Stabilize and equip young people

On the second floor of the Rivière-des-Prairies Mental Health Hospital in east Montreal, the drab hallways give way to colourful walls covered in drawings and positive thoughts. Here, in the largest child psychiatry department in Quebec, about 750 children are hospitalized each year.

Three young people sit silently at a table in front of their puzzles. A fourth calls her family on the unit’s landline.

It’s late May. At the end of the hallway, open doors lead to a large deck overlooking the woods adjacent to the hospital. It’s one of the busiest times of year on the unit. “There’s a lot of suicidal crises,” says child psychiatrist Kimberly Pham.

It’s no coincidence that it falls at the end of the school year. “The final exam period can stress them out a lot. It’s not necessarily the trigger, but it contributes a lot,” says Dr.^D Pham.

The traffic usually dies down around mid-June. “There is no more school, there are no more rules, so the young person does not face his difficulties,” notes the head of the secondary emergency department, Kathleen Bertrand.

Adolescents are accommodated in the short-term hospitalization unit for a maximum of two to three days.

In total, the short-term unit has six rooms. If necessary, three stretchers can be added. The majority of adolescents hospitalized in this unit are there because of suicidal thoughts. The factors involved are numerous: school stress, conflicts between friends or lovers, family problems. “Most of the time, the factors accumulate and the young person exceeds his or her ability to adapt,” explains Dr.^D Pham.

During their stay, the young people’s days are filled with medical meetings, group therapeutic activities and individual reflections adapted to their situation. Books and stretching exercises occupy their free time.

Time is limited here, however. “We cannot resolve all the factors that triggered the crisis,” continues Dr.^D Pham. The goal is to stabilize young people and give them the tools to quickly return to their families.

A thousand young people in the emergency room

Small premises are located a few steps from the short-term hospitalization unit. They make up the secondary emergency room. A real hub of the child psychiatry department, this is where young people are treated when they arrive at the hospital.

The emergency room receives approximately 1,000 young people per year from 13 hospitals in the Montreal, Laval, Lanaudière and Mauricie–Centre-du-Québec regions. “In some emergencies, there are no child psychiatrists on site, so patients come here to be assessed,” explains Dr.^D Pascale Gregoire.

After their assessment, some young people will receive outpatient follow-up, others will be hospitalized for a short period – in the short-term hospitalization unit – or for a longer period in the children’s or adolescents’ unit.

Patients “who are doing the worst” will be admitted to the psychiatric intensive care unit, says M^me Bertrand. It is the only unit of its kind in Quebec.

Located at the far end of the second floor, the intensive care unit has only three small glass rooms that overlook the staff station. “We always have to see them,” says M.^me Bertrand. The unit generally accepts patients at high risk of suicide, in psychosis or bipolar.

To prevent a young person from attempting to end his or her life, some patients have no sheets on their beds and wear paper gowns. The young people are under constant surveillance, even in the bathroom. The toilet flush is locked, only the staff can activate it. There is also no shower curtain. The average stay is a few days.

A busy schedule

When they are feeling better, some will join the adolescent unit, which has about ten young people. The green and yellow walls of the unit contrast with the austere climate of intensive care.

It is 10 a.m., the teenagers are gathered in the living room and waiting for their workshop to begin.

Every morning at 9am, the youth must be washed, have had breakfast and be ready to start their day. This is followed by a walk outside, before therapeutic activities to equip the youth for the challenges of daily life. In the evening, they will be able to receive visits from their family.

The young people enter a small room located across from their rooms. A colorful game board is placed in the center of the table. They take turns rolling a giant die and are invited to answer questions on social networks. “Maxime sends hurtful messages to Simon. Is this a bullying situation?” psychoeducator Roxanne Lavallée asks the group.

“What is bullying?” a young patient replies. “It’s hurtful words that can affect a person,” replies the teenager next to her. “So yes, it’s bullying,” the young woman concludes.

They will generally be hospitalized for three to six weeks. “We aim for stays of less than a month, but it varies,” says Eve Cadieux, interim assistant director of mental health, children and adolescents. A similar unit is also available for children aged 6 to 12.

Clinical nurse Annie Thibault wants to break down taboos about mental health. “Even today, it’s easier for some parents to say that their child has physical care than mental health care.” She wants things to change. “I’ve been here for seven years and I’m still surprised and amazed by the strength they demonstrate through illness.”