"Medical care and mental health care for teenagers"

About: Box Hill Hospital / Emergency Department Child & Youth Mental Health Service (CYMHS)

(as a parent/guardian),

My teenage daughter took an overdose of medication (first time ever doing anything like this post breaking up with her boyfriend of 1 year). I wasn't sure if it was sufficient to warrant going to hospital, so I called the chemist to check. They recommended talking to the Poisons Hotline, who then took 5 minutes to answer and said to call an ambulance. The ambulance arrived 30+ minutes later and decided she needed to go to hospital to be seen.

Once at Box Hill, within 10 minutes she was moved from ambulance stretcher to waiting room where a nurse promptly took her blood pressure, explained there was a wait for hospital beds and we would probably need to also see the psych triage nurse. When I asked how much of a wait / how many people were ahead of us for psych triage - the response was that they were unsure, they had only come on an hour ago.

After a few hours of waiting, everyone else in the waiting room had been checked over by the nurses, blood pressures checked, blankets and tablets offered but not my daughter. It seemed strange no one had checked on my daughter. She had all of the sticky things attached to her for an ECG, but they were unable to make it work in the ambulance. I was starting to think maybe they get you to wait 4 hours and then do a blood test to clear you. She took the tablets at 4:30 pm, we had arrived at the hospital at 6 pm, so by 8:30 pm (4 hours later) I decided to go and find out what was happening. I asked if we were waiting to do a blood test as 4 hours had elapsed. I was advised she does not need to see a doctor at all and she had at least a 2 hour wait for the psych consult. I took her home without waiting.

The next morning it struck me that perhaps I should not give her the normal dose of medications as maybe I would give her an overdose myself, so I called the hospital. Eventually I convinced the ward clerk I needed to talk to a medical staff... she wasn't keen to put me through since my daughter wasn't seen by a doctor. The nurse first asked about the ECG (geez... should she have had one?!!), then she told me the tablets did have a long half-life, so definitely don't give her the medications that day, but will be okay the next day. I called the chemist... they thought give it a break for two days, but was concerned, re. withdrawal symptoms.

While picking my daughter up from school (she'd broken down and was distraught), I was contacted by CYMHS staff (Child and Youth Mental Health Services). I explained I was currently meeting with the school well-being staff and could she call me back in an hour. She requested I call her back instead. When I got home and settled my daughter, I tried a few times to call them, once I selected option 2, it rung and hung up. At 4:30pm I tried again, after being on hold for 25 minutes, I was told they had phone issues and it had been a quiet day for them. We had a very short talk as it was now after 5 pm, I was advised that definitely go back on the medications the next day, (i.e. with only the 1 day break), she was familiar with the meds and this was correct advice. Meanwhile, someone would call me on Monday to follow up/finish our conversation. I had her check the hospital admission notes... no mention what medications my daughter took normally.

On Saturday, my daughter had a sore stomach and was feeling sick. She even vomited a few times but as she hadn't eaten anything, nothing came up. She was alternated the day crying off and on, complaining about how sore her stomach was/how sick she was. Later Saturday afternoon I also heard back from her paediatrician, who was actually away on annual leave. In his opinion we should cease the meds for 3 days (too late by then, we had taken them that morning).

Sunday morning, as soon as the clinic was open, I took her to the doctors as she was still in pain, was still feeling sick and really - at this stage, she had not been medically cleared. He diagnosed her with an inflamed stomach and put her on some meds to suppress the acid, and anti-nausea tablets, with recommendation to follow up with the family doctor in a few days. His recommendation was to stop immediately one of her normal tablets, as it could be contributing to the pain and in conjunction with the overdose and distress due to the breakup, causing her stomach problems. That made good sense. She had been complaining of feeling sick for weeks, but not enough that we took her to see the doctor.

Fast forward to today, physically - the family doctor has taken bloods, given her more anti-nausea meds and referred her to get a stomach ultrasound. Mentally, she is a wreck, hasn't been at able to work (when she normally loves her job), has not been able to stay at school/go to school (she doesn't skip school) and still we never heard back from CYHMS.

Major concern # 1: No medical staff or doctor talked to me to get my daughter's medical history. They did not know what drugs she was on already, what her normal dosage was and why she was medicated. They did not know she had a pre-existing sore stomach/nausea issue. They did not give me advice on whether she should stop taking her meds because they didn't know she had regular medications. They did not know she was allergic to band-aids... the ECG pads were in place for 4 hours, they hurt her to remove them and left red dots - she was worried that they wouldn't go away and would itch / become inflamed.

Major concern # 2: If it was serious enough that other medical experts (chemist, Poisons Hot Line and ambo's) said she had to go hospital, should they at least talk with us, so we could ask questions/get reassurance? She felt like no one cared about her, since no one listened. She was worried and got zero re-assurance. She went home with the ECG pads in place and I had no answers for her why the ECG wasn't done by staff.

Major concern # 3: Psych triage - why is it acceptable that children/teenagers do not have a dedicated psych nurse/or at least get priority to be seen within 2 hours of presenting? Why is it acceptable there is a 6+ hour wait (typically to be seen)... Based on previous experience with my other daughter... the child can escalated to the point of being medicated to keep them calm while they wait, so they are incapable of talking coherently when they eventually get seen. Mental health management at hospitals is a broken system. Try arriving a 6 pm and then at 1:30 am being told, night shift didn't arrive (called in sick, no replacement) so you can either take them home and come back another time or wait until morning shift arrive. Why is there only 1 staff on?

Major concern # 4: CYHMS - Early intervention. Surely the first time ever a child has an overdosed/presented with a mental health issue, is the time to throw all resources to nip it at the bud/address it early/prevent it from deteriorating and provide support for family so they can say the right things/make the best decisions etc. Making promises to call back on Monday and then not doing it is not acceptable. After a week, she isn't getting over it, she won't see the well-being team or school psychologist. She isn't improving, she is now refusing to go to school. It better not be the start of a 3 year journey that I have had with my eldest daughter!

Responses

Response from David Plunkett, Chief Executive, Eastern Health

picture of David Plunkett

Dear sunss96

Thank you for providing feedback on yours and your daughter's experience both with the Emergency Department at Box Hill Hospital and also the Eastern Health Child and Youth Mental Health Service.

I would like to apologise that we did not meet expectations in a number of areas.

In order for a full review to be undertaken, could I please ask if you could make confidential contact with the Eastern Health Centre for Patient Experience either on 1800 EASTERN or feedback@easternhealth.org.au

I hope you do make contact as there are clearly things we need to understand better and make improvements in. If you choose not to make contact, I will respect your decision but I certainly hope you do.

Thank you again and kind regards

David

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