Page 5

President’s Message

Mental Health Advocacy By Jason Bynum, MD IT HAS BEEN A VERY EXCITING and busy past couple of months at the medical society, and this has played out to be the year of mental health advocacy. While this has been purely coincidental with my presidency, the mental health crisis has truly come to a head, predominantly due to the massive influx of patients into our local emergency rooms. Physicians are encouraged to visit the SSVMS website, www.ssvms.org, to download a recentlypublished white paper on the subject. Several SSVMS members have worked very hard on this, and we are truly proud of their efforts. I have been involved for quite some time with the Lanterman Petris Short Act (LPS) Reform Task Force. As a child psychiatrist, I have shared with the task force my concerns about involuntary holds of minors. My colleagues in other parts of the state tell me that the vast majority of adolescent patients brought to inpatient psychiatric facilities are brought in voluntarily by their parents or guardians. In our region, however, we have a very different process. At the inpatient psychiatric hospital where I work, 100 percent of the adolescents who are admitted arrive on involuntary holds. Here’s the problem: Frequently, a teen will tell a teacher or school counselor about emotional struggles that are leading to concerns for suicide. Law enforcement is then called, the minor is placed on a 5150, and taken to the emergency room. Ultimately, they come to me, or to a facility like mine, and I am frequently the first phone call the parents or legal guardians receive. Not only is this a concern for me professionally and ethically, but I am also the parent of two boys. I would be quite upset if I were unable to find where my child was taken, if he were ever placed on an involuntary hold.

As a child psychiatrist, the best part of my job is working within the framework of a family in which the patient is a minor. Informed consent, decision making about safety, and alternatives to hospitalization, are all part of the process in working with families. Doesn’t a legal guardian have the right to provide an alternative to hospitalization? I have sent hundreds of kids home when the family is able to provide me with a rational safety plan, is committed to outpatient treatment, and where there is not a concern for neglect or abuse. This is a tough debate. On one hand, is parental consent the best decision for the child? While on the other, is the presumed 100 percent failsafe protection a hospitalization can provide best for the minor? I base much of my family-oriented approach on two points. First, a legal hearing should be in place if my opinion is different from the legal guardians who are presumed to have capacity. In other states, this is how it is handled. If I differ strongly from the decision of parents, an emergent Child Protective Services worker would be called and a midnight order obtained from the on-call civil judge. Second, I believe the assumption that my ability to keep their child safer in the hospital than at home with 24/7 monitoring is faulty. Psychiatric hospitals are more acute in their pathology than ever before, and a reasonable alternative should be considered. In addition to the white paper, I have prepared a resolution for the 2015 CMA House of Delegates calling on our professional organization to increase lobbying efforts to modernize our procedures for involuntary holds. I invite interested readers to contact me with your thoughts on this important issue. jbynum23@me.com

September/October 2015

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

3

2015-Sep/Oct - SSV Medicine  

Sierra Sacramento Valley Medicine is the official journal of the Sierra Sacramento Valley Medical Society (SSVMS) and promotes the history,...

2015-Sep/Oct - SSV Medicine  

Sierra Sacramento Valley Medicine is the official journal of the Sierra Sacramento Valley Medical Society (SSVMS) and promotes the history,...