New clinic provides rapid response for kids in crisis

Parents and caregivers can hit the emergency button on a child’s mental health crisis much sooner now thanks to a new clinic at Hotel Dieu Hospital in Kingston.

The only service of its kind between Toronto and Ottawa, the new Child and Adolescent Mental Health Urgent Consult Clinic (CAMHUCC) assesses and supports youth ages 12 to 17 with urgent mental health issues such as those with suicidal or violent behaviours, kids who threaten violence or those with control issues due to alcohol or drugs.

“Immediately after an emergency or crisis there’s a window of opportunity to carry out brief crisis interventions that are effective and preventative. This new clinic provides that window,” says Dr. Nasreen Roberts, head of child and adolescent psychiatry at Hotel Dieu, Kingston General Hospital and Queen’s University.

“The clinic is geared to keeping these kids out of the ER and to getting them rapidly assessed and on the road to treatment,” she says. “Rather than sit waiting in the ER for six or eight hours and then maybe six weeks for a clinic appointment, children and families can access the urgent consult clinic within 48 hours. They can get the help they need quickly and, at the outset at least, avoid or minimize the chance of hospital admission.”

Supported by about $290,000 in new funding from the South East Local Integration Health Network, the pilot clinic is just entering its second year. It receives four to six urgent referrals every day from hospital ERs, school boards and community agencies in the Kingston region. At the one-year mark, it is averaging about 40 new assessments each month, a jump from the original goal of 29.

Roberts points out that a child’s mental health crisis does not always translate into hospital admission and that parents have indicated they can wait knowing that professional help is just a day or two away. “Any parent will tell you they can wait that 48 hours for a clinic appointment,” she says.

The urgent consult team includes a psychiatrist, social worker, nurse and medical residents.  After an initial assessment, intervention can involve four to six brief follow-up sessions with the CAMHUCC team and possibly referral to another service such as the hospital’s anxiety clinic.  The idea is to help bridge the child to appropriate counselling with a community agency although in some cases hospital admission is necessary.

About 40 per cent of the clinic’s referrals are males and 60 per cent are female. One striking statistic has emerged since the clinic opened: About 49 per cent of the referred youth talk about bullying and teasing as a reason for experiencing depression or feelings of wanting to hurt people. Of that 49 per cent, 82 per cent of the kids reported actively thinking about suicide.

“The culture of mental health is definitely changing for youth,” says team social worker Nicholas Axas. “Kids are more comfortable now about talking about issues such as bullying or depression because they’re so openly communicated and discussed on social media these days.

“That culture shift extends to parents, teachers and other caregivers. Now they’re less likely to dismiss a child’s behaviour as something related to ‘just being a teenager’ and instead to be aware of—and to act on—tough issues facing kids such as bullying and substance abuse.”

Roberts applauds the community for working collaboratively with Hotel Dieu to make the new clinic a success. “We’ve had tremendous support from schools and community agencies.  And we know that the ER physicians really appreciate the service. They’re very concerned about these kids and don’t want to see them going from pillar to post to get help.

“We’ve done an informal survey with area ERs and the feedback is that this new clinic is working. It’s helping to decrease the number of youth waiting in the ER and diverting them to more appropriate supports.  That’s good news for families in this region.”