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Kids and mental health: CHOC builds the county’s first inpatient facility for youths ages 3 to 18

From The Daily Pilot

By Allyson Escobar

One of the earliest hints arrived when Chris Dureiko was picking up her eldest son, Sean, from day care. She noticed the then-9-year-old’s hands were red and bruised, as if he had a rash.

“[Then] I caught him one day washing his hands while counting for half an hour,” recalled Dureiko, who lives in Irvine. “He was always extremely afraid of germs. If something would touch another, that thing would become contaminated and had to be removed.

“There was social isolation, constant hand-washing and showers. Eventually the school district had to take him out of a regular classroom because he couldn’t touch the pencils or materials.”

Even at age 6 months, Sean was unusually restless.

“His intelligence was normal and fine, but it was his behavior — he wasn’t affectionate and basically couldn’t be soothed. He would actually throw a lot of temper tantrums,” Dureiko remembered.

Sean was later diagnosed with attention-deficit/hyperactivity disorder, or ADHD, bipolarism, obsessive-compulsive disorder and anxiety.

About one in five youths nationwide will have a diagnosable mental health disorder by the age of 14, according to research from the Children’s Hospital of Orange County. Of the 20% of O.C. youths reporting the need for help with mental health issues, less than a third get that help.

Dr. Heather Huszti, chief psychologist at CHOC, says the need for pediatric services in the county is equivalent to filling three Angel Stadiums with kids who have a mental health disorder but only one of those stadiums receiving treatment.

“It’s a really big problem when the bulk of the work comes in intensive inpatient or outpatient programs,” said Huszti, noting that in 2014, out of 1,805 mentally ill kids and adolescents (18 and under) from Orange County, only 824 were hospitalized for treatment of psychiatric problems in their home region.

The rest were treated in Los Angeles, San Bernardino and other neighboring counties.

For adolescents (ages 12 to 18) with psychiatric problems, only 32 inpatient beds — at the UC Irvine Medical Center and College Hospital in Costa Mesa — are available in Orange County. That’s one bed per 22,000 kids, according to information provided by CHOC.

For children under age 12, there are zero inpatient beds in Orange County.

This is where CHOC comes in.

In early 2015, the children’s hospital announced plans for a program-heavy mental health initiative to address the crisis. At the center of the initiative is the construction of an inpatient psychiatric center for children 3 to 18 years old.

The innovative new center — under construction on the third floor of CHOC’s research building, which is part of the campus in Orange — will be the first pediatric inpatient mental health center in Orange County.

It is expected to have 18 private rooms, an outdoor playground and multipurpose areas — for consultation, therapy, recreation and treatment — and will be the only psychiatric facility in California where parents can stay in the rooms with their kids, according to CHOC.

Construction started in September, and the unit is expected to open at the end of 2017 or by early 2018.

By working with a network of other hospitals (such as Kaiser Permanente, St. Joseph, Hoag and Mission Hospital), churches and community organizations, county agencies, health insurers, the Orange County justice system and board of education, CHOC aims to provide access to mental health resources and primary mental health care in the county to ages 3 to 18.

The annual cost of the program is projected to reach $16 million, and start-up costs are around $11 million, according to Andrea Hanigan, CHOC’s senior public relations specialist.

The money for construction and operation of the initiative is coming from a state grant and local philanthropists, including George and Julia Argyros and Sandy Segerstrom Daniels, an owner in South Coast Plaza in Costa Mesa. About $15 million has been raised so far, Hanigan said.

The initiative’s aim is to screen the children and intervene as soon as they get to the emergency department, as well as educate parents, pediatricians and others to recognize common signs of mental illness in children, avoid crisis and continue providing support after hospitalization.

The National Alliance on Mental Illness Orange County — the local branch of a nationwide grassroots organization that offers support to families affected by mental illness — has committed to working with CHOC on the educational part of the initiative.

“Having a loved one with mental illness often has barriers associated with beginning effective treatment — social stigma and misunderstanding, family shame, anosognosia [when someone is unaware of his or her illness],” said John Leyerle, executive committee president of NAMI Orange County.

“The goal is to emerge with robust tools to work together, to progress in the wellness journey.”

Kimberly Chavalas Cripe, president and CEO of CHOC, said in a statement: “CHOC Children’s is committed to taking a leadership role in creating a comprehensive mental health system of care for children and teens in Orange County. Together, with our partners in the community, we will address the alarming deficiency of mental health services, and make sure that children and families have access to high-quality care without stigma or barriers.”

A longtime presence

Opened in 1964, CHOC was the first children’s hospital in Orange County. It has since expanded to include a second campus (in Mission Viejo), four institutes (heart, neuroscience, orthopaedic and cancer), and a new state-of-the-art pediatric care unit and emergency department in the South Tower, which opened in 2013.

It also runs outpatient therapy clinics and employs on-site pediatric psychologists to treat the young patients with mental and behavioral disorders.

“Pediatric psychology is a specialty area. … We work with kids with medical diagnoses on the psychological issues that children with medical conditions are at higher risk for: anxiety, depression, adherence,” Huszti explained.

But many a child’s mental health struggles are not tied to a medical condition.

According to a 2014 report by the Orange County Health Care Agency, Health Policy and Research, the rate of child hospitalizations for mental illness (measured per 10,000 children) increased from a low of 11.3 in 2008 to 20.8 in 2014.

Cities with high rates of hospitalizations related to mental illness include Orange, Tustin, San Clemente, Laguna Niguel and Huntington Beach, according to data from California’s Office of Statewide Health Planning and Development, although the reasons for this are not immediately clear.

“When a child needs to be hospitalized for psychiatric reasons, most often it’s because they’ve threatened to kill themselves,” Huszti continued. “Substance abuse and mental health-related issues are all reasons for being admitted, with a major [reason] being depression.”

Other reasons for inpatient treatment cited in the report include mood disorders (including bipolarism), schizophrenia and psychosis.

According to CHOC mental health research, after accidents, suicide is the second leading cause of death in young people ages 10 to 24. Even for children ages 10 to 12, studies find suicide to be more and more common.

For Saddleback Church Pastor Rick Warren and his wife, Kay, these statistics have been painfully real. In 2013, their youngest son, Matthew, committed suicide after struggling with depression since early childhood. He was 27.

“Depression is a deadly illness. … Every single one of those of those deaths was preventable,” Huszti said. But we don’t talk about it because there’s a stigma, because people don’t seek treatment. People don’t talk about their feelings. They aren’t educated about it.”

The Warrens’ heartbreak sparked an important meeting the following year about pediatric mental health among the couple, Cripe, Huszti, CHOC’s chief medical officer, Dr. Maria Minon, and business and healthcare leaders. That discussion became the groundwork for a new mental health task force, Huszti said.

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UC Irvine

CHOC Children's is affiliated with the UC Irvine School of Medicine