Standing orders for camp mental health?

[Astocker93]

Hi folks!

I work year-round running the health center at an outdoor education site. In our standing orders/policies and protocols, there is no mention of mental health whatsoever. In the last six months alone, we've found two students with disordered eating habits, half a dozen who were self-harming, and a number more who were likely struggling with their own mental health issues but had nobody at home who ever noticed (mood disorders, anxiety/panic disorders, etc.).

I am meeting with our director this afternoon to discuss a handful of things, including updates needed in our standing orders and protocol. This is something I feel should be included, but I'm not sure if that makes sense or if I just seem to be overreacting (since earlier this week I had a student tell me he wanted to kill himself). Does your facility have standing orders or written protocol for how to handle mental health difficulties as you come across them? At the very least, I'd like to have Mental Health First Aid as part of our training. Does this seem reasonable?

Thanks,

Amanda

[zzisaac]

If you search the ACA website for MESH (mental, emotional, social health) you will find a lot of resources. I would start there. acacamps.org

[Alex Egan, LPN, EMT-B]

PFA is an excellent course but it really gears to immediately after trauma. The type of mental illness I have seen at camp is well underway by the time it gets to me. Ultimately my approach is simple. Is this child safe to return to the program, or do they need emergency assistance. If necessary I would refer to the ED. In the absence of a clear emergency, but the child's symptoms are concerning enough that I'm not 100% sure of safety, or they are disruptive to the camp program, then I have to work with the camp director and parent to handle the situation.

In the past this has been the child going home, being evaluated by a mental health professional, who then signs off on them returning. Really if the child's own mental health professional, we need to determine the appropriateness for the program and their need for treatment.

Its important to realize, and make sure that your management realizes the limitations of the camp health center. Stay in your lane, I provide mostly healthcare, some light dental care (loose teeth, cutting brace wires that are out and poking) and light mental health (panic attacks, anxiety, homesickness). Anything else is beyond me and would be irresponsible.

If if you want protocols, I think that's great. Identify local resources, if there is a local child psychologist who would take referrals then that's on option to offer the parents of a child with symptoms that are concerning but not emergent. A set policy on just who's call it is to send out, treat on site, or request the parents take them home to get evaluated. There should be a policy on how deal with the sudden death or suicide of staff or camper. Also one for a violent crime on camp. Clear policy, chain of command, and emergency resource list in these situations are amazingly helpful in these times of crisis.

[Astocker93]

Hey Alex,

Thank you SO much!

We always contact the parents, but the protocols are always a nice backup for when we really feel the child needs to go home or be evaluated, but the parent believes otherwise. I don't want treatment plans or anything- that's so far out of my realm of knowledge I'd revoke my own license =p

But yes, I just want to develop a written document with clear instructions and resources, if necessary. I really appreciate your response! It's going to be so helpful as I work on this project. I feel like it would be beneficial for the staff to know who to contact, and my staff to know what to do, exactly, when something happens.

Again, thank you so much. I really appreciate it.

[Alex Egan, LPN, EMT-B]

I think your onto something with a policy. I had a cry bad experience at a camp I worked at. A young lady with some ideation was brought to the health center by counselor. The director said to hold her there until they spoke with her mother in the morning. "She's not safe to be in the dorm" is what the director said. The issue is that as a health office I'm not set up for nor trained for a suicide watch. I advised him that I can offer an increased level of supervision but if he or the counselor (by counselor I mean a person who was similar to a school guidance counselor not a line level staffer) believed her to be a danger to herself she had to go. He was adamant that she was staying, and she never expressed ideation or plan to me. I go next door to our sick rooms and the counselor is taking the pushpins off the bulletin board "so she doesn't hurt herself" I was furious. I told him that as the mental health professional employed by this organization he and the director were advised that I cannot provide a suicide watch here and if she needs that level of supervision she need to be transferred to the ED. I then told him that if he thinks she's unsafe with those pushpins then he better commit to sending her out because if he took the pins out it was saying he thought she was a danger and if she couldn't be trusted with push pins then she dam sure couldn't be trusted with shoe laces and sheets. it was crazy and the main reason why I didn't return. It was totally this guys first job out of school and he was out of his depth. The director was disinterested in doing anything but keeping the mother happy. I had no leg to stand on because the conversation where she disclosed the ideation did not involve me, and she wouldn't disclose to be, but my department was left holding the ball. Oh what a fine nursing note and incident report it ended up being. She slept there without incident and ended up going home a few days later.

compare that to my present camp where we had a similar situation. The parents were arriving in the AM. The camp director slept in the room with the camper to make sure she was safe and didn't feel isolated or punished.

[Alex Egan, LPN, EMT-B]

Please let us know what you come up with. I think there is a definite need for what your trying to do. Let me know of I can be of assistance in any way.