Common Mental Health Referral Concerns

In pediatric critical care settings, mental health consultation requests are diverse and require eclectic assessment and intervention approaches. Referral questions can be specific (e.g., "Please assess this patient for depression") or, more typically, vague general cries for help to assist the child, family, or staff (Meyer et al. 1996). Other common referral concerns include depression, anxiety, and other psychiatric symptomatology; changes in mental status; suicide attempts and other nonaccidental injuries; and support related to anticipatory bereavement and end-of-life issues.

The mental health consultant's direct access to patients is typically limited because pediatric patients in critical care settings are often sedated and pharmacologically paralyzed (Board 2005) or those who are awake are largely disengaged from their environment (Cataldo et al. 1979). Referral records from our institution, Children's Hospital Boston, indicate that only about half of the mental health consultation referrals request direct service to patients themselves; the remainder of referrals are initiated on behalf of parents or other family members, who have been described as "second-order patients" due to the pervasive nature of their own psychological needs (Ferrell and Coyle 2008).

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