Running Head: HEALTH CARE ACCESS TO CHILDREN IN PSYCHIATRIC FACILITIES 1

Health Care Assess to Children in Psychiatric Facilities

Delaware Technical Community College

NUR 420 Nursing Policy

Reneé S. Smallwood

October 5, 2018
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Abstract

It takes a village to raise a child. It is up to the community and ultimately politicians to advocate

for children in mental health facilities. Children in psychiatric facilities endure the most trauma

due to history and struggle once placed in the outside world. Being restrained in a mental health

facility is not healthy and tends to have significant consequences in children, adolescents, and

teens. Change must occur to support children placed in psychiatric institutions to adapt and be

successful citizens. Education is essential in understanding the mental disable culture, and it is

vital for people directly involved to know about caring for children with a history of traumatic

disorders which have been known to affect their well-being.

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Health Care Access to Children in Psychiatric Facilities

Around the world, many populations and subsets encounter less than ideal health care and

treatment. These victims often become patients and are subjected to many injustices and health

disparities. The millions of children and adolescents who suffer from mental health in the United

States (US) is tremendous and many times leads to hospitalizations for treatment, and safety

from oneself as well as others. Often when children are admitted into an acute psychiatric

facility, it is because they struggle with managing their emotions or behaviors. Some hurt

themselves, others, and destroy property, triggered by traumatic exposures such as neglect,

sexual, mental and emotional abuse, death, loss of loved ones, and poverty. According to Anixt,

Copeland-Linder, Haynie, & Cheng (2012), “adolescent exposure to violence has been

associated with symptoms of psychological trauma including depression, anger, anxiety,

dissociation, and posttraumatic stress” (p. 125). Anger has a rippling effect on future behavioral

concerns of fighting which puts the child at risk for repeat injury, violating other children, and

many other cycles of violence. Anixt et al., explains, “young victims of interpersonal violence

report a need for many psychological and social services, with mental health being one of the

greatest areas of need” (p. 125). It is evident that this is a severe issue in need of close attention.

Sadly, the rate of children who have endured trauma is increasing. According to Dopp,

Hanson, Saunders, Dismuke, & Moreland (2017), “children and adolescents have high rates of

trauma exposure as evidenced by national estimates of 702,000 victims of child abuse and

neglect in and of one in 20 youth meeting criteria for a posttraumatic stress disorder. Also, the

annual economic burden of childhood trauma in expenses pertaining to mental healthcare lost

productivity, and participation in social services is over $120 billion” (p. 87). These findings are

disturbing because so many children are innocent victims of things beyond their control and
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furthermore puts these youth at risk for mistreatment. While being hospitalized in a psychiatric

hospital, there are times when one may require restraints, seclusion, medication or physical

removal from the environment. This becomes challenging for the staff and leaves much room for

mistreatment and patient abuse. Although theses angered youth are culprits of many

wrongdoings, they are likewise patients in need of psychological care and treatment. Isobel et al.,

(2013) explains, “seclusion was once considered therapeutic, now it is understood to cause

profound distress. A national project is focused on documenting and ending its use and

promoting alternative approaches” (p. 39). Seclusion is utilized in so many disciplines including

simple ones as extended children time-outs to the greatly enforced separate confinement systems

used in the prison systems. One would be neglectful not to ponder on the destructive components

of these findings. It is vital that caregivers and staff members be trained and educated on the

delicate of ensuring these mentally-bruised children success in being healthy members of

society.

The setting in which the children psychological health is cared for must be one that the

youngsters can restore, grow and learn to work through their distress. It needs to be positive and

constructive, yet beneficial. As Dobb et al., (2017) infer, “because residential staff members are,

in essence, the youth’s immediate caregivers during residential treatment, the functioning of the

team as a surrogate family system can have a profound effect on the youth’s functioning. If a

team does not have a good system for communication among members or if team members do

not consistently uphold residence expectations, the milieu environment is distressed” (p. 95). The

challenges ahead include working with groups of children with a variety of diagnosis, triggers,

and other issues but protecting a balanced atmosphere gives individuals within their care a safe

place to express themselves and learn how to work through their hardships.
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There have been many models aimed at helping reduce restraints and seclusion when

treating traumatized youth, but one of the most renown and public interventions is Trauma-

Informed Care (TIC). According to Isobel et al., (2013), “TIC is a much broader and universally

applicable approach to care that requires a wide understanding of complex forms of trauma;

recognition of the prevalence of trauma; understanding how trauma impacts upon the life and

experiences of individuals; and a reassessment and modification of all processes of service to

reduce iatrogenic harm” (p. 589). The importance of TIC training is paramount and teaches the

staff to be more understanding of their patients’ actions and responses producing an effective

interaction without the use of restraints.

Presenting the complications and adversities of using restraints and involuntary seclusion

of children to government officials is essential to combat the increasing issue. According to

Isobel et al., (2013), “numerous federal, state, and local initiatives focus on building capacity to

deliver trauma-informed care (TIC) across many systems serving maltreated children…There is

much consonance among these initiatives in how to conceptualize TIC. Most share the

assumptions that TIC involves awareness of the prevalence of trauma and its impact on health

and mental health; recognizes signs and symptoms of trauma in children, families, and staff;

responds with evidence-based practices; and, avoids traumatization” (p.101). Representing the

essence of TIC and its direct benefits of caring for children who have mental sicknesses is

essential in succeeding and treating them. Other efforts noted were those regarding substance

abuse which often coexists with mental illnesses. “Since the early 1970’s, mental health

advocates have been working in conjunction with federal legislation to secure the passage of

mental health parity legislation (United States Department of Health and Human Services

[HHS])” (Mason, Gardner, Outlaw, & O’Grady, 2016, p. 225). Senators Paul Wellstone and
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House Member Pete Domenici led the effort to achieve mental health parity and addiction

(MHPA) that prohibited insurance plans from being able to pay less to treat psychological health

disorders compared with what they pay to treat physical sicknesses. The issues with the MHPA

was that it did not include substance abuse which research shows that mental health and

substance often go hand and hand. “Researchers have determined that when only one of the co-

occurring disorders (mental health or substance abuse disorder) is treated, both disorders usually

get worse” (Mason et al., 2016, p. 225). The issue with the MHPA led to a more extensive bill;

The Wellstone and Domenici Mental Health Parity and Addiction Equity Act of 2008

(MHPAEPA), which included the substance abuse component of mental health. Such policies

exist, but with the rise in mental health concerns demands the need for more.

Kathy Cloutier, State Senator of Corrections & Public Safety, Health, Children, and

Social Services supported initiatives to help teenagers transitioning into adulthood who have

formerly been in the custody of the Department of Services for Children, Youth, and their

Families (DSCYF), ensuring they are provided mental and/ or behavioral health services. Per

“House Bill 40: An Act to Amend Title 13 of the Delaware Code Relating to Mental and

Behavioral Health Transition Plans”, teenagers advancing into adulthood be afforded mental and

behavioral health services. Children in the custody of DSCYF have suffered trauma while in

their home setting leading to these same children seeking psychological help. As these children

continue to mature and become adults the problems seem to stay around and supporting them

will help their mental security. In addition to spiritual safety, this induces mentally-well citizens

of our everyday society, and the aftermath of that poses massive effects.
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There are several stakeholders whom all share the common interest of supporting mental

health and those who suffer from them; all recognizing the need for proper treatment, care, and

attention. The National Alliance on Mental Illness (NAMI), is a nationwide organization that has

affiliates in every state and offices in more than 1,000 local communities in the United States.

They pride their selves in going to extremes to ensure all people affected by mental illness

receive the services they need and warrant in a timely fashion. “NAMI members work to fulfill

the mission by providing support, education and advocacy” (National Alliance on Mental

Illnesses, n.d.). Next there’s the country’s leading nonprofit dedicated to helping all people live

mentally healthier lives, Mental Health America (MHA) “With their more than 320 affiliates

nationwide they represent a growing movement of Americans who promote mental wellness for

the health and well-being of the nation in the time of crisis” (National Center on Domestic

Violence, Trauma & Mental Health, 2017, para. 8). Their message is one that believes good

mental health is fundamental to the health and well-being of every person of the nation. MHA

wants all people to recognize how to protect and improve mental health. Stakeholders are

essential for resources, information, and support.

A plan for action is needed to combat the increasing problematic flaws of treatment in

psychiatric facilities. There is a specific and organized way a Bill is introduced and passed.

“Only members of the US Congress (or a state legislator) can introduce bills (Mason et al., 2016,

p.377.) According to Mason et al., (2016) once a bill is presented to Congress there is a two-year

deadline to get the bill passed into law, or it will default. Members of Congress put proposed

bills in a box called the hopper, and for most bills, it is challenging to get every member on one

accord, therefore preventing many bills from becoming law.

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As I am initiating a plan to action, I plan to first conduct a study over time on the effects of

restraint and solitary confinement of pediatric mental health patients. With this study, I will be

able to show a trend in physical, mental, and emotional changes after implementation of such.

After conducting the research and analyzing, I will then reach out to State Representative

Cloutier and propose a need for action regarding the use of restraints in psychiatric facilities, the

detrimental effects of solitude, and the need for state-mandated TIC training for caretakers at

these facilities. I plan to gather the support of the local chapter of one or both stakeholders

mentioned above and campaign for change. In this process, I hope to show a vivid picture of how

negatively restraints and solitude effects the mind which is essential in treating patients who are

already inflicted with a mental disease. Ultimately, I have goals of making children who are

victims of traumas which may never be able to fathom, healing process in psychiatric facilities

more promising and conducive to healing. Over the next 90 days, I will reach out to Meadowood

and Rockford Psychiatric and initiate the proceeding to conduct the study. I also plan to research

training programs to suggest as models to present to Senator Cloutier. The process of getting

laws and policies in effect is a long one that requires diligence and determination. I will keep this

in mind during my quest.

Intense and thorough individual psychotherapy, constructive interaction in the therapeutic

environment integrated with trained mental health professionals will help rehabilitate children

who need hospitalization due to mental illnesses. Guidelines on restraints and seclusions about

these children should be authorized and revised before they become victims of farther injury,

mistreatment, trauma and even death. The need for it is essential as mental illnesses only

intensify when left untreated, subjecting many traumatized and vulnerable children, adolescents,

and youth to many health disparities, and injustices.

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References
Ainxt, J.S., Copeland-Linder, N., Haynie, D., & Cheng, T. L. (2012). Burden of Unmet Mental

Health Needs in Assault-Injured Youths Presenting to the Emergency Department.

Academic Pediatrics, 12(2), 125-130.

Belfer, M. L., (2014). Global Child Mental Health. Psychiatric Times. 31 (2). 1-5

Dopp, A. R., Hanson, R.F., Saunders, B. E., Dismuke, C. E., & Moreland, A.D. (2017)
Community-based implementation of trauma-focused interventions for youth; Economic

impact of the learning collaborative model. Psychological Services. 14(1). 57-65.

doe:10.1037/ser0000131.

Isobel, M. A., Brown, A., McCauley, K., Navalta, C. (2013). Trauma Systems Therapy in

Residential Settings: Improving Emotion Regulation and the Social Environment of

Traumatized Children and Youth in Congregate Care. Journal of Family Violence, 28(7).

29-139. doi:10.1007/s10896-013-9542-9

Mason, D. J., Gardner, D. B., Outlaw, F. H., O’Grady, E. T. (2016). Policy and Politics: in

Nursing Healthcare, 7th Edition St. Louis, Missouri: Elsevier

National Alliance on Mental Illness. (n.d.). NAMI Mobile Mission Statement. Retrieved from

National Alliance on Mental Illness: http://www.namimobile.org/mission.html

National Center on Domestic Violence, Trauma & Mental Health. (2017). National Mental

Health Organizations. Retrieved from National Center on Domestic Violence, Trauma &

Mental Health: http://ww0w.nationalcenterdvtraumamh.org/resources/national-mental-

health-organizations/