Dr. Katie Schmitt is the youthful, high-energy psychiatrist who leads a hospital on Madison’s southwest side devoted to treating children and adolescents struggling with severe mental health conditions, some of whom have threatened or attempted suicide.
The young people, ages 6 to 18, come voluntarily to the UnityPoint Health-Meriter Child and Adolescent Hospital, which is the only community-based program of its kind in south-central Wisconsin.
“Kids might come here if they’re incredibly anxious, to the point that it’s impairing them,” Schmitt told me. “Our younger population struggles a lot with aggression. … We definitely see a range of kids who really can’t maintain safety.”
I was told Schmitt and her hospital’s distinctive team and mission would make a good column. When I arrived, I found a small, nondescript building staffed by passionate professionals, tucked amid high-end homes off McKee Road on the city’s periphery.
The hospital is expanding its 20-bed inpatient capacity by 10 beds, among other improvements, and is seeking contributions through a capital campaign to support the work. While the hospital treats about 850 young people per year, it routinely has waiting lists, as many as 27 kids per day during the school year.
The demand for mental health services reflects a national trend. A new study by the Pew Research Center reported that 70 percent of teens surveyed said anxiety and depression are major problems for either them or their peers. The study revealed similar results across gender, racial and socio-economic lines.
Given such demand, I asked Schmitt why public fundraising is necessary for what seems such an obvious and pressing medical need.
“It’s a great question, and probably pretty complicated, but I would imagine a lot of it has to do with the stigma around mental illness,” she said, and drew a parallel. “So you have a kiddo who is at American Family Children’s Hospital being treated for cancer, and there are tons of movements to get that kiddo support, right? Like, people are coming out of the woodwork to support the family.”
But, she adds, when “somebody’s hospitalized for depression, for suicidality, for being the victim of trauma and struggling with that, it’s like: ‘Shh, we don’t want to talk about that. We can’t advertise that.’ I don't know if it’s shame, if it’s embarrassment.
“There’s such a disconnect (when people suggest) mental health isn’t a medical illness, which I totally disagree with, but I think it’s just part of that stigma and what’s going to be accepted and what is appropriate to elicit support from others. I also think it is partly created by our health care system.”
The hospital expansion began last November and is scheduled to open in October, and fundraising is ongoing. The $3-million project will add space for group therapy, yoga, a kitchen, another school room (where kids can keep up on their studies), a walking track and a field sports area. A new outpatient wing will allow up to 3,000 visits a year for kids needing additional support.
Schmitt, who has worked there for nine years, said the average stay is about one week, during which time a young person is seen daily by a child psychiatrist and a team of professionals. She said: “If you think about it, a kid who comes in for that week, the number of assessments they get, the level of care would take months (as an) outpatient, months and months.”
While everyone has his or her own room, the patients meet in one of two groups, 12 years and under and 13 years and up.
“When most people think of a hospital, they think of people hooked up to machines in their rooms,” Schmitt said. At this hospital, group interactions are a key element, she added.
“I think most kids feel like they are validated and supported. They feel like there are other kids here who get it. It’s their favorite group (setting) by far, because they can offer advice, they can receive advice.”
Schmitt added, “I just talked with (a patient) earlier today, and she’s like, ‘I can’t believe that places like this exist where I met 11 other kids who are actually going through really similar things, and I don’t feel alone.’ ”
I asked her to describe a typical patient.
“Several of our little ones (ages 6 to 10 years) struggle with externalizing behaviors — so they may come in (after) aggressive or reactive behaviors at school and at home,” she said.
“As the ages increase, we see many more kids who are struggling with depression and anxiety. Many of the teenagers we care for have either struggled with suicidal thoughts or have attempted to end their lives. Trauma also plays a role in several of these kids’ lives; I am constantly struck by what some young people have experienced and their resilience.”
For our conversation and tour, Schmitt brought along clinical specialist Jeremy Pieper, a 10-year employee, and she pointed a spotlight on the entire hospital staff, many of whom have also worked there for many years.
A key element of their work is creating a specific safety plan for each patient, especially for adolescents.
“It really goes through everything, what to do in a crisis … what are the warning signs that they’re looking for?” Pieper said.
As I listened, it occurred to me there must be tremendous pressure on staff to determine when a young person is ready for release.
“Physicians really lead that,” responded Schmitt. “We’re meeting with the kids every day. We’re talking to them about medicines, about stressors, about coping skills, about safety. We assess urges to engage in self-harm, aggression, any kind of strong emotion that would’ve led to them coming here.
“One of the keys to our model of care is to engage the family every single day, making sure that they’re feeling ready to support their child as they transition home.”
I asked her, marveling a bit, what draws hospital staff to such stressful roles. Her reply: “You can have 50 people with depression and not a single one of them is the same, just that opportunity to know the most vulnerable parts of somebody’s life and help them through that.”
Noble work indeed.