News

Stanford Children's Health to launch new 'critical' youth mental health services

Partnership with inpatient unit, outpatient program among initiatives coming in new year

Stanford Children's Health and Lucile Packard Children's Hospital will be addressing in 2017 what they describe as "immediate critical needs" in youth mental health by launching a range of new programs and services that will support local teenagers at high risk for suicide.

The healthcare organizations' new efforts, from bringing a team of Stanford doctors to a local adolescent inpatient hospital unit and creating an intensive after-school program for suicidal teenagers, seek to provide as comprehensive a safety net as possible for youth and families who have often struggled to access the support they needed during moments of crisis.

The first "low-hanging fruit" Stanford Children's Health felt it could quickly grab was to develop a team of doctors to staff the closest hospital that offers inpatient hospitalization for teenagers, at Mills-Peninsula Health Services in San Mateo, said Stanford child and adolescent psychiatrist Antonio Hardan, who has been involved in the planning for this and other related initiatives.

The team -- made up of a child-adolescent psychiatrist, psychologist and psychiatry fellow -- will eventually cover up to eight beds at the 17-bed unit to provide hospitalized teenagers access to Stanford doctors. The team approach, Hardan said, means the doctors will support a larger group of patients, rather than one or two, with some staff responsible for seeing them during the week and others over the weekend. They hope this will improve patients' experiences in the hospital and prevent re-hospitalization.

"Inpatient stay is usually short," Hardan said, "but our goal by having all this manpower is to optimize the stay and prevent future re-hospitalization or worsening of the underlying psychiatric condition."

Daniel Becker, medical director of behavioral health at Mills-Peninsula, said the partnership will address "potential discontinuity" in care for patients who might see Stanford doctors but be hospitalized at Mills.

A more "seamless" and "normalized" process, Becker said, could also help decrease stigma for young people coping with mental illness.

"We don't want them to think negatively about themselves or their situation," he told the Weekly. "The continuity helps that."

They also hope it will help stave off staff turnover, which is high in inpatient units around the country, Hardan said.

"We don't want to do something for the short term. ... By developing the team, it will allow us to keep people fresh and keep them motivated to do good work," he said.

The added teaching component of including a psychiatry fellow on the team will, Hardan hopes, increase the pool of people who have real experience in -- and thus are more willing to work in -- an inpatient setting.

The new Mills-Peninsula team will also be a learning experience for Stanford, laying the groundwork for the creation of similar teams at other local hospitals, Hardan said.

The possibility of Stanford opening its own adolescent inpatient unit is still "on the table," Hardan said.

Earlier this year, Lucile Packard Children's Hospital, Mountain View's El Camino Hospital and Kaiser Permanente jointly responded to a Request for Proposal (RFP) from Santa Clara County to open a child and adolescent unit within county borders, but Hardan said another hospital's proposal was chosen. County officials are still in negotiations with the selected vendor and have yet to disclose whom they chose. (The county also received responses from Fremont Hospital, statewide nonprofit EMQ Families First and a joint response from San Jose nonprofit Bay Area Children's Association (BACA) and PrairieCare Medical Group, a Minnesota-based psychiatric healthcare system.)

San Jose Behavioral Health, a new hospital in south San Jose, also opened an inpatient unit for adolescents this year.

In the second half of 2017, Stanford plans to launch a six-month after-school outpatient program that will include both an intensive outpatient program, or IOP, and a comprehensive outpatient component for 13 to 17 year olds who are suicidal or para-suicidal, meaning they are harming themselves in non-lethal ways, like cutting or burning.

The IOP will provide teens with clinical services for three hours a day, three to four days a week. The comprehensive outpatient program will provide at-risk teenagers with weekly therapy (individual, group and family) and medication management, among other services. Patients can participate in either the intensive outpatient program or the outpatient component, and can move from one to the other over the course of the six months depending on the severity of their symptoms, Hardan said.

They will also have 24-7 access to a team of doctors and clinicians familiar with their case — and who, more importantly, the teens are familiar with.

"In case of Caroline calls at 2 a.m., she doesn't have to tell her whole story all over again," Hardan said, using a hypothetical example. "She will reach out to a team member who is familiar with her case and can problem solve with her right there."

Hardan hopes to house the intensive outpatient program at the Lucile Packard Children's Hospital in Palo Alto, but alternative locations include Stanford's Castro Commons Clinic in Mountain View or a Stanford specialty services clinic in Sunnyvale.

Having another local intensive outpatient program will be a boon for local teens and families. Nearby is El Camino Hospital's popular outpatient program, the After School Program Interventions and Resiliency Education (ASPIRE), which was expanded this year to serve middle school students and 18 to 25 year olds as well as high schoolers. Stanford's prgoram will start by serving about eight teens, Hardan said.

However, "if there is a need to have more patients being part of that program, I think we are open to that," he said.

Other new mental-health initiatives coming from Stanford in 2017 include an expanded crisis team that will be readily available to youth who go to the emergency room for help but might not need to be hospitalized. Instead of telling a patient like this — who might not have his or her own therapist or be familiar with their options for care — to call a number and then face a months-long waiting list, the hospital will connect teens directly with this crisis team. The team will provide three to four sessions with a patient and their family and then help connect them with longer-term mental-health care, if needed.

Local high schools will also be able to call this crisis team directly to refer students, Hardan said. The team will be made up of a psychiatrist and two psychologists and, in the future, a case manager.

Stanford also plans to launch a new school-based program in Palo Alto Unified's elementary schools next year.

"In collaboration with school administrators and teachers, we will help evaluate and treat moderate- to high-risk students in need of immediate care, and also work with teachers and families to identify issues that may lead to future challenges," Stanford Medicine freelance writer Julie Greicius wrote in the fall edition of Packard Children's News, which details the hospital's plans for the new year.

Other plans include recruiting more faculty with specialized expertise on everything from addiction and anxiety to autism and eating disorders, creating a single crisis hotline that any local family or health care provider can call for referrals and resources and investing in research to "better understand the underlying biology of mental health," among others, the article states.

Stanford Medicine's Center for Youth Mental Health and Wellbeing is also spearheading an effort to open new youth mental health centers, including at least one in Santa Clara County, that will provide comprehensive physical and mental health services in a comfortable setting at little or no cost to teens.

The "biggest challenge ahead" in mental health, Mills-Peninsula's Becker said, falls within this category of upstream prevention services. Making mental-health care available more broadly and immediately, including in primary-care settings, will hopefully get teenagers the help they need earlier, rather than at the point where hospitalization is necessary, he said.

Editor's note: This story was updated to correct inaccurate information about a wait list for El Camino Hospital's intensive outpatient program, ASPIRE. There is currently no wait for the program and has not been for more than a year, said Michael Fitzgerald, executive director of mental health and addiction services at El Camino.

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Any person who is feeling depressed, troubled or suicidal can call 1-800-784-2433 to speak with a crisis counselor. People in Santa Clara County can call 1-855-278-4204. Spanish speakers can call 1-888-628-9454.

People can reach trained counselors at Crisis Text Line by texting 741741.

Links below provide more resources where one can receive help:

Resources: How to help those in crisis

Guest opinion: How to help those in crisis

Q&A about mental health: Local experts offer their advice, guidance

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Follow the Palo Alto Weekly/Palo Alto Online on Twitter @PaloAltoWeekly and Facebook for breaking news, local events, photos, videos and more.

Comments

1 person likes this
Posted by Harold Al. Maio
a resident of another community
on Dec 20, 2016 at 11:54 am

-----help decrease stigma for young people coping with mental illness.


What a strange utterance.

Never did I hear from the Women's Movement, “decrease the stigma of rape”. They told us unequivocally to stop uttering those words, we had done enough harm.

Be wary of them this time around, they do the precise same harm.

Harold A. Maio, retired mental health editor


15 people like this
Posted by Marc Vincenti
a resident of Barron Park
on Dec 20, 2016 at 1:27 pm

Marc Vincenti is a registered user.

Time and again, helpful people in this community are establishing clinics, programs, services to "support local teenagers at high risk for suicide."

At the same time, though, so little is being done to undo the conditions that are pushing our kids into that zone of high risk.

It's as if we were putting up more and more field hospitals while doing very little to curb the warfare.

Mental illness, on its own, doesn't necessarily lead to suicide. Many mentally ill people cope, recover, do not end their lives. What's different about Palo Alto's teens is that so many have chosen this extreme remedy for their despair.

We might well ask why!

Dr. Shashank Joshi of the Department of Adolescent Health at Stanford pointed us in a useful direction when, in February, 2015, he stood before the school board and told the community:

"As is true for other teen suicides and suicide clusters in California and the rest of the country, environmental factors must be examined closely, and are often highly influential in any student’s well-being."

I agree. The youth we've lost have all shared an environment. Our cases of teen suicide do not spring out of nowhere, merely from within individual minds or families--but are caused in part by the world our teenagers live in.

We can't continue to simply hospitalize or treat or educate or repair them out of that world. We've got to change that world.

For reasons I don't understand, we're neglecting to change the institutions that we send our youth to for four key developmental years--a time of life so intense and consequential that most of us remember it through decades of class reunions.

Our teens spend more waking hours at school or doing schoolwork than anything else in their lives, and they see their teachers for more hours per day than their parents. Our kids identify with their alma maters and are emotionally, spiritually possessed by them and their cultures.

Yet we continue to deposit our kids in an environment that includes impersonal class-sizes (routinely above thirty) where they feel unrecognized and can't create lifelines with their teachers; where guidance counseling isn't regularly required for kids over-eager to sign up for four, five, six AP courses; where there's no easy, nightly way for kids to give teachers' feedback on homework loads; where cellphones are used to provide social comfort during class; where grades are so relentlessly reported that students have little time to recover from the usual setbacks of adolescence; and where a culture of cheating (rates of 50%, 60%, 70%, as at high schools nationwide) poisons student morale.

With the exception of changes to the bell schedule, our District and school officials have resisted doing much at all to improve the environment into which we daily, weekly, yearly send our kids.

I think it's unrealistic to hope we'll solve the problems of sending our youth into endangering front lines simply by setting up more field hospitals to treat their injuries.

Please join the community alliance Save the 2,008--now with more than 500 local members--to create a safer, more hopeful environment for Palo Alto's high-schoolers.

Sincerely,
Marc Vincenti
Gunn English Dept. (1995-2010)
Chairman, Save the 2,008
savethe2008.com



10 people like this
Posted by Stanford Health System Sux
a resident of Crescent Park
on Dec 20, 2016 at 2:02 pm

Two problems: Most health insurers HATE Stanford because they overcharge.

Stanford's Patient care is awful, UNLESS you are under 12 years of age.

[Portion removed.]


7 people like this
Posted by Sarah1000
a resident of Los Altos
on Dec 20, 2016 at 3:21 pm

The newly-expanded Children's Hospital scheduled to open in 2017 will offer 821,000 sq feet of space and promises to deliver ". . . care for virtually all pediatric and obstetric conditions . . . while caring for emotional needs as well." Web Link Yet, this world-class hospital will not offer a single bed for anyone under 18 who is having a mental health crisis. The excellent doctors and nurses in Child and Adolescent Psychiatry at LPCH are desperate to treat our children in their time of greatest need. At minimum, they should have access to those patients who are fortunate enough to end up at Mills when they are sent away from Stanford to receive treatment. It's shameful that our children will continue to be sent away at all.
(I would also add that, in addition to the ASPIRE program through El Camino Hospital, Bay Area Children's Association also offers a very well-regarded outpatient program as well as an excellent team of MFTs and Child/Adolescent psychiatrists.)


13 people like this
Posted by Gunn parent
a resident of Gunn High School
on Dec 20, 2016 at 3:56 pm

Shame on Lucile Packard Children's Hospital. Rates of teen anxiety and depression are skyrocketing. Ground zero seems to be right here in Silicon Valley. Yet mental health is not enough of a money maker for LPCH to set aside any beds for kids in their backyard who are suffering. Kids from both high schools continue to be hospitalized far away from home due to lack of capacity here. It is outrageous and it all comes down to Stanford and money.


8 people like this
Posted by Marietta
a resident of another community
on Dec 20, 2016 at 4:36 pm

It is always good to see more plans to help solve this problem for our youth, but how many youngsters can you save if you move faster? How much money is one child worth? It seems a lot is not done by lack of funds. How much faster would you be willing to work on this issue if this were YOUR child or relative? Tomorrow would not be soon enough. What other good, but not urgent programs could be put on "hold" until this matter of life and death is solved for ALL our youth? This is URGENT!


3 people like this
Posted by We will see
a resident of Gunn High School
on Dec 20, 2016 at 10:43 pm

Just repaint Gunn and change the schedule. Again. Should fix everything.


1 person likes this
Posted by Gunn Parent
a resident of Gunn High School
on Dec 20, 2016 at 10:45 pm

[Post removed.]


8 people like this
Posted by PaloAltoMom
a resident of Midtown
on Dec 20, 2016 at 11:35 pm

We are forever reminded that mental health is analogous to physical health. If I brought my child to the pediatrician overweight, inactive and sleep deprived, I imagine I would get a lesson on preventive healthcare. I would be told of the relationship between diet and exercise and physical health. Somehow, mental health problems in this community are treated as though they fall straight from the sky with no rhyme or reason - children just have mental health problems that have no connection to lifestyle. Curious how the physical health analogy breaks down this way. I don't buy it.


2 people like this
Posted by Peter de Schweinitz
a resident of Palo Verde
on Dec 21, 2016 at 8:02 pm

During adolescence, all (or virtually all) people go through a stage of dis-continuity, that is, a stage in which it is difficult to see how one's past and present may link into a future. This puts youth essentially everywhere at risk of suicide. Communities that are able to create a safety net or "hedge" to suicide are those which create cultural continuity, an identity individuals are able to latch onto during crises of discontinuity. The associations between cultural continuity and community suicide rates have been well-described and researched by Michael Chandler and Christopher Lalonde in an article ("Cultural Continuity as a Hedge Against Suicide in First Nations Communities") published during the 1990s about First Nations communities in Canada. If I were in charge, so to speak, I would be looking closely at how Palo Alto is able to create a sense of larger, cultural identity in its teens (all teens). We have for too long assumed that cosmopolitan youth and people generally are post-cultural. They are not. We are not only individuals and mental health must be understood as a product (in large part) of social factors. What larger identity do our youth latch onto? What role do they play in their society?


2 people like this
Posted by Midtown mom
a resident of Midtown
on Dec 21, 2016 at 11:47 pm

Peter- thank you for the information on the cultural continuity study. That makes perfect sense to me Since teens are preoccupied with building an identity. The trouble is, around here achievement is the whole narrative. And while I like achievement as much as the next person as one element in a person,s life- not the whole thing. We have no culture outside of what we do and what we earn- even our social lives have become a part of consumer culture (post your perfect dinner on Instagram- see how many likes and comments you get- make money for instagram and yourself crazy ;-) I think people do better when they are connected to a bigger story- preferably a story that affirms our inherent value.


7 people like this
Posted by Let Down Again
a resident of Professorville
on Dec 22, 2016 at 1:09 pm

As always with Stanford/Packard, this is probably yet another case of too little, way too late.

Worse, it will most likely be run by student doctors, with attending physicians nowhere to be found.

Thanks for nothing, once again.


3 people like this
Posted by Mama Bear
a resident of another community
on Dec 29, 2016 at 12:20 pm

It's about time someone paid attention to what is really happening to teens and that adults don’t automatically assume teens are faking their condition to avoid school. I am tired of my child being placed in a mold that does not fit my child’s needs. I have had to learn the hard way to stand up for my child's needs and at times had to go against doctors recommends as sometimes those recommendations did more harm than good to my child. We know our children best and if we pay attention, we can figure out what types of treatments work and which do not. El Camino Hospital has an AMAZING program (ASPIRE) which helps teens with what they are dealing with and does not judge them. The down side to the program is that once the teens complete it, there really is not much follow-up. Teens are not all the same and should not be treated as if they are.


Sorry, but further commenting on this topic has been closed.

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