Stanford Children's Health and Lucile Packard Children's Hospital will be addressing in 2017 what they describe as "immediate critical needs" in youth mental health by launching a range of new programs and services that will support local teenagers at high risk for suicide.
The healthcare organizations' new efforts, from bringing a team of Stanford doctors to a local adolescent inpatient hospital unit and creating an intensive after-school program for suicidal teenagers, seek to provide as comprehensive a safety net as possible for youth and families who have often struggled to access the support they needed during moments of crisis.
The first "low-hanging fruit" Stanford Children's Health felt it could quickly grab was to develop a team of doctors to staff the closest hospital that offers inpatient hospitalization for teenagers, at Mills-Peninsula Health Services in San Mateo, said Stanford child and adolescent psychiatrist Antonio Hardan, who has been involved in the planning for this and other related initiatives.
The team -- made up of a child-adolescent psychiatrist, psychologist and psychiatry fellow -- will eventually cover up to eight beds at the 17-bed unit to provide hospitalized teenagers access to Stanford doctors. The team approach, Hardan said, means the doctors will support a larger group of patients, rather than one or two, with some staff responsible for seeing them during the week and others over the weekend. They hope this will improve patients' experiences in the hospital and prevent re-hospitalization.
"Inpatient stay is usually short," Hardan said, "but our goal by having all this manpower is to optimize the stay and prevent future re-hospitalization or worsening of the underlying psychiatric condition."
Daniel Becker, medical director of behavioral health at Mills-Peninsula, said the partnership will address "potential discontinuity" in care for patients who might see Stanford doctors but be hospitalized at Mills.
A more "seamless" and "normalized" process, Becker said, could also help decrease stigma for young people coping with mental illness.
"We don't want them to think negatively about themselves or their situation," he told the Weekly. "The continuity helps that."
They also hope it will help stave off staff turnover, which is high in inpatient units around the country, Hardan said.
"We don't want to do something for the short term. ... By developing the team, it will allow us to keep people fresh and keep them motivated to do good work," he said.
The added teaching component of including a psychiatry fellow on the team will, Hardan hopes, increase the pool of people who have real experience in -- and thus are more willing to work in -- an inpatient setting.
The new Mills-Peninsula team will also be a learning experience for Stanford, laying the groundwork for the creation of similar teams at other local hospitals, Hardan said.
The possibility of Stanford opening its own adolescent inpatient unit is still "on the table," Hardan said.
Earlier this year, Lucile Packard Children's Hospital, Mountain View's El Camino Hospital and Kaiser Permanente jointly responded to a Request for Proposal (RFP) from Santa Clara County to open a child and adolescent unit within county borders, but Hardan said another hospital's proposal was chosen. County officials are still in negotiations with the selected vendor and have yet to disclose whom they chose. (The county also received responses from Fremont Hospital, statewide nonprofit EMQ Families First and a joint response from San Jose nonprofit Bay Area Children's Association (BACA) and PrairieCare Medical Group, a Minnesota-based psychiatric healthcare system.)
San Jose Behavioral Health, a new hospital in south San Jose, also opened an inpatient unit for adolescents this year.
In the second half of 2017, Stanford plans to launch a six-month after-school outpatient program that will include both an intensive outpatient program, or IOP, and a comprehensive outpatient component for 13 to 17 year olds who are suicidal or para-suicidal, meaning they are harming themselves in non-lethal ways, like cutting or burning.
The IOP will provide teens with clinical services for three hours a day, three to four days a week. The comprehensive outpatient program will provide at-risk teenagers with weekly therapy (individual, group and family) and medication management, among other services. Patients can participate in either the intensive outpatient program or the outpatient component, and can move from one to the other depending on the severity of their symptoms, Hardan said.
They will also have 24-7 access to a team of doctors and clinicians familiar with their case — and who, more importantly, the teens are familiar with.
"In case of Caroline calls at 2 a.m., she doesn't have to tell her whole story all over again," Hardan said, using a hypothetical example. "She will reach out to a team member who is familiar with her case and can problem solve with her right there."
Hardan hopes to house the intensive outpatient program at the Lucile Packard Children's Hospital in Palo Alto, but alternative locations include Stanford's Castro Commons Clinic in Mountain View or a Stanford specialty services clinic in Sunnyvale.
Having another local intensive outpatient program will be a boon for local teens and families. Nearby is El Camino Hospital's popular yet small outpatient program, the After School Program Interventions and Resiliency Education (ASPIRE). Stanford's will also be small, however, starting with eight teens, Hardan said.
However, "if there is a need to have more patients being part of that program, I think we are open to that," he said.
Other new mental-health initiatives coming from Stanford in 2017 include an expanded crisis team that will be readily available to youth who go to the emergency room for help but might not need to be hospitalized. Instead of telling a patient like this — who might not have his or her own therapist or be familiar with their options for care — to call a number and then face a months-long waiting list, the hospital will connect teens directly with this crisis team. The team will provide three to four sessions with a patient and their family and then help connect them with longer-term mental-health care, if needed.
Local high schools will also be able to call this crisis team directly to refer students, Hardan said. The team will be made up of a psychiatrist and two psychologists and, in the future, a case manager.
Stanford also plans to launch a new school-based program in Palo Alto Unified's elementary schools next year.
"In collaboration with school administrators and teachers, we will help evaluate and treat moderate- to high-risk students in need of immediate care, and also work with teachers and families to identify issues that may lead to future challenges," Stanford Medicine freelance writer Julie Greicius wrote in the fall edition of Packard Children's News, which details the hospital's plans for the new year.
Other plans include recruiting more faculty with specialized expertise on everything from addiction and anxiety to autism and eating disorders, creating a single crisis hotline that any local family or health care provider can call for referrals and resources and investing in research to "better understand the underlying biology of mental health," among others, the article states.
Stanford Medicine's Center for Youth Mental Health and Wellbeing is also spearheading an effort to open new youth mental health centers, including at least one in Santa Clara County, that will provide comprehensive physical and mental health services in a comfortable setting at little or no cost to teens.
The "biggest challenge ahead" in mental health, Mills-Peninsula's Becker said, falls within this category of upstream prevention services. Making mental-health care available more broadly and immediately, including in primary-care settings, will hopefully get teenagers the help they need earlier, rather than at the point where hospitalization is necessary, he said.
Editor's note: This story was updated to correct inaccurate information about a wait list for El Camino Hospital's intensive outpatient program, ASPIRE. There is currently no wait for the program and has not been for more than a year, said Michael Fitzgerald, executive director of mental health and addiction services at El Camino.
Any person who is feeling depressed, troubled or suicidal can call 1-800-784-2433 to speak with a crisis counselor. People in Santa Clara County can call 1-855-278-4204. Spanish speakers can call 1-888-628-9454.
People can reach trained counselors at Crisis Text Line by texting 741741.
Links below provide more resources where one can receive help: