PsychSense: Sensible Psychological Solutions

I found an online article listing questions parents should ask before considering psychiatric hospitalization for their children.  I think there are some qood questions here, but I would like to add my 2 cents to certain questions. 

In the spirit of full disclosure I am a Psychiatric NP with many years experience including inpatient units. Psychiatric admissions and hospitalizations have changed dramatically in the last 20 years. What used to be for weeks even months is now days.

1. What type of therapies will my child have while in the hospital and how are they better than outpatient therapy? The reality is that therapies in hospitals are usually limited to medications and sometimes groups. The groups are educational and do not meet the criteria for psychotherapy (aimed at some type of change).  Of course If they are done well, they can be helpful in terms of offering information such as how to deal with feelings, anger and stress managment.

 Hospital admission is not for therapy any more but for treatment of crisis, specifically to maintain safety.  Hospitalization  is best used to prevent suicide,  self-harm,  or violence.  Remember if your child is on a unit with other more troubled kids they may  copy  worse behaviors. Due to insurance company rules and today’s model of treatment the usual process of hospitalization is to stablilize and discharge the person ASAP.  This often means use of medications quickly  with little time to evaluate theraputic effects, dosages or side effects.

  2.  Will my child receive in depth psychological testing and psychotherapy by a clinical psychologist while hospitalized? Or will the treatment mainly consist of drug therapy by a psychiatrist?

This appears to be a question written by and from a  psychologists point of view. Most units do not have psychologists as therapists (they cost more) but may use them as  consultants to do psycological testing if needed (usually determined by the Psychiatrist or Psychiatric NP ). Psychological testing CAN be helpful in determining  personality style, making diagnosis and identifing learning disabilities and IQ. It is usually only done once or twice in a lifetime as these things don’t change. It is very expensive and its use is determined by the culture. ( what is the view of the value of the testing. how many psychologists are present in the system). Psychological testing is not an exact science,  neither is psychiatry or medicine.

I request psychological testing  to determine IQ and screen for learning disability, to help with diagnosis if I am unclear (notice the word help, this is not a sure thing but an interpretation).  I also like  it for what is called a validity scale, that is it can tell if the person is exaggerating or providing inconsistent answers.

The persons who manage inpatient units are psychiatric nurses and social workers, they may see the patients for a few minutes a day (as does the psychiatrist) but that’s not therapy, it is more management. The goal is usually to discharge the person as soon as possible, especially before the insurance runs out. This is not necessarily bad, but it  does tend to increase use and dosage of medication as the time for evaluation of effects is limited.

3. Will we be attending family counseling sessions regularly?

Family meetings are often part of the hospitalization. Calling this counseling is a stretch in my opinion. They are most often used to obtain or  convey information and plan for discharge. Family counseling or therapy is often necessary when working with children but this needs to be done on an outpatient basis.

4.  When our child is discharged, will it be necessary for him or her to receive follow-up care?

In my opinion any child that needed psychiatric admission needs follow up whether they recieve medication or not. Here is where family therapy is often needed.

I would love to hear your comments or experiences with this issue.

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