This unit is designed to provide fast and safe screening services to your child.  While under our care, the team will provide all of your  child's needs. Should you or your child need anything, please find the nearest staff member and they will be happy to assist you. 

Many people come to the hospital for many different reasons.  Although the outcome at this time may be unclear, this document hopefully serves  to help clarify and to provide information to help ease your mind.

This is a unit that is designed to aid those having psychiatric emergencies. The unit doors are locked, and visiting is not allowed. There are no cell phones allowed. And many items are restricted.

This website is designed to give much needed information to you so together we can best help your child.

Did you know that about 1 in 4 people live with a diagnosable mental health condition or substance use disorder? Or that mental illness affects all kinds of people, regardless of age, gender, race, religion, sexuality, income bracket, or life experience.? There are influencing factors such as stigma, lack of knowledge, cost, and availability of treatment that can prevent a child from getting the help they need.  This website will help to provide information so you can make the most informed decision for your child.  You will find not only information on the process of psychiatric evaluation, but also information on treatment, medications, as well as local resources for you and your child. 

The process of finding treatment can be confusing and overwhelming, this website, along with the helpful and knowledgeable staff, are here to help you. 

If you have trouble reading or are visually impaired, the following is a video that explains the process:

https://www.youtube.com/watch?v=7Qyig5XV5NA

Just as you may bring a child to a hospital for a medical illness or emergency, mental illness needs to be treated in the same way.  There are many mental illnesses that can be readily treated with therapy and in some cases medication. Some mental illnesses have symptoms that can be harmful to the person or others. The purpose of the evaluation today is to determine the mental health needs of your child, to assess safety of your child, and to determine how much help, if any, would be beneficial.The following is a list of common mental health concerns and their associated symptoms: 

Depression: 

• Feelings of sadness, tearfulness, emptiness or hopelessness.
• Angry outbursts, irritability or frustration, even over small matters.
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports.
• Sleep disturbances, including insomnia or sleeping too much.

Anxiety: 

• Feeling restless, wound-up, irritable, or on-edge.
• Being easily fatigued.
• Having difficulty concentrating.
• Having headaches, muscle aches, stomach-aches, or unexplained pains.
• Difficulty controlling feelings of worry.
• Having sleep problems, such as difficulty falling or staying asleep.

Bullying: 

• Frequently feeling sick or faking illness. 
• Changes in eating habits, such as suddenly skipping meals or binge eating. 
• Your child may come home from school hungry because they did not eat lunch.
• Difficulty sleeping or frequent nightmares. 
• Declining grades, loss of interest in schoolwork, or not wanting to go to school.
• Sudden loss of friends or avoidance of social situations.
• Feelings of helplessness or decreased self esteem. 
• Self-destructive behaviors such as running away from home, harming themselves, or talking about suicide

ADHD (Attention Deficit Hyperactivity Disorder)

• acting without thinking.
• interrupting conversations.
• being unable to sit still, especially in calm or quiet surroundings.
• constantly fidgeting.
• being unable to concentrate on tasks.

Suicidal Thoughts

• Wish to be dead.
• Wish to go to sleep and not wake u.p
• Writing a suicide note.
• Posting suicidal statements online.

Self Harm Behaviors 

• Self injurious behaviors including cutting, burning, and hitting oneself
• Injuries may not be completely obvious  and are often hidden on inner thighs

• Threatening to hurt/kill oneself or thinking/expressing desire to hurt/kill oneself, or better off dead. 
• Excessive focus on death.
• Current access or seeking access to firearms, pills, or other lethal means
• Giving away personal items.
• Additional warning signs of Suicidal Thinking.
• Changes in mood, sleeping and/or eating.
• Expressing there is no reason for living, no sense of purpose in life, or feeling hopeless.
• Withdrawing from friends, family, and social activities.
• Isolation.
• Risk taking and reckless behavior, particularly if a change from regular behavior.
• New or increased substance use.
• Lost of interest in things previously enjoyed. 

The process begins by coming into the emergency room.  Your child will be seen by a treatment team consisting of doctors, social workers, nurses, and patient care technicians.  The treatment teams role will be to determine what is happening now, and what the next steps will be.  

Through interviews and observation, a treatment plan will be created. There are several outcomes from this evaluation. Times may vary.  Based on the findings of the treatment team, your child will either be discharged home or placed into a level of care.Level of care refers to the level of mental health treatment. The intensity and duration of treatment is correlated to the findings of the psychiatric evaluation. Levels of care range from inpatient hospitalization to outpatient therapy. Each level varies in intensity and duration.

Typically, mental illness is treated with seeing a therapist or starting medications.  With children, a psychiatrist or other provider may not start medications right away and first try family and/or behavioral interventions. If the psychiatrist does choose medications, it is important to note that medications, such as antidepressants and mood stabilizers, have been well studied and proven effective.  If you have further questions, you should speak to the provider treating your child regarding starting/stopping medications and possible side effects.You will need to answer many questions regarding the reasons that brought your child into crisis. We encourage you to answer the questions honestly as it will help place your child  in the most appropriate level of care.

Of the many forms of treatment for mental illness, they all have one thing in common: help for you and your child. Treatment will help you or your child with mental illness.  

Most forms of treatment are voluntary. Voluntary means that both the provider and the patient agree treatment is necessary, so they engage in treatment together. Every patient has the right to refuse treatment- including therapy and medications. There is an important exception to note. If a patient is dangerous to themselves or to others, a patient can be treated involuntarily. Involuntary treatment means that the providers believe there is an imminent risk of harm, and the patient does not wish to be treated. The patient is then put into treatment against their wishes. It is important to note that all patients under the age of 13 are considered involuntary in New Jersey. In order for an individual to be committed involuntarily, the following requirements are needed: (1) the patient is mentally ill; (2) the mental illness causes the patient to be dangerous to self or others or property as defined by NJSA §§ 30:4-27.2(h) and - 27.2(i). In these circumstances, the parent may feel overwhelmed. This is very common. Sometimes hospitalization is necessary for the prognosis of your child to change.

As mentioned earlier, your child's treatment team will develop a plan that includes a disposition. This disposition will include some sort of treatment modality.  We refer to these as "levels of care".  The following is a brief description of the different levels of care.

• Inpatient Hospitalization:  Inpatient  treatment is a short-term program where your child will live in a treatment center.  While hospitalized, your child will attend daily group therapy sessions and meet with a therapist, nurse, and clinician daily. These units are safe spaces designed to provide a therapeutic and safe environment for your child.  While hospitalized, the treatment team may decide to start medications. This is an ideal location for your child to start medications because they will be have medical monitoring. There are also residential programs available for specific mental illnesses such as eating disorders and substance abuse.

• Partial Hospitalization: Partial Hospitalization is a type of treatment where your child will go to a program in the morning and afternoon to receive therapy, medication, and monitoring.  Much like the inpatient program, this treatment type provides a large amount of treatment hours, but your child will return home in the evening, much like going to school. 

• Intensive Outpatient Program (IOP): An intensive outpatient program consists of three days a week for approximately 3-5 hours for each session. During the IOP, your child will receive group and individualized therapy as well as medications if appropriate. This level of care is a great follow up to an inpatient or partial hospitalization.

• Outpatient Program (OP): An outpatient program typically meets once a week for 1-3 hours.  During this program, your child will meet with a therapist and attend group therapy sessions. This program can be used as a follow up treatment for an intensive outpatient program. 

  Mental illness is very real, and also very treatable. It is also important for you to be supported during this process.The following are local resources for support:For a list of local support groups, please access: Njgroups.org (NJ support group clearinghouse)There are also online meetings listed there.

For phone support, please contact the following. These support lines are for you and your child should they wish to talk to someone or require additional information

Suicide National Lifeline…….…………….Dial 988

Self Harm…………………..………........800-DONTCUT

Second Floor…………………….…...... 888-222-2228

Teen line………………………….….... 800-852-8336

Abuse RAINN……….….…………....….800-656-4673

National Substance Use…………....….844-289-0879

Substance Use IME..…………..…....….844-276-2777

PTSD………………………………....…..877-717-7873

The Trevor Project (LGTBQ)...................866-488-7386   

 It is not guaranteed that your child will need medications, but in many cases, doctors will prescribe medications to help alleviate symptoms. This section will provide more detailed information about why a doctor is prescribing the medication and also potential side effects and how to keep your child safe. 

FDA-approved antidepressants for children and teenagers 

 Medication*                                         

Duloxetine (Cymbalta, Drizalma Sprinkle)  7 and older               GAD (General Anxiety Disorder)        

Escitalopram (Lexapro)                                       12 and older               MDD (Major Depressive D/o)

Fluoxetine (Prozac)                                                8 and older.                                                        MDD

Fluvoxamine (Luvox)                                              7 and older                                                        OCD

Lurasidone (Latuda)                                             10 and older.                        Bipolar Depression

Olanzapine and fluoxetine (Symbyax).        10 and older                        Bipolar Depression

Sertraline (Zoloft)                                                  6 and older                                                        OCD

*Many of these drugs are also available in generic form.

Recommended initial dose and maximum dose vary by age.

• Mood Stabilizers (Antipsychotics)

Trade Name.                     Generic Name

Abilify.                                 aripiprazole

Geodon.                             ziprasidone

Invega/Sustenna            paliperidone

Latuda.                              Lurasidone

Risperdal/Consta.         risperidone

Seroquel.                          quetiapine

Zyprexa.                            olanzapine

Haldol.                               haloperidol

Thorazine                         chlorpromazine

COMMON SIDE EFFECTS 

Some medications can have side effects. It is important to be on the look out of the any changes in your child's presentation or behaviors.  In some cases, if a doctor is starting a medication, the doctor may want your child to stay in the hospital for a short period of time to make sure the child is adjusting well to the medication.  The following are potential side effects for your child when starting a medication

• Increased Risk of Suicide

  Some antidepressants come with a "bl;ack box warning" for increased suicidality in adolescents.  Do not be alarmed. 

• EPS 

Type                 Description                                                          Time                Treatment 

Dystonia.     Tongue swelling, jaw locking (emergency)  Minutes to hours.                  Benadryl  injection

Akathisia          Restlessness                                                              Days to weeks                   Propranolol 

Parkinsonism.  Shuffling gait, rigidity                                      Weeks to months               Benadryl, Cogentin

Tardive dyskinesia.  Lip smacking                                               Months to years.                Valbenazine

SUN SAFETY AND MEDICATIONS

Some antipsychotic medications may impair the body's ability to regulate its own temperature. During hot and humid weather, individuals taking antipsychotic medications are at risk of developing excessive body temperature, orhyperthermia, which can be fatal.

 Individuals with chronic medical conditions are especially vulnerable, e.g. heart and pulmonary disease, diabetes and alcoholism, etc. Heat exhaustion is the most common heat-related condition, which is most likely to occur in people who are involved in physical activity outdoors during heat waves.

Heat stroke is a more serious condition of dehydration and salt depletion which can be life threatening.