IWK says staff must weigh risks, benefits of keeping children in crisis in hospital

The IWK Health Centre has made progress in treating children with mental-health issues over the last decade, but much work remains to be done, the hospital's chief of child and adolescent psychiatry says.

Dr. Alexa Bagnell spoke to CBC's Mainstreet to explain how the IWK handles admissions, treatments and discharge planning for young people dealing with mental-health and addictions issues.

"Our emergency room is our crisis centre for all children [and] youth with mental health and addictions needs, and that would include children and youth with autism-spectrum disorder who have mental health and addictions needs," Bagnell said Thursday.

A Nova Scotia activist and mother spoke to Prime Minister Justin Trudeau this week about the care her nine-year-old son has received from the IWK for his severe autism and aggressive fits.

Bagnell could not speak about specific cases, but said the IWK offers a mix of in-patient and outpatient care.

"There's always room to improve, and that's across systems and also within the delivery of mental-health care across our province," she said.

In-patient care or outpatient?

"We see a wide range of conditions and problems and diagnoses," Bagnell said. "We decide on what levels of care based on the needs of that patient and family."

Bagnell said the emergency-room assessment is based on staff interacting with the child, the child's family, other health-care providers, and the emergency room team. That helps them decide on a treatment or discharge plan for the child and family.

"We're balancing what would be the benefits of coming into hospital and what are the risks of coming into hospital," Bagnell said.

"We know that  sometimes in-patient hospitalization is needed and can be beneficial and there are other times when in-patient admission actually can cause harm or problems for a child or family by taking them out of their environment and putting them in a hospital setting."

She said when they decide against admission, they work with the family and community teams.

"Families are often tired and scared, so really putting those supports into place is part of our job in the emergency room."

Mobile crisis care unit

Maureen Brennan, director of mental health addictions at the IWK, said they have an urgent-care outpatient service they can connect families to immediately.

"What we're saying is anyone who shows up at the IWK emergency is going to be assessed with what their clinical needs are and a plan is going to be put in place that matches that need," Brennan said. "There are always opportunities for us to improve."

The IWK also uses a mobile crisis care team it runs with the Nova Scotia Health Authority.