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CHKD seeks state approval for a $50 million mental health facility

Virginian-Pilot - 3/15/2018

March 15--NORFOLK -- In a move he described as tectonic, the president of Children's Hospital of The King's Daughters said the health system will expand its mental-health footprint in the community with a proposal for a $50 million psychiatric center.

The hospital must get state approval before moving forward, but president and CEO Jim Dahling said CHKD is committed to embracing what its community surveys have shown to be the No. 1 health concern: mental health services for children.

Three to five children a day arrive in the hospital's emergency room in need of a mental health evaluation, a number that has increased by 40 percent during the past four years, according to CHKD.

If the children have both a medical and psychiatric condition, they can be admitted for inpatient care. But if their sole diagnosis is psychiatric, they need to be referred to a psychiatric facility. In some situations, such as eating disorders, that means traveling out of state.

The hospital submitted paperwork to the Virginia Department of Health on March 1 to build a new medical tower, to be located just off Brambleton Avenue, on the same medical campus as CHKD, Eastern Virginia Medical School and Sentara Norfolk General Hospital. The tower would have three floors for mental health "day treatment" programs and 48 inpatient beds. Two more floors would be for other medical services, and four underground levels would be for parking.

The expanded mental health program would employ about 250 health care providers and support staff, and treat children 2 to 18 years of age.

The request for a "certificate of public need" would also include 12 beds in the current hospital for inpatient psychiatric treatment. The proposal will be reviewed by the state health officials to make sure the need for services is justified. A public hearing also will be conducted, likely in May or June. The state health commissioner is expected to make a final decision by early August.

"Everyone from parents to social workers to government agencies to school systems are telling us that mental health services for children are the No. 1 priority," Dahling said in an interview Tuesday.

National statistics are showing that 1-in-5 children need mental health services.

"The tipping point was the frequency of children coming into the ER in crisis," Dahling said. "Parents are saying, 'Please help.' There are simply not enough localities to place them. They stay in the ER sometimes for a day. You roll all of that together, and we cannot walk away."

A five-day snapshot of 14 mental health patients seen in the ER included:

* A 5-year-old with a history of setting fires, and being violent to animals and adults.

* A 16-year-old who took his parent's diabetes medication after experiencing suicidal thoughts. His brother died by suicide at 13.

* A 13-year-old who experienced sexual assault and later overdosed on Benadryl.

* An 8-year-old who expressed suicidal and homicidal thoughts and tried to jump out of a second-story window.

Currently, the system receives 15 to 20 mental health referrals a day from primary and specialty care providers. One day in February, 153 children were on the waiting list, with waits as long as six weeks.

The hospital has one psychiatrist and is now recruiting for more, but a national shortage has made that challenging.

Stephanie Osler, director of mental health services at CHKD, said there are four local inpatient units they can refer children to: Kempsville Center for Behavioral Health in Norfolk, Maryview Behavioral Medicine Center in Portsmouth, Riverside Behavioral Health Center in Hampton, and Newport News Behavioral Health Center in Newport News.

But there have been times when those facilities have been full or the situation would not be good for the child. For instance, if it's a young child or someone with autism, or a child who is gay, lesbian or transgender, sharing a room, or even a unit, would be difficult. Parents and caregivers often have to travel to Staunton, which has a state children's mental health facility, or to Northern Virginia, or even out of state.

Osler said it's particularly hard to find appropriate programs for children with eating disorders. The system has also struggled to find treatment for children as young as 3 or 4 getting kicked out of day-care and preschool settings because of behavior problems.

Courtney Boone, president of the Virginia Beach chapter of National Alliance on Mental Health, said parents with children who need mental health services often go outside the region, creating hardships for the children and parents. She shared an email from a local mother:

"When you are at the point of needing acute care for your child, neither of you are in a place you want to be. If you have done it more than once, a bad experience at a previous placement can also cause anxiety for both of you, and sometimes as a parent, you can delay getting needed help because of the options available."

Another woman, a 59-year-old Norfolk mother of a 13-year-old daughter and a 10-year-old son with mental health issues, said she's had to take her son to Johns Hopkins University in Baltimore for treatment for brain injury and psychiatric problems, and her daughter to Northern Virginia.

She and her husband were foster parents of the two children, who were severely abused when they were young, and they have since adopted them. "She was 4 years old when she was traumatized, but it's like it was yesterday," said the mother, who asked not to have their names used to keep private their background of abuse and mental illness.

They are both in and out of the hospital. At times, her daughter has had to wait more than a day at CHKD before a psychiatric bed was found for her.

"It's a shame to have to go so far to get help," she said. "Northern Virginia? That's ridiculous. That's shameful. But for so many people, that is what we have to do."

Amy Sampson, vice president over mental health services for CHKD, said that in the past, the health system has typically focused on medical and surgical needs of children and handed off acute psychiatric care to other facilities. But so many medical conditions have a psychiatric component, and the rate of children experiencing mental health problems is on the rise.

One pediatrician made the observation that diagnoses were shifting from typical ear infections to attention deficits, depression and obsessive-compulsive disorders: "I am stymied here and have little to no assistance. It is like fighting a battle and I am not armed."

In 2014, the health system assigned six licensed clinical social workers to do mental health assessments and interventions. The first year, the system's mental health team did 3,500 visits. Since then the number of mental health therapists assigned to that duty has grown to 25 and they are on track for 18,000 visits at nine different CHKD locations this year.

That was the first step in bolstering mental health services, along with getting mental health training for pediatricians.

"We want to give children a gliding path, post-discharge, so they don't end up back in the ER two weeks later," Dahling said.

If the system gets state approval, it would take two years to get the 12 beds in use in the current hospital and four years for the new facility to be built.

The King's Daughters, founding organization of CHKD, has pledged $1 million to the mental health initiative. Dahling said the health system will be talking with government officials, community leaders and philanthropic organizations to raise funding for the effort.

Dahling said the move will eclipse the most recent shift in strategy, which was when they began building medical centers and urgent care clinics in other parts of the region 15 years ago.

"It's extremely exciting," he said. "And a little terrifying."

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