit? Because it's hopeless?

What do you mean by "low pay"? $15/hour?

Assistant Village Idiot said...

Combination. It's sad, because they are just kids, often caught in a maelstrom of bad illness, bad parents, poor ability to understand, or lots of rejection. And they are still cute, even when they are difficult. You get beat up a lot, because kids in dyscontrol have little thought of their own safety, and so are more unpredictable.

Hopelessness is mixed. There is a pretty good awareness that some of these kids have a better life coming, if they can get out of the house at 18, or into a placement that at least tries to be kind. But the underside is sensing the possibility of decades of unhappiness ahead.

Yeah, $13-18/hour depending. And you can get overtime. That's not bad if you are starting out, sharing an apartment with friends or living with your parents. But it's tough to raise a family on that. We have lots of immigrants working as what we call Mental Health Workers, usually those who came as adults and are intelligent enough but aren't ever going to have good enough English fluency for careers with ladders. Or single moms who chose bad boyfriends/husbands and are looking at a lifetime of scrambling. We really depend on both of those in finding enough of them that have those natural, intuitive skills. Working for the state, the excellent negotiated health insurance works for them, and they also can get some status and admiration that they can't get in other professions. In both cases, they have children of their own and some skills thereby.

I understand in other states it's not such a great pool of workers to draw from. I really don't know about that, I don't study it.

boxty woot said...

Thanks for the info. I'm surprised it's hard to find good workers. With a little overtime that's about $35k a year in a city with a median household income of $50k and a median house price of $180k.

Where I'm at the median household income is $65k but the median house price is $530k. And believe me, a $530k house is a dump in a bad neighborhood with terrible schools. And we pay taxes out the wazoo (income, sales, and property). But at least it's warm in the winter...

Retriever said...

IMHO,one reason people dread it is that it is so upsetting seeing kids in such bad shape. This initially leads to a lot of parent blaming(less threatening to attribute kids' state to bad/dysfunctional parents than face the fact that kid is severely ill with something that may afflict them the rest of their life.

. With shorter stays now, staff often only see the kids' typical but temporary improvement when scared/soothed by being in a different environment, one where very little is expected of them. Inexperienced techs see this improvement as a sign of how awful the parents are. I know I was guilty of this when first serving as a chaplain a million years ago on the unit for severely disturbed young kids. I had this happy notion the Sound of Music style discipline and love would cure them all from the noxious effects off poverty and bad parenting. Absolute BS! In fact, when the initial institutional calming effect wears off and kid starts exhibiting some of the same signs as at home, they decide parents have ruined him or her, overmedicate and disengage. Unless they are saintly nuns like some I used to work w....


Most parents find it terrifying, humiliating and threatening to have a kid on a psych ward. They feel they have failed as parents that their kid is psychotic or suicidal or violent. Their hearts are broken. But no one on the unit gives a shit about them or their other (traumatized) children. Their greatest fear is that their kid will be taken away from them by some ignorant a&$hole who doesn't understand mental illness and disability. That their kid will be put in the foster care system and subjected to abuse and neglect by semi literate people running kiddie mills for the money. So they bluster a lot for the benefit of social workers in a futile attempt to show that they are trying to set boundaries and limts. That they are not chaotic and boundary less.


The truth is, by the time the kid arrives at the hospital the entire family is near collapse. You don't have the right to judge if you haven't had to guard a manic and hostile eight year old who sleeps 2 hours a nght (parents take turns to watch 24/7, tho both have jobs) for 3 weeks while calling every mental hospital in 50 miles looking for a bed. Social worker doing jack shit to this end, psychologist so scared of kid's violence that they insist on parents being in room w them always. You don't have the right to judge if you haven't lived w one spouse being laid off because his firm's health insurer sad the firm's rates would double because of the kid's diagnosis if he was kept on the payroll. You don't have the right if you don't live in a family with zero respite ever. If you aren't prepared to support the parents (who are the kid's best hope 99% of the time) If you can't be compassionate instead of judgmental about the fact that the other kids are developing depression and anxiety in response to the wild one? For whom there is no adequate help? Is that the chaotic parents' fault or an indictment of inadequate mental health care for kids. All out society does is dose them into stupor w dangerous anti-psychotics, but that's management not treatment.

For the record: the best care our relatives have ever got in England or here, has been from the state hospitals. Better staff. More dedicated. Willing to deal w truly ill people...teaching hospitals are awful mostly as inexperienced clinicians flounder and mis-manage very sick people. And families get spotlighted as The Problem.

Excuse cellphone typos in this rant. Anger not aimed at you AVI, just upset at terrible state of kiddie mental health care. Andeven crankier than usual seeing yet another public handwringing over our local heroin problem, nearby. Drug addicts suffer from self inflicted wounds. They deserve our help and compassion in recovery, but kids are more deserving of scarce dollars.

lelia said...

Oh, Retriever. I do hear you. I raised a violent autistic child. My other children, my husband and I, the other people I came to know with difficult children, ohhhhh. I had hoped we would be magically exempt from the ills that come with that kind of stress.
Nope.
P.S. At 37 she is content, agoraphobic, and hardly ever violent. She hasn't damaged me in years now and loves her little home and home care provider. I like to think I've recovered, though I'm still shocked from time to time to see how much older I look than the people my same age.

Donna B. said...

retriever, lelia: yeah, what y'all said. And more of the same.