In a Children’s Psychiatric Hospital

The number of children’s psychiatric hospitals in the U.S. is growing (www.ushosptial.info). I am the clinical dietitian of a children’s psychiatric hospital in Georgia. This hospital treats eighty children and is always full with a waiting list for admission. Approximately 86 percent of admissions are boys; 92 percent are African-American, and 65 percent are readmissions. Medicare and Medicaid pay for all admissions.


DIAGNOSIS AND TREATMENT

The hospital provides psychiatric and mental health treatment for mood, behavior and anxiety disorders for children and adolescents between the ages of nine and seventeen. Some of the children have committed crimes and are too young to be imprisoned. Most are diagnosed with “conduct disorder,” which means that their parents are unable to manage them. Other children have disorders manifested from family neglect and abuse. At times the hospital seeks to place children in a group or foster home following therapy.

Other psychiatric diagnoses might include anxiety, ADHD, mental retardation, chronic fatigue, substance abuse and self-mutilation. Medical diagnoses include diabetes, hypertension, and hyperlipidemia (high cholesterol and/ or triglycerides). Most children present with multiple diagnoses.

My job responsibility at this facility is to complete an initial assessment of each patient, addressing special diet orders written by the physician. I evaluate blood levels, if test reports are available, for vitamin deficiency. I am expected to recommend lowfat diet protocols for hyperlipidemia and monitor weight trend during the hospitalization. I feel that the true reason a dietitian is employed at most facilities is to meet state guidelines for reimbursement rather than to implement genuine nutritional therapy for these children.

If a diet instruction is performed, it must be ordered by the physician. Only one diet instruction has been requested in my three years of working at this facility, despite the fact that most of the children eat horribly and many are morbidly obese. That single diet instruction had been ordered for a lowfat, low-cholesterol diet to “lower cholesterol” in a thirteen-year-old patient taking a statin drug.

Most physicians believe that diet changes are not important, especially if the patient returns to a home environment where the family cannot provide proper foods because of financial strictures or other reasons. The hospital’s treatment plan is wholly based upon, and reliant upon, pharmaceutical intervention. Changing dietary habits is not, and never was, a part of the treatment plan.

Based on an actual patient, a typical diagnosis and treatment plan for a sixteen-year-old African-American male might look like this:

DIAGNOSIS:

Bipolar
ADHD
Mild mental retardation (low IQ)
Oppositional/defiant behavior
Depression: two past suicide attempts
Hypertension
Hyperlipidemia
Morbid obesity:
Height: 64 inches,
Weight: 242 pounds
Body mass index: 41

TREATMENT:

Lipitor – high cholesterol
Clonidine – blood pressure,
ADHD Lithium – bipolar, depression
Seroquel – bipolar
Metformin – to control the increased appetite caused by Seroquel
Social Services – (social worker)

A diet instruction for this patient was not requested. The patient’s diet history is poor, consisting mostly of refined foods and sugars. The patient does not drink milk and receives little sunshine. No blood nutritional levels were drawn. No vitamin or mineral therapy is in place.

A HOLISTIC APPROACH

The patient discussed above is taking Seroquel, a frequently prescribed psychotropic medication. A side effect of this medication is increased appetite and weight gain. The patient was later prescribed Metformin to suppress the increased appetite caused by the Seroquel. This medication, usually used to control blood glucose in diabetics, is often prescribed to control appetite in adolescents.1,2

Metformin is the diabetes drug I often think of when I think of nutrient depletion. Metformin is thought to decrease the absorption of vitamin B12 by lowering intrinsic factor in the gut—which is necessary for the absorption of this vitamin—or possibly through other mechanisms.3,4 Reduced B12 serum levels occur in up to 30 percent of those individuals who take Metformin chronically. Those with a higher risk of developing the deficiency include this group of adolescent patients, whose diet is poor and whose vitamin B12 intake is most likely inadequate.2 At B12 levels only slightly lower than normal for a very short period of time, a range of symptoms such as poor memory, fatigue, and depression may be experienced.5

A holistic medical approach would treat the “source” of this patient’s disorders, which might include nutritional deficiency. It would be appropriate in this case to evaluate B12 blood levels, especially since the child presents with two of the symptoms typically caused by B12 deficiency. If B12 was found to be low, analyze B12 intake as well as the patient’s ability to absorb B12 and then suggest vitamin supplementation if he was unable to meet his increased B12 requirements through diet alone.

Vitamin D levels should also be evaluated, given the fact that this patient does not drink milk and spends most of his days indoors, along with a diagnosis which many studies link to low vitamin D levels.6,7 In my three years of working at this hospital I have never seen a pateint’s vitamin D or B12 levels tested or nutritional supplementation initiated.

A healthy diet program of whole, unrefined foods that work within the family budget should be initiated. The entire family should be involved in this new nutritional plan.

This approach should not devalue the benefit accomplished by pharmaceutical intervention, which is often necessary. Pharmaceutical therapy to suppress symptoms in combination with healing modalities such as nutritional therapy would be the ideal approach.

THE REALITY

The prospect of treating psychiatric conditions nutritionally with or without pharmaceutical intervention is promising and researched, but rarely implemented in practice. I think nutritional therapy is not part of the treatment plan nor is it sought because the physician conducts the treatment plan and is not aware of or does not understand a nutrition-based therapy approach.

Unless physicians have studied outside the parameters of the pharmaceutical industry presentation, they only understand how to treat a disease process pharmaceutically. A physician’s education and continuing education (classes, seminars, workshops, books, articles, studies) are all conducted and presented via a pharmaceutical partner or investment partner who is financially involved and motivated within the industry.

Other physicians believe that a therapy must be firmly grounded in “proven” fact before utilized; an assurance only afforded by the pharmaceutical industry since research studies are expensive to conduct.

My greatest frustration is in observing how reluctant physicians are to give up “control” of the patient, never asking another practitioner’s advice about a treatment they do not understand, even if the treatment is safe and has no ill side effects.

GOOD NEWS

These days I observe more pharmacists, nutritionists, and researchers conducting evidence-based studies on the dangers and side effects of pharmaceutical therapy. “Natural Medicines Database” (http://naturaldatabase.therapeuticresearch.com) is a good reference, providing a list of medications that cause nutritional depletion, with corresponding backup studies. The site provides information on the medications’ side effects as well as other herbal or homeopathic remedies that may be used alternatively. It lists evidence-based studies linked to the use of herbal and homeopathic remedies and encourages researchers to study and submit material.

I find it encouraging that this is a reference suggested by the Academy of Nutrition and Dietetics (American Dietetic Association)–Dietitians in Functional and Integrative Medicine practice group.

FOOD

On my first day of work at this hospital three years ago the administrator requested that I change the menu plan. After seeing the menu, I assumed he’d made the request because the menu contained so many refined foods and sugars. I later found it was because the patients were complaining about the food.

Here is what the menu plan looks like. It faithfully follows the guidelines of the Academy of Nutrition and Dietetics (American Dietetic Association):

Breakfast:

Eggs
Sausage/Bacon
Toast/Biscuit/Muffin/Sweet Roll/
Pop Tart/Pancakes
Cold Cereal /Oatmeal
Lowfat or Skim Milk
Fruit Juice

Lunch/Dinner:

Chicken Nuggets
Pizza
Hot Dogs/Hamburger
Fried/ Baked Chicken
Tacos
Salad or Vegetable
French Fries/Potatoes
Roll/Bread
Cake/Cookies
Lowfat Ice Cream/Sherbert
Canned/Fresh Fruit
Lowfat or Skim Milk
Fruit Punch/Lemon Lime Soda

Snacks:

Pre-packaged crackers, cookies or chips
Fruit juice/Fruit Punch/Lemon Lime Soda
Lowfat or Skim milk

All menu items are frozen, pre-packaged or canned, with the exception of salads or some fruit which may be fresh. I had big plans for changing this menu, hoping to meld WAPF principles into the guidelines of the Academy of Nutrition and Dietetics and teach the patients about dietary changes with classes.

The administrator asked me to first interview the patients to find out what they did not like about the food (the real reason he had consulted me) and what they would prefer instead. These are some of the patients’ requests:

Ranch dressing with everything—the lowfat type because it is sweeter
Froot Loops and Cocoa Puffs cereals
Chocolate milk
Chicken wings with BBQ sauce dip
Ketchup at every meal
Coke or Pepsi
Sugar substitute in the pink package
Icing on cakes
Coffee
Red Bull energy drink

When these same patients were asked what they thought they should eat in order to be healthier their answers included:

Cereal
Oatmeal
Ensure
Energy bars
Gatorade/Sports drinks
Lowfat and nonfat foods

Virtually all of the children obtained their nutrition education from television commercials.

I approached the administrator with a proposal to provide healthier meals and snacks, consisting of less sugar and refined foods, and to start weekly nutrition classes for the patients. I let him know the cost of the meals would increase, as well as the cost for me to conduct the classes. I also informed him that this was not what the patients themselves had requested. My proposal was immediately vetoed, followed by an explanation that the hospital must contain costs.

A few months later I was asked to conduct nutrition classes for patients in order to meet state funding requirements. I found the instruction difficult, as I ended up directing the patients to avoid the very foods that were served.

CONCLUSION

Treatment success in the hospital setting looks only at superficial results. Outward appearance is not the inward reality. These children are not healing from disease at this hospital. The treatment is merely combating or masking symptoms via pharmaceutical intervention. To truly heal these children, physicians must willingly turn to practitioners with training outside of the pharmaceutical model in the treatment plan.

We must end the monopoly that the pharmaceutical and refined food industries hold on nutrition and health care. Until we do, we as a nation will only become sicker—at ever younger ages—while the current medical model of invasive and pharmaceutical interventions burgeons entirely out of control.

REFERENCES

1. G Paoliso, Effect of metformin on food intake in obese subjects. European Journal of Clinical Investigation 28: 6 (June 1998):441-446.

2. MB Davidson. An overview of metformin in the treatment of type II diabetes mellitus. American Journal of Medicine 102: 1 (Jan 1997) 101-110.

3. Callagan TS, Megaloblastic anemia due to Vitamin B12 malabsorption associated with long term metformin treatment. Br Med J 1980;280 1214-16.

4. Gilligan MA, Metformin and B12 deficiency. Arch Internal Medicine 2002.162:484-5.

5. Dietary Supplement Fact Sheet – B12. Office of Dietary Supplements, National Institute of Health. 28 September 2011.

6. http://www.naturalnews.com/031273_vitamin D_depression. html

7. http://vitamindcouncil.org/health-conditions/mentalhealth-and-learning-disorders/depression.html

 

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Spring 2012.

Kim Rodriguez, MS, RD, LD, is the proprietor of Aiken Nutrition, offering private nutrition consultations, and is a WAPF chapter leader in Aiken, South Carolina. Contact Kim at (803) 644-4463 or aikennutrition@bellsouth.net

7 Responses to In a Children’s Psychiatric Hospital

  1. Dana says:

    You should see the menus in regular children’s hospitals. They are just as disgraceful. I looked at one while my daughter was in for a few days and said to myself, “They expect children to HEAL on that???”

  2. gokhals says:

    Tragic
    This is just tragic!

  3. Completely outrageous!
    It is absolutely sickening to me that this is what we are doing to the children who most desperately need real, nourishing food!

  4. JoAnna says:

    How to change this?
    If one wants to become a health professional in a position to change this, which type of health professional would you recommend? A neurologist? A psychiatrist? Or something else altogether?

  5. Bennette Carr says:

    Confirms past experience
    As a young teenager I was admited to two different childrens hospitals for the treatment of depression, anxiety, and suicidal behavior. I was depressed, had regular thoughts of dying, anxiety was through the roof. Had been on 6-7 different medications to treat the problems. I constantly changed medicines because I felt nothing worked and some even worsened the conditions or cause new problems. I was morbidly obese weighing 216 pounds at 15 years old and I was roughly 5’6. I lacked sunshine, physical activity, watched too much tv and spent too much time in alternate internet reality games such as World of Warcraft. My diet was a disaster, full of processed starches, sugars, oils, ect. Luckily i still ate good portions of meat, but I did not drink milk at this time. I was turned off from milk by my mother because she only drank skim which I hated. I decided to just stay away from milk since I only really liked whole and I believed at this time that fats were making me fat. The hosptial visits did nothing to improve my situation except for the fact that I had to see others who were much worse off than me and had very very serious medical disorders. I was just the kid who was sad. I had no motivation to do anything, I recall spending my first two days in bed, refusing to even leave for meals. My conditions began to improve when I left. I made a personal decision to never take any of the medications ever again. I threw them all into a sewer, I was very angry at this time. Not only at myself for coming to such a low point in my life, but the doctors because they could do nothing to help me. They only worsened things. I began to try to lose weight and made a small effort to start walking. The didnt walk much because I lacked fuel and my “healthy” diet was not working. Over the years things slowly improved, although a had some huge stumbles here and there. My parents divorced shortly after my depression days. I blamed myself like any other kid, I felt I was the source of their finacial problems due to my hospital bills. I was still mildly depressed, but was determine never to slip back that low point of wanting to die. I kept myself happy with friends. Today I am about to turn 19, I weigh a healthy 160 pounds and carry a fairly significant amount of muscle mass. I am happy for the most part. I have friends and maintain healthy relationships with my parents. I am in the process of getting back into school and working towards joining the military. I maintain a healthy diet, eating a low carbohydrate diet that is closer to my ancestors largely based on meat with the inclusion farm fresh raw cows milk and pastured eggs. I currently walk roughly 5-7 miles daily, sometimes with a 35 pound weighted vest. Resistance train 2-3 times weekly using my own body weight and the vest. I also enjoy sprinting and taking long hikes. I am on no medications and have no plans to take any medications for the rest of my life. My interest now are in the well being of my mitochondria and strengthening myself mentally and physically. I also have an interest in homeopathic remedies and using natures own forms of medicine. I regularly drink herbal teas(unsweetened)and lately have used raw honey to help with congestive health problems. I hope you all enjoy my story and perhaps it will be inspiring to any current day healthcare professionals.

  6. Moddy says:

    This is also the case with children in juvenille detention facilities and drug rehab centers. I’ve seen both with my own eyes. The attitude I’ve seen most often from psychiatrists and administrators at these places has been that nutrition is important, but best not to worry about that until their psychological health problems are under control. I’ve also seen a lot of those ‘sneaky foods’ used when tabulating the nutritional value of the meals provided. Such as, canned ravioli has a ‘serving’ or so of vegetables in a car because of the tomato sauce – therefore this cheap beef stuffed pasta in a corn syrup-based sauce counts as a patient’s daily fruits and vegetables.

    You should also note that many more-affordable treatment centers do not prepare food on the premises at all – there’s no cook, no real kitchen, and thus no fresh food or meals made from whole foods. Every last thing eaten at these places in prepackaged and frozen in a large manufacturing plant that gives discounts for the volume a residental treatment center can consume. Yet such places are often the only option within these children’s families’ financial reach (or else they are assigned there by the court, which also chooses based in part of the per capita cost of the center).

  7. Maria says:

    A mom
    Thank you for this article. We hv seen that adult and childrens hospitals do not give their patients many, if any, healing foods, sadly. How do we find practitioners with training outside of the pharmaceutical model who can help children, including autistic children, (and adults) heal from mental health challenges from anxiety to depression to schizophrenia, especially if we are WP/Sally Fallon believers?

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