Psychiatric Hospitalization of Children and Teends

When children and adolescents experience a severe mental health crisis that cannot be treated in a community outpatient setting, such as pediatric and adolescent psychiatric outpatient care, crisis staff,  balancing homes or psychiatric hospitalization, the need for hospitalization in a pediatric and adolescent psychiatric inpatient department will be examined.  

The thought of psychiatric hospitalization for your son or daughter is unquestionably difficult and painful to fathom and is one of the most heartbreaking decisions that a parent can make. It is natural to worry, to feel anxious, grief and sadness over the mental health crisis and difficulty they are experiencing. One can also feel frustrated, confused and helpless when facing their distress, the severity of which is not always fully comprehended by parents. As a result of these difficulties, many parents find it hard to recognize the mental health crisis or may experience guilt and even shame. They frequently seek treatment only when the condition deteriorates and there is significant worsening of the symptoms.  

It is important to state that despite the processes, thoughts and emotions that parents may experience, seeking outpatient treatment as soon as possible significantly improves the likelihood of rapid recovery, healing and restored function while avoiding the need for hospitalization. Hence, if your son or daughter is experiencing a severe mental health crisis, active measures should be taken, and professional assistance should be sought as soon as possible. The best way is to consult therapists in the community who know your child to examine intense therapeutic options available in your HMO. In extremely urgent circumstances, when the professional recommendation is to immediately seek assistance at a psychiatric ER, it is important to follow the instructions while simultaneously continuing to examine the options available  for the near future - this review is frequently conducted in conjunction with the department staff as well as with the supervision and assistance of the HMO. For example: an adolescent teenage girl experiencing a severe psychotic crisis accompanied by significant unrest and distress may initially be referred for hospitalization but as soon as her mental health condition allows (even with partial stabilization of the restlessness), alternative options in the community, such as a balancing house, may be considered with the therapeutic staff. 

When hospitalization is needed

Circumstances that generally result in hospitalization occur when the mental health in children or adolescents is life-threatening, such as suicide, self-injury, risky behavior attributed to the mental health of the patient, or behavior that poses a danger to the environment due to severe unrest or aggression.  

In some circumstances, hospitalization may be required due to significant functional decline, organizational difficulties or severe emotional distress that cannot be treated in the community.  

Other circumstances that require hospitalization may involve incidental physical morbidity attributed to the state of mental health, such as eating disorders or severe depression that result in weight loss and other physical symptoms.  

The hospitalization of children and adolescents is designed to administer intense therapy to control and stabilize mental health in order to facilitate a return home and transition to outpatient treatment as quickly as possible. 

Who is eligible for the Pediatric and Adolescent Department

Inpatients in the Adolescent Departments are youth between the ages of 12-18 (or slightly older than 18, depending on the special circumstances) who are coping with various difficulties and complexities that may pose an immediate or imminent danger to them. Children under the age of 12 are generally treated in therapeutic frameworks in the community such as in clinics, crisis intervention centers, outpatient centers, etc. In extremely complex cases, when psychiatric hospitalization is required for children under the age of 12, Israel has several special psychiatric departments that specialize in pediatric mental health disabilities. 

Pediatric and adolescent psychiatric departments treat a range of mental health disabilities, with the type of diagnosis being irrelevant. The reason for hospitalization is essentially attributed to several factors: 

• Intensity of the symptoms. 
• Resulting emotional distress and functional decline. 
• Symptoms that pose a risk to the child and his/her environment.  
• No adequate therapy is available for them in the community.  

Some departments provide a response to a wide range of disorders, such as mood disorders, obsessive compulsive disorders, psychotic disorders, personality disorders, etc. Other departments specialize in specific areas, such as treatment of trauma and eating disorders.  

Hospitalization referral and intake 

Children or adolescents who are experiencing a serious mental health crisis and who require urgent assistance can, with their parents, turn to their family physician or HMO urgent care center to consult about the relevant therapeutic option and, if necessary, obtain a referral to the ER. 

In the most extreme cases in which the emotional state poses a danger, immediately and directly contact the ER for assistance and treatment, much as if you were coping with other physical conditions.  

If you were referred to the ER, you must arrive for an examination in the ER of the medical center listed in the referral. Upon arrival, bring the letter of referral with you (if one exists) and any other document or medical summary that is relevant to the mental health disability. The decision to hospitalize in a hospital department is only made following a medical examination that establishes the necessity of hospitalization due to the condition. 

If the minor patient does not agree to hospitalization, even when the guardian agrees, two options are available: 

• if the minor is older than 15 years of age and refuses hospitalization – court approval for hospitalization must be requested.  
• If the minor is younger than 15 years of age and refuses hospitalization – the case is sent to the District Pediatric and Adolescent Psychiatric Committee for a decision.  

In any case, hospitalization of a minor based solely on the parents’ consent will not exceed two months.  

If the minor is requesting hospitalization without the consent of the parents and is older than 15 years of age - the request will be sent to court, which will rule on the matter.  
Important to know: If the parents are married, the supervision of one parent alone is sufficient. If the parents are divorced, the consent of the parent not present during the child’s examination is required. 

Department intake 

If during the ER, a decision is made to hospitalize the patient, you will be referred to the relevant department in the medical center itself (the referral will occasionally be made to a relevant department in another medical center).  

Upon arriving in the inpatient department, an organized admissions process will begin by the medical and nursing staff, after which the department intake process will begin, including explanations about the department, incorporation in the daily schedule and introduction to the therapeutic staff. Every patient being hospitalized is associated with the primary caregiver (Case Manager), who specializes in one of the following fields: medicine, psychology, social work or nursing, and whose role is to integrate and coordinate multidisciplinary care during hospitalization.  

The intake process during the initial days is performed with the patient receiving supervision, support and special attention, reflecting an understanding of the difficulty and concerns of patients while facilitating their acclimatization in the department. 

Daily schedule 

The inpatient departments have a fixed daily schedule: 

• Wake up in the morning around 7:30–8:00. 
• Time for organization and breakfast. 
• Start of activity including work on academic performance, various group therapies and individual therapies. Most of the morning activities are performed in special classrooms that are headed by regular staff from the Ministry of Education in order to maintain functional and academic continuity.  
• Lunch. 
• Continued school activity, group therapies and individual therapies. 
• Afternoon and evenings are dedicated to family visits and recreation, some of which are structured by students and volunteers, under the guidance and supervision of the therapeutic staff. 
• Dinner. 
• Continued recreational activity. 
• Enter rooms, organize for sleep, lights out. 

Department staff

The department’s multidisciplinary staff employs various mental health specialists including psychiatrists, nurses, psychologists, psychotherapists, occupational therapists, art therapists, dietitians, etc. The staff work together on a daily basis, including multidisciplinary staff meetings that convene several times a week. 

While the psychiatric staff is responsible for disease diagnosis and management, therapy, follow-up and issuing of medical directives, the nursing staff is available to patients 24/7, ensuring that their basic needs are met while providing emotional support and supervision in addition to managing and coordinating care on a daily basis. 

Many pediatric and adolescent inpatient departments employ a dietitian as part of their therapeutic staff, realizing that mental health disabilities in children and youth frequently manifest through the body, which, inter alia, affects eating (eating too much or too little). This area is critically important for children due to the developmental aspects involved. 

The psychology and psychotherapy staff in the department are responsible for conversational therapies adopting various approaches and models, both individual and group, for patients and their families. Additionally, art therapists provide emotional therapy through creation and expression. The occupational therapy staff is responsible for improving organizational skills as well as cognitive, motor and behavioral function in various areas, depending on the patient’s condition.

For more information about the therapeutic staff, read the article Who Can Offer Therapy

Visits to the department

The therapeutic staff in the department encourages the maintenance and strengthening of family and social ties, realizing that these relationships play a critical role in resilience and support that will help the patient during and after hospitalization.  

Family members can visit every day, during the department’s visiting hours, with many departments imposing restrictions on the number and age of visitors. Visits may be scheduled in special rooms designated for family visits (also suitable for visits with younger siblings) or joint family trips, with the approval of the therapeutic staff, to the medical center courtyard.  

Occasionally, when the family situation is complex, visits may occur following preparation and coordination with the patient or the patient and the parents, as part of the therapeutic framework. It is important to note that although family visits are encouraged, they are not mandatory. The adolescent can decide that they do not want to meet with the parents or family, with the assumption being the therapeutic supervision and intervention on this issue will promote future visits that the patient desires and is willing to attend. 

Use of a personal telephone and laptop 

The approach to use of telephones and laptops is based on medical center policy. Some departments do not allow the use of smartphones or laptops with cameras in an effort to maintain medical confidentiality and avoid the possibility of uploading inappropriate content to the patients themselves, or to prevent exposing other patients to this content.

Period of hospitalization 

The duration of hospitalization is based on clinical needs, with the main goal being controlling and stabilizing the mental health disability, thereby enabling the continuation of therapy in the community. Some patients are hospitalized for several days, while others are hospitalized for particularly long times - especially when difficulties arise in achieving control over the mental health disability, in obtaining continuity of care in the community and the need for out-of-home placement. In these circumstances, check with the HMO and the department staff about intensive therapeutic options available in the community, to the extent permitted by the mental health disability. 

The average overall time, which refers to both the gaps between the various patients, is approximately three months.  

Discharge from the department 

Discharge from the department for continued care in the community occurs when the department staff, in conjunction with the patient or the patient and parents, agree that the defined therapeutic goals have been achieved, or that it is impossible or inappropriate to achieve the goals in the department but rather in another adapted setting.  

There are cases when the parents request that the minor be discharged against the recommendations of the medical staff. In these cases, the staff will consider the ramifications of failure to continue dare in the department against the options presented by the parents, and will discharge the patient, or will turn to the courts in accordance with the Youth Law (Care and Supervision)“ or the Pediatric and Adolescent Psychiatric Committee in accordance with Treatment of Mental Patients Law“. 

It is important to remember that discharge is a complex process and received differently by each one. It may trigger mixed feelings of joy and excitement on the one hand as well as anxiety and uncertainty - which may trigger emotional flooding and even manifesting as therapeutic regression. The therapeutic staff is familiar and aware of these feelings. In order to facilitate a good and successful transition back into the community and daily life, preliminary preparation and gradual adaptations will be made ahead of the change, including coordination of continuity of care, supervised vacations, integration in academic and occupational frameworks, etc.  

If a more significant period of adjustment is needed, the patient can be discharged from the department into outpatient care, including several weekly visits of several hours per visit. During these visits, the patient receives multidisciplinary treatment in an individual and group setting until he or she is capable of continuing therapy in the community. 

For a list of psychiatric hospitals or psychiatric departments in general hospitals.