Strong relationships with clinicians can empower children and their families to engage more fully in their mental health treatment.
Throughout the country, pediatric emergency room visits by families, children, and adolescents experiencing mental health crises have increased during the COVID-19 pandemic. Emergency room healthcare professionals are overwhelmed by the number of patients, the lack of available inpatient child psychiatric beds, and the limited mental health resources in the community. They are faced with challenging decisions on how to comfort, advise, and care for these families.
As a child and adolescent psychiatrist, I often sit across from young people experiencing intense feelings that are blocking their ability to find meaning in their lives. Many underlying issues contribute to childhood depression, anxiety, and suicidal thoughts and behaviors. However, these patients often speak about feeling invisible in their homes, schools, and communities. Part of our job is to SEE these young patients and help them feel seen.
The fast pace needed to maintain medical treatment in an emergency department can be limiting when one is eliciting emotional stories and attempting to find ways to emotionally connect with kids and their families. Here are some things I like to keep in mind:
1. Expect and normalize strong emotions and conflict.
Emotions such as anger, resentment, and frustration will likely be a part of the interaction and may be directed toward you. Learn to value all emotions as biological signals and expression of those needing our support, and work on accepting your own emotions.
2. Recognize that your own emotions may affect your patient care.
Seek support to maintain your own mental wellbeing so you can best serve those seeking help.
3. Involve family members as much as possible.
Mental health concerns often result in feelings of confusion, guilt, and sometimes shame. Notice and explicitly acknowledge the strengths of the family. Expressing your observations, such as, “I can see you love your child so much,” can sometimes help soften challenging emotions so families can better engage their rational thinking.
4. Use available resources.
Engage other healthcare professionals, such as social workers, chaplains, and trainees. Show you value their voices. Tell them they are an important part of the team.
5. Learn about the system of care in your community.
Because of the limited availability of intensive mental health services, most children experiencing emotional crisis will need to return home as they wait to be connected to community mental health services. Find ways to strengthen the child and family’s foundational pillars to get them through the time it may take to be connected with outpatient mental health professionals. School counselors and teachers, faith leaders, peer support groups, and other family members may be accessible resources to assist in monitoring and supporting the child and their family.
6. Empower your patient.
Explicitly naming the child’s strengths can be empowering and can encourage them to become more involved in the treatment planning. Affirm the child’s skills and qualities, such as, “I can see you are working so hard to . . .” or “You’re so brave to communicate your feelings.”
In a world that provides limited opportunities to express intense emotions, healthcare professionals can model this to patients who are experiencing emotional difficulties. Helping to hold and honor safe spaces for children and adolescents to feel loved, supported, and valued, even in times of emotional distress, is a skill that we can nurture.