New space for child and adolescent mental health

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It’s been 10 years since St. Joseph’s Health Centre inToronto(St. Joe’s) first opened its Child and Adolescent Mental Health program in what was renovated space in the paediatric unit. Now a decade later, this program will be housed for the first time in a space designed specifically with this program in mind.

“In the new year, this program will move into St. Joe’s new Our Lady of Mercy (OLM) patient wing in a space that is double what is currently offered,” says Dan Land, Administrative Program Director of Mental Health and Addictions.

The current six inpatient beds will be moving into the newly created space, but one big improvement is child and adolescent outpatients will now be treated on the same floor as the inpatients. Previously they were in separate buildings.

St. Joe’s has a contract with The Toronto Catholic District School Board for a full-time teacher, who has been with the program since its inception. The teacher instructs the inpatients in a classroom within the unit. The new space will also have capacity for an outpatient classroom, but this is subject to funding approval.

St. Joe’s Child and Adolescent psychiatrist Dr, Nagi Ghabbour helped create the program in 2001 following two years of planning as part of a 30 bed child and adolescent network within the city of Toronto. Ghabbour recalls just 12 inpatient beds before the Ontario government approved millions in funding for additional beds in Toronto at St. Joe’s and four other hospitals.

Part of patients’ admissions to St. Joe’s is to see how they are doing in school as it’s a measure of their ability to function. “If someone is depressed, they will not necessarily be able to function in school because they won’t be able to pay attention,” says Ghabbour. “Some patients will come here with comorbid attention deficit disorder or a learning disorder that hasn’t been diagnosed and that of course contributes to self-esteem issues and confidence.”

The inhouse teacher obtains educational records from the various schools children were at prior to being admitted and works intensely with the students and schools to help build the children’s confidence for future educational success. “They do homework and it normalizes the life of a child here in our unit,” says Ghabbour. “It is also giving them the message that school is an important part of their lives.”

St. Joe’s program currently sees a range of children and adolescents from 4-and-a-half to 19 years old. Those aged 19 and older are served in the adult mental health program. Ninety per cent of child and youth inpatients come from the emergency department, which is one of the busiest for mental health and addictions inToronto. There are 400 emergency room visits annually for child and youth with mental health and addictions issues and of those, 120 will be admitted throughout the year. The average length of stay is two weeks although some inpatients are in hospital for months.
Of the young patients admitted, 80 per cent will have issues related to suicide. St. Joe’s is the only hospital inToronto with a specialized Child and Youth Crisis Counsellor working along side a psychiatrist to assess patients in the emergency room. These professionals engage with the youth and their families to obtain a comprehensive history to help with priority admissions.

The crisis team for young patients operates from 11:30am to 11:30pm and gets support from the adult patient crisis team the remaining 12 hours daily. Ghabbour says, “We are seeing younger patients with multiple addictions along with their mental illness. We are just identifying more addiction issues in children and adolescents than before. There’s more poly-substance use at a younger age and it is more severe than before.”

The new program space will also feature a new multidisciplinary room, an outdoor terrace for some fresh air, an exercise room, a new exam room, a second interview room, more workspace for interprofessional students, more accessible showers and washrooms, improved storage space, better lighting, a washer and dryer and a much larger team station improving overall function.

Ghabbour also believes the stigma around youth and suicide is changing in schools with more support for students from their peers who take them to guidance counsellors or emergency rooms in hospitals such. St. Joe’s is part of the Toronto Early Intervention in Psychosis Network of 14 community agencies and hospitals in this city to develop early access to treatment.

“We are very excited to be able to open the unit in the new year and work closely with our community partners and continue to provide excellent client care to children and adolescents,” explains Land.