Board Of Visitors INPATIENT SERVICES

38 Psychiatric And Mental Health Services Operational Policy 6.3.3.1 Outpatient Services • Children and adolescents referred to General Psychiatry or Child and Adolescent Psychiatry may be managed as outpatients. • Sources of referrals include: o General practitioners. o Primary care practitioners from the health clinics medical oficers and family medicine specialists. o Private practice specialists including psychiatrists. o Medical oficers or specialists in public sector hospitals. o Allied health professionals. o Teachers and other professionals. Screening triaging of the referrals should be done to ensure that patients who require urgent attention be managed accordingly. In the clinics, the children and adolescents will be assessed based on history, physical examination and psychiatric examination. Relevant investigations may be performed where necessary. A provisional diagnosis will be arrived and explained to the children, adolescents and their parents or other family members. Relevant information pertaining to the diagnosis and management will be provided psycho-education. Decisions regarding management will be made with the active participation of the patients, parents and relevant family members. Referrals should be made to appropriate professionals where necessary. This may include contacting educational or welfare authorities to ensure their involvement and support. Follow-up visits should be scheduled based on the individual needs of the patients. Defaulter tracing should be routinely done to ensure compliance with follow-up. 39 Psychiatric And Mental Health Services Operational Policy 6.3.3.2 Inpatient Services Some patients may require admission to the wards for more intensive treatment. In the absence of dedicated Child and Adolescent wards, care must be taken to prevent complications arising from admitting child and adolescent patients into adult psychiatry wards. In general, admission of children aged less than 12 years into adult wards should be avoided as far as possible to prevent trauma and complications to the child. Arrangements should be made with Pediatrics to admit child patients into Pediatric wards, if possible. Common reasons for inpatient treatment: • severe depression • serious suicidal risk • severe psychotic states • severe anorexia nervosa Decisions to admit should be made at specialist or consultant level. Nursing staff should be trained to manage the needs of child and adolescent inpatients. Regular ward rounds are required to be done daily by psychiatrists and medical oficers where review of management and appropriate changes are made. Length of inpatient management should be tailored to the speciic needs of each patient. 6.3.3.3 Ward Referrals Consultation-Liaison General psychiatrists and child and adolescent psychiatrists should respond promptly to referrals of children and adolescents from other wards. Depending on the urgency, patients should be seen within 24 hours of referral or even immediately as the case may be. It is essential that a thorough examination be made and indings or recommendations conveyed to the patients, parents and referring doctors as soon as possible. Treatment should be instituted without delay. Psychiatrists should coordinate the services of allied