In recent news, the state of Illinois is under fire regarding the Department of Child and Family Services (DCFS) prolonging the stay of children, in their custody, in child psychiatric units past their stabilization period due to the lack of placement availability. The argument arising is, “how are these unnecessary extended stays in psychiatric units affecting the mental stability of a child who is already deemed stabilized and ready for discharge.” If you are familiar and have worked closely with children in foster care, then you are aware of the commonalities of the environments in which they may come from and the types of adversities they have had to overcome or are still overcoming. As a result, many children will present mostly with behavioral issues and adjustment disorders rather than more serious mental illnesses; not to say that other illnesses are not present or possible.
Knowing this, when a child is hospitalized for psychiatric needs, they are on a locked floor or locked building, if the facility is strictly for behavioral health, meaning key cards are needed for access throughout. Their access to being outdoors is limited, if at all. They are on a strict schedule for daily milieu: activities, phone calls, showers, medication, sleep, eating, and group or individual therapy. Almost like a jail, restriction is high.
So, how can extending the stay of a stabilized child on a psych unit become detrimental to their mental growth and stability?
- The child can become institutionalized and pick up behaviors they did not possess before being hospitalized.
- Their interaction with the outside world is limited.
- There can be inconsistency in their ability to build and maintain friendships and relationships because psych units are revolving doors for patients and staff.
- Their ability to trust can be interrupted.
Why and how are many of these children hospitalized?
When we think about mental illness, we mainly consider the most common diagnoses like Depression, Schizophrenia, or Bipolar disorders which can be passed down genetically. However, unless you are studying or working in the field of Psychology, then one would rarely consider the diagnoses that are most common amongst children and adolescents; Oppositional Defiant Disorder (ODD), Intermittent Explosive Disorder or Conduct Disorder. To provide small insight on these three diagnoses, they are mainly described as:
ODD – Angry/Irritable mood; Argumentative/Defiant Behavior; Vindictiveness
Intermittent Explosive Disorder – Inability to control their anger. Can be verbally and physically aggressive with property damage and the level of their outburst goes beyond the initial problem.
Conduct Disorder – Aggression towards People and Animals; Destructive Behavior; Deceitfulness or Theft; Serious Violations of Rules
These diagnoses are most commonly observed in those between the ages of 6 and 18. These behaviors could look like normal temper tantrums or acting out for attention behaviors that only occur in certain environments, and most times they are. A child or adolescent may act in an aggressive manner in school or home due to numerous provocations and it can be taken out of context if that parent or teacher is not familiar with the child, their history of encounters or even the basic developmental growth process. When a child begins to display these behaviors and they are left unacknowledged for a length of time, the immediate reaction is to have the child taken for a Psychiatric Evaluation. This could then lead to medication prescribing. Psychotropic medications carry serious side effects such as suicidal ideations (SI), psychosis, etc. When the child begins to display SI or psychosis, they are hospitalized for stabilization and further evaluation. As for the children in DCFS custody, one of the main concerns within this recent news report is that once these children are hospitalized and lose their placement due to behavior, they are kept in these psych facilities beyond stabilization until adequate placement can be provided.
Attached are two articles discussing the recent lawsuit against DCFS of IL.