E13: Dr. Shivana Naidoo - Talking it Through Mental Health Goes to School

Note: This episode discusses mental health crises and mentions suicide. If you or a loved one are experiencing thoughts of suicide, know that you are not alone and help is available. You can call or text “988” - the National Crisis/Suicide Hotline. They are available 24 hours a day, 7 days a week.

Dr. Shivana Naidoo is a child and adolescent psychiatrist with a broad range of experience working in various settings including inpatient, outpatient, emergency, partial treatment, and private practice both virtually and in person. She joins Jo-Ann and Candida to discuss communication when a child or teen (or anyone) is in a difficult mental health situation or crisis in a school or healthcare setting.

Dr. Naidoo emphasized that parents and teens are empowered in most situations to ask questions, to get more information from other sources, and to not agree to anything that doesn’t seem right. She acknowledges that the available care options vary depending on where you live - state by state, county by county as well as the type of place you live in such as rural, suburban, or urban settings. However, in general, there are protocols for schools and hospitals to follow when a student of any age presents behavior or symptoms that indicate the need for further evaluation. If there is a situation at home in which parents/caregivers may question whether to inform the school, the risks of survival and health of the child should be considered.

Unless it is a medical or psychiatric emergency, avoiding the emergency room is best, if at all possible. Most hospital emergency rooms are not well suited to dealing with mental health situations or crises, especially for children and teens. If that is the best or only option at the time, and if you can choose which hospital to go to, an academic medical center or larger hospital will often provide the most resources. If a school has reached out to you about your child needing to go to the emergency room, Dr. Naidoo explains that, when possible, the parent/guardian should first make phone calls to the child’s pediatrician and mental health providers to get more information and consider if there are options besides emergency rooms, such as Mobile Crisis Teams.

Dr. Naidoo advises that once the child is being evaluated in an emergency room or other acute care setting, the caregivers ask questions and write down the names and responses. This ensures that the information will not be lost and often encourages hospital personnel to be more attuned to the patient and parent/caregiver. If there is a decision being made between hospital admission or discharge to home a parent/caregiver can take several steps to ensure that, if the child is discharged, they will have appointments as soon as possible with the appropriate providers (therapist, psychiatrist, pediatrician). If the parent/caregiver can assure the hospital staff that the home setting is safe, that information will be included in the decision making about whether a child goes home or is admitted.

 In terms of home safety planning Dr. Naidoo recommends using the GOSECURE acronym to remove or secure hazards in the home and make a safety plan:

Guns
Overdose options
Sharps
Electric cords
Car keys
Underage drinking
Reattempt [likely to be the same method]
Exits/Entrance [elopement]

The best decisions about how to help a child experiencing a mental health crisis will grow out of honest conversations with everyone on the team - the child, parent/caregivers, outpatient treatment providers, and hospital staff. School personnel are also often involved, especially if the crisis occurred at school. Communication between all of these parties is essential for successfully navigating these difficult situations. 

Resources

Do Better MD - Dr. Naidoo’s website

Bradley REACH - virtual partial hospital program

Orchid Exchange - online therapy and support groups

American Academy of Child and Adolescent Psychiatry

Youth Risk Be