Mental health consultation in the pediatric intensive care unit.

Abstract

The need for psychosocial intervention to be integrated with medical care on intensive care units is high, but too often mental health professionals are ill-equipped by traditional training programs for such work. Medical crisis counseling provides a conceptual framework useful in developing the skills needed to effectively intervene in such settings. The pediatric intensive care unit (PICU) is arguably one of the most emotionally demanding and high-stress areas where mental health clinicians may be asked to consult. This article describes medical crisis consultation in the PICU setting, suggests survival strategies for the mental health consultant to the PICU, and provides illustrative case examples.The words intensive care evoke a visceral response in most people, and the mental health consultant in a general hospital is no exception. The pediatric intensive care setting can be especially stressful because of the presence of critically ill children, distressed family members, and pressures associated with the societal value placed on children. Undoubtedly, diagnostic acumen, clinical experience, and understanding of the consultation process and hospital system serve the consultant well in the pediatric intensive care unit (PICU) as they do in other contexts.There are, however, unique aspects of consultation in such settings that are worth knowing and that may enhance the consultant's overall effectiveness. Our purpose with this article is to share our clinical perspectives regarding important survival strategies for the mental health consultant to the PICU. We provide an overview of the critical care setting and the types of consultation requests typically encountered. Practical suggestions are detailed in four consultative domains: patient, family, staff, and consultant. Four case illustrations from our clinical work ELAINE C. MEYER earned her BSN and MSN from the University of Pennsylvania School of Nursing. She earned a PhD in clinical psychology from the University of Rhode Island. She is a staff psychologist and former Linda Pollin Fellow on the multidisciplinary intensive care unit at Children's Hospital in Boston, and she is an instructor in psychology at Harvard Medical School. She is also clinical assistant professor of pediatrics at Brown University School of Medicine in Providence, RI. DAVID RAY DEMASO earned a BS and a medical degree from the University of Michigan. He is child psychiatrist and clinical director of the Department of Psychiatry at Children's Hospital of Boston and is assistant professor of psychiatry at Harvard Medical School. He is clinical mentor in the Linda Pollin Fellows program.

Improving the Quality of End-of-Life Care in the Pediatric Intensive Care Unit: Parents' Priorities and Recommendations

“…18 Previous work has also documented the pivotal and often intense role that critical care staff can play in supporting some families at the end of life. 18,42,45,47,48 Staff members' genuine expression of emotions and concern is generally perceived positively, encouraged, and well-remembered by parents. 18,49 Indeed, clinicians need not fear displaying their empathy and own emotions, for this is the very substance that can convey one's humanity and matters deeply to parents.…”

“…40,41 Unfortunately, the prevailing mode of end-of-life discussions focusing on laboratory values, organ systems, and individual treatments may be too specific and disjointed to facilitate understanding and decision-making or to meet the family's psychosocial needs. 10,18 End-of-life discussions that focus on organ systems or offer information only on a need-to-know basis may not hit the mark 18,39,42 and can leave some families feeling overwhelmed, underinformed, or wondering what the information means relative to their child's quality of life and survival.…”

Adolescents in Acute Mental Distress on Inpatient Pediatric Settings: Reflections From a Pediatric Liaison Practitioner

“…A body of work has identified that nurses as a professional group are subject to high levels of emotional intensity and stress and are often in intimate contact with death, illness, and trauma, considered above that which an ordinary person could bear (Lawrence, 1995; Menzies‐Lyth, 1988; Meyer, DeMaso, & Koocher, 1996). Meyer et al.…”

“…A body of work has identified that nurses as a professional group are subject to high levels of emotional intensity and stress and are often in intimate contact with death, illness, and trauma, considered above that which an ordinary person could bear (Lawrence, 1995; Menzies‐Lyth, 1988; Meyer, DeMaso, & Koocher, 1996). Meyer et al. suggests that the stress experienced by pediatric nurses may be even more intense because of the level of variability in the kinds of patients they work with and the societal expectations that exist for children's health and lifespan.…”

Appalachian diabetes patients' preferences for mental health treatment

“…In addition, the past two decades have seen psychology merge with other health/wellness disciplines-especially in the area of medicine. For example, opportunities now are available for psychologists in the areas of behavioral medicine, cardiology, pediatrics, neurology, surgery, oncology, spinal cord injury units, and genetic counseling (Allan & Sheidt, 1996;Asken, 1979;Blanchard, 1982;Carpenter, 1989;Cummings, 1992;Dana & May, 1986;Drotar, 1998;Gabinet & Friedson, 1980;Masur, 1979;Meyer, DeMaso, & Koocher, 1996;Sayette & Mayne, 1990;Shiloh, 1996;Taylor, 1987;Tovian, 1991).…”