Research

Assessment #1

Date: September 7, 2018

Subject: Child Psychiatry

MLA or APA citation:

Klass, Perri. “Kids' Suicide‐Related Hospital Visits Rise Sharply.” The New York Times, The

New York Times Company, 16 May 2018,

www.nytimes.com/2018/05/16/well/family/suicide‐adolescents‐

hospital.html?rref=collection%2Ftimestopic%2FPsychiatry%2Band%2BPsychiatris

ts&action=click&contentCollection=health®ion=stream&module=stream_unit&vers

ion=latest&contentPlacement=8&pgtype=collection.

Assessment:

Currently, I am most interested in the happenings in child and adolescent psychiatry

because it is most relevant in my life. For this reason, I chose an article that discusses

suicide, something very relevant for all of today’s society, but in the future I also want to

research additional disorders that are intriguing but don’t necessarily have an educational

spotlight as large as the one on depression, such as bipolar disorder and eating disorders.

While this article published by the New York Times doesn’t necessarily state

anything particularly revolutionary, I find interest in the smaller things that it talks about

and the smaller things that are also hiding in the spaces between the lines. In today’s

schools where lessons on depression have been drilled into us for years—although these

lessons do not always include how to be supportive when a close friend or relative is

dealing with depression other than contacting a suicide hotline or text messaging service—

it’s not a huge surprise when we are told that suicide‐related hospital visits have nearly
tripled in the past decade. However, when I read this line, I considered what this statement

really means: for this to have happened, enough people are reaching a far enough state into

depression to attempt suicide and require treatment. Enough people have reached past this

point that suicide claims the second‐highest spot as the cause of death for those as young as

10‐year‐olds to those as old as their early 30s. That’s a large age group. That understanding

is quite shocking. And my understanding makes me realize just how important the job of a

psychiatrist really is for people of all ages.

I read this article through the eyes of an individual wanting to understand the

treatment for suicide attempts and how to take action myself to help those around me who

may be suffering from these sorts of struggles. After the initial shocking statistics, the

article carried on to answer my questions. For treatment of these patients, therapy and

discussion with a mental health worker are imperative, but due to a shortage of these

workers, many are sent home with only medication. Not only does knowing this increase

my sense of a call to action to help these patients, but I also am now considering what it

would be like to work in a psychiatric hospital. Up until now, I have always seen private

practice as more ideal due to the flexibility of the schedule and the deeper connection with

the client, but I realize now that working in a hospital may also be rewarding due to the

difference I would be making despite its difficulty. However, I would like to discuss these

pros and cons with my mentor because it is hard to be certain of what will work for me

without hands‐on experience.

After this, the article answered my second inquiry about how to take action to help

those currently around me. I have especially taken notice of the stress on the importance of

communication between parent and child in a way that shows that the parent is listening,
accepting, and open to helping. During my time in ISM, I’d like to learn more techniques on

how to not only talk to people professionally but how to talk to people with the approach of

a psychiatrist; I want to make people feel more comfortable around me and open up with

their difficulties. The article did not talk much in detail about these techniques, so this will

definitely be a subject to research at a later date.

I want my product for ISM to be relevant to other people by helping students who

currently have mental health issues and spreading awareness of the need for

communication and understanding to prevent the development of these issues. While this

description is still vague, reading this article has both renewed my sense of an “end goal”

for ISM of creating a product that will help the students, like those in the article, who

struggle with suicidal thoughts and encouraged my interest in the field of psychiatry even

further.
Article:

Kids’ Suicide-Related Hospital Visits Rise Sharply

From 2008 to 2015, the proportion of emergency room and hospital encounters for Commented [1]: A 7 year time span

suicide-related diagnoses almost tripled.

By Perri Klass, M.D.

May 16, 2018

About five years ago, pediatricians at Vanderbilt University Medical Center in

Nashville found that more and more of their inpatient beds at the children’s hospital were

occupied by children and adolescents with mental health issues, especially those who had

come in because of suicide attempts, or suicidal thoughts. These patients were known as

“boarders”: They were waiting for psychiatric placement because it wasn’t safe for them to

go home.

The doctors wondered whether the problem was specific to their city, perhaps

reflecting scarce local resources. But in a new study in the journal Pediatrics, they found

that this same pattern held true around the country over the period from 2008 to 2015. Commented [2]: Making it a nation-wide problem

“What we find nationwide is that over the last decade, the numbers of kids being

admitted or seeking help in the emergency department or hospital for suicidal ideation or

attempts have dramatically increased,” said Dr. Gregory Plemmons, an associate professor

of pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt and the first author

on the study. In fact, over the study period, the proportion of emergency room and hospital

encounters for these suicide‐related diagnoses almost tripled, from 0.66 percent in 2008 to

1.82 percent in 2015. And the rate of increase was highest among adolescent girls. Commented [3]: I wonder why exactly this is... It could
be because girls are often more sensitive than men,
which could cause more suicidal thoughts.
 Seeking help for depression, or for suicidal thoughts, is actually a good thing, much Commented [4]: True! This trend also shows the
effects of education and outreach programs on suicide.
better than not seeking help, but the increase is part of a disturbing trend of rising distress

among adolescents. Suicide is the second leading cause of death in young people, after

unintentional injury, starting with the 10 to 14 age group, continuing through 15‐ to 24‐ Commented [5]: That makes this a problem for people
as young as just entering middle school to those well
into their careers. Suicide is preventable as well, in
year‐olds (and also the next group, ages 24 to 34). Suicide rates have been rising in the comparison to unintentional injury that takes the spot
as first leading cause of death, which makes it such an
United States, with especially notable increases among young women; in 2016, the Centers important place for improvement in the future.

for Disease Control and Prevention announced that middle school students were as likely

to die from suicide as from traffic accidents. Commented [6]: In other words, they are as likely to
die from an intentional action as from something
unintentional.
In the new study, the researchers noted a strong temporal relationship between the

school year and the frequency of the encounters for suicidal thoughts or actions; the rate Commented [7]: School stresses come not only from
homework and grades but also socially from
interactions with peers.
dropped sharply in the summer, which is notably different, Dr. Plemmons said, from the

pattern in adults, where July and August are higher risk months. Performance anxiety or Commented [8]: I'm curious why this is for adults.

social pressures could be factors, Dr. Plemmons said, and schools can potentially play a role

in identifying kids at risk, and in delivering treatment.

Even after suicide attempts, many adolescents who are seen in emergency

departments do not get mental health evaluations, said Dr. Ruth S. Gerson, assistant

professor of child and adolescent psychiatry at N.Y.U. Langone Health, and the co‐editor of

“Helping Kids in Crisis.” Instead, they are treated medically, and then released. Medical Commented [9]: Medication doesn't always work for
everyone and might only mask the problems that
adolescent are going through if there us no proper
doctors often don’t have the support or the training, she said, to do the mental health mental health evaluation. I don't think just using
medication would reduce the number of future suicide
assessment and stabilization. And when people don’t get that mental health assessment in attempts.

the emergency room, they are at increased risk of making another suicide attempt.

Although suicide ranks just after trauma as a leading cause of death, there are many

high‐level pediatric trauma centers but very few dedicated pediatric psychiatry emergency
rooms, Dr. Gerson said. She is the director of one such facility, the Bellevue Hospital Center

Children’s Comprehensive Psychiatric Emergency Program, where some 2,400 children

and adolescents are evaluated every year. Every child who comes in gets a complete

mental health evaluation, which can include not only talking to the child and the parents, Commented [10]: This is much more ideal, but for it to
happen, there needs to be more investment in
psychiatry ERs mentioned before.
but also to the outside therapist, the pediatrician and the school.

“We bring all this information back to the child and parent and make a safety plan,”

Dr. Gerson said. “A portion we admit to inpatient, but we also have access to immediate

outpatient care which lets us do intensive therapy even without admitting the child to the

hospital.”

But many places don’t have the ability to do that assessment or arrange that care.

There has not been enough of an investment in children’s mental health, Dr. Gerson said,

either in high quality outpatient care or inpatient beds, given the magnitude of the

problem. There is “really poor access to outpatient care, particularly quick access,” she said.

“People get admitted and end up boarding because there’s no other option.”

It is also widely understood in the pediatrics community that there are not enough

mental health workers available to our patients, not enough outpatient therapists and not

enough inpatient beds. “We’re lobbying every day for more facilities, more beds, more

mental health providers,” Dr. Plemmons said. Many adolescents with depression do not

look for help, and many don’t have access to mental health specialists; the American

Academy of Pediatrics published guidelines earlier this year for primary care pediatricians

dealing with adolescent depression, and recommended screening all children 12 and up.
 Some experts worry that the suicide theme in the Netflix series “13 Reasons Why,”

which recently debuted a new season, may contribute to what is known as suicide

contagion.

“I would recommend to parents either ideally don’t have your kid watch ’13 Reasons

Why,’ or other shows with graphic depictions of suicide or self‐harm,” Dr. Gerson said in an

email. But “if your kid wants to watch it, watch it together — the whole series, not just one

episode — and talk about what you see, so you can help your kid understand and process Commented [11]: While watching a show together like
this sounds dull and awkward, I do think it's a good
idea for parents to discuss and understand the mental
anything that is upsetting or triggering.” states of their children better.

“If kids are saying, I’m thinking about suicide, or I wish I didn’t exist, or I wish I

didn’t wake up — take that seriously,” Dr. Gerson said. Parents should try not to panic, she

said, because if they get very emotional, their children may worry about hurting or

disappointing them and stop talking.

“Stay calm. Ask, ‘Tell me more about what you’re thinking,’ show the kid you’re

taking it seriously,” she said. “I see parents who in a very well‐intentioned way will say Commented [12]: This builds trust as well.

things like, ‘Oh no, honey, everything’s fine, let’s think about the good things.’” And again,

that may make a distressed child clam up.

Parents who have reason to be concerned must find a way to get the child evaluated.

That doesn’t have to mean the emergency room; you can start by calling your pediatrician.

But a parent will have to decide whether the child “is able to be safe in that process —

emotionally stable enough that they can drive with you to the pediatrician’s office — or is

your child really in distress at this moment and you need to call 911.”

“It’s pretty important if this is the first time you’re hearing about this from your

child that a professional should evaluate them,” said Dr. Stephanie Kennebeck, an associate
professor of clinical pediatrics at Cincinnati Children’s Hospital and the author of a recent

review on suicidal behavior in children and adolescents.

In their medical center, she said, and in many others, a psychiatric response line

offers parents a chance to talk it over on the phone to help decide whether or not to bring

the child in. But again, if the child is violent or the parent is frightened, call for help in de‐

escalating the situation and ensuring safe transport: “If the child is in imminent aggressive

or physical risk, it’s totally reasonable to call 911.” Commented [13]: Usually, I think of 911 being used
for crime or injury, but it's true that these kinds of
situations would also give a justified reason to call.
After a full mental health assessment, Dr. Kennebeck said, deciding which children

need to be hospitalized comes down to a question of safety. Can the child say, “I was feeling

suicidal earlier but now I am feeling safe with you”? Does the parent feel able to control the

environment and keep the child safe?

“The No. 1 thing that I learned is that asking about these thoughts in no way makes

someone that way,” Dr. Plemmons said. “I think there’s a huge fear that there’s a suggestive

power, and that has not been shown to be the case.” Instead, he said, “talking about it and Commented [14]: That's a good way to phrase it.

destigmatizing it is hugely important.”

“We know there are therapies and treatments that work, and we know that small

things really, really make a difference for kids,” Dr. Gerson said. “They really just need us to

listen and say, ‘I’m sorry you’re hurting; we’re going to find a way to get you some help.”

She noted that parents should make clear to their child, “I really want to know how

to help you best. I know this is something a lot of kids struggle with. I’m not mad at you.

We’re going to figure out how to get through this together.” Commented [15]: Communication is essential in
situations like this.

For help, call the National Suicide Prevention line, 1‐800‐273‐8255.