Safe haven
Inpatient psychiatric unit specializes in acute care

Robert Lobis, MD x

For patients, families and clinicians, treatment of psychiatric illnesses can be much more difficult than simply addressing the illness by itself. Few other diagnoses are as heavily dependent upon family involvement in treatment, and even fewer are as misunderstood and stigmatized. These challenges are even more pronounced when the patient has a comorbid medical illness, such as diabetes, that complicates or reduces the child’s ability to care for him or herself.

For those times when young patients can’t be managed in outpatient settings, have significant medical risks or severe psychiatric symptomatology, or are aggressive or dangerous—either to themselves or others—Children’s Hospital Boston offers the Richmond Psychiatry Inpatient Service, also known as Bader 5. This 18-bed unit specializes in caring for children and adolescents, age 3 to 18, with depression, anxiety, eating disorders, complex somatoform disorders and chronic medical conditions that can be exacerbated by psychiatric illnesses.

Bader 5 is staffed by nearly 60 full- and part-time staff, including three attending physicians, nearly 40 nurses, a staff psychologist, five social workers, a nutritionist and several residents. In addition, there are two recreational therapists that help patients interact socially, and two teachers who help them keep up with school work.

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Sally Nelson, RN, MEd x

The unit is broken into two areas, one for school-age children age 6 to 12 and one for adolescents age 13 to 18. Children younger than 6 have individualized programs. In all age groups, patients’ schedules include time for individual, group, and family therapy, as well as psychopharmacology consultation and school work. Time is also included for patients to interact socially where they see—many for the first time—that they are not the only ones with a specific problem.

The concentration of individualized services available on Bader 5 allows staff to accomplish things that others can’t, but the focus is always on the patient and family and how they have to work together to address the issues that led the hospitalization.

“When children have to be hospitalized for a psychiatric illness, they feel things are out of control, and the parents feel helpless,” says Robert Lobis, MD, medical director of Bader 5. “We address those feelings in a few ways. First we work with the family as a whole to define the focal problem, or what we’ll be working on while the child is in the hospital. We make it very clear that we’re treating the acute reason the patient was admitted to the hospital; offering the front end of a longer program that will take place in an outpatient setting. Then we educate both the patient and parents about the illness and help them draw a distinction between a child who has a problem and a child who is a problem. Finally we work closely with the whole family to design a treatment program that helps them control that problem.”

Often, however, parents’ expectations of what the Bader 5 staff can accomplish are unrealistic. “Many of them feel that their child’s psychiatric illness will be ‘cured’ by the time they leave the hospital,” says Sally Nelson, RN, MEd, program director of Bader 5. “They want us to fix things. So we try to make it clear that we’re the first step in a long process and that their involvement is key.”

In addition to working with staff to design a treatment plan and set shared goals, parents are expected to spend significant time with their children at the hospital and are asked to come to two or three meetings each week.

“We tell parents that their child is not in isolation here, and try to empower them to help their child manage the illness,” says Nelson. “There are family meetings and a parents group, and we plan time for parents and children to leave the unit together before discharge so they can test some new behaviors. When they come back we evaluate how things went so we can solve problems before they get out of the safe hospital environment.”

Once the child is released from the hospital (a typical stay is usually about two weeks), the family is given an extensive treatment plan that is shared with the child’s primary care physician. In addition, schools and agencies like the Department of Social Services are educated about the illness and how to help the child follow the plan.

Insurance concerns often make psychiatric hospitalizations more difficult than they already are. Nelson and Lobis note that the services provided on Bader 5 are out of network for most insurance carriers and that it is important for parents to check whether their insurance will pay for the hospitalization.

The Department of Psychiatry at Children’s developed “Helping with Your Child’s Psychiatric Hospitalization: A Practical Guide for Parents” to answer questions patients and families have about inpatient psychiatric hospitalizations. It is available at http://www.childrenshospital.org/cfapps/psych/parentguide.pdf.

Richmond Psychiatry Inpatient Service
Phone: 617.355.7726
Fax: 617.734.3751

Robert Lobis, MD
robert.lobis@tch.harvard.edu
Phone: 617.355.7134

Sally Nelson, RN, MEd
sally.nelson@tch.harvard.edu
Phone: 617.355.7944