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Dell Children's now includes outpatient mental health under the same roof

New medical director for psychiatry working on expanding care

Nicole Villalpando
The Grace Grego Maxwell Mental Health Unit at the Dell Children's Medical Center of Central Texas opened last May. [JAY JANNER / AMERICAN-STATESMAN]

Last May, when Dell Children's Medical Center of Central Texas opened the Grace Grego Maxwell Mental Health Unit, it was with the hope that it would provide a more integrated experience for families in Central Texas. The center opened with both inpatient (hospitalization) and intensive outpatient care, as well as mental health emergency care.

Now outpatient care also has moved to the campus with the relocation of the Texas Child Study Center from near West 38th Street. It's a move that made sense as pediatric psychiatric hospitalization moved from Seton Shoal Creek Hospital near West 35th Street to Dell Children's.

"We think it's going to help us offer a more streamlined approach," says Dr. Roshni Koli, the new medical director of psychiatry at Dell Children's Medical Center, which includes the hospital and all the clinics, including Texas Child Study Center.

"We want to decrease the stigma of a mental health condition," she says.

Often families feel that seeing a doctor for mental health feels different than seeing a pediatrician, she says, but it's the same as other medical conditions. Having mental health care in the same place as physical health care helps decrease that stigma.

The move comes as the Journal of American Medical Association Pediatrics published research that the incidence of mental health disorders in children has been increasing over the decades. Some 50,212 parents of children ages 0-17 were surveyed. Nationally, 16.5 percent of children had at least one mental health disorder, and of those, 49.4 percent did not receive treatment for it. Texas' numbers were similar to the national averages.

Koli says Dell Children's is "actively working to see more children and families." It is looking at different levels of services and hiring more child psychiatrists.

Right now, to get outpatient treatment through Texas Child Study Center, children can wait anywhere from a couple of weeks to several months, she says.

That's reflective of a national shortage of child psychiatrists, she says. Austin also has the problem that many communities have: Many child psychiatrists don't accept insurance. "That makes it difficult for some families," she says, and is one of the gaps in care.

Texas Child Study Center does accept insurance. "We're trying to improve access," she says. "It makes a big difference."

One of the ways Koli is interested in improving access to care is through Texas Senate Bill 10, which if passed would allow mental health telemedicine to be used. Doctors would be able to see patients without having to physically be with them. That might be patients consulting with a psychiatrist from a pediatrician's office, or it could be remotely from their house.

"Telehealth is going to be pretty big," Koli says.

That bill also would expand the research that universities could do on mental health care and expand the training for and number of people working in mental health care.

Currently one of the ways Dell Children's has been working on expanding care is collaborating with other community groups such as school districts and state- and county-wide initiatives. It also has mental health professionals embedded in some of its clinics, such as the complex care clinic and the blood and cancer clinic.

Maxwell Mental Health Unit has been fairly full since it opened in May, Koli says. Since May, 703 children have been admitted. "We're definitely seeing there is a need," she says. November through March tends to be the busy season. As soon as a child is discharged, the bed is filled again.

Most patients are continuing to go through the regular emergency room, which has behavioral health-trained social workers who do psychiatric assessments. If there is a physical medical condition or need for stabilization, they stay in the hospital. If not, then they would move to the mental health unit. Some families do go straight to the mental health unit.

If there is not a bed available, patients sometimes wait in the emergency room until a bed opens up or they are transferred to a different hospital where a bed is available.

The goal is to decrease the wait time for both inpatient and outpatient care. "Community investment and philanthropic investment in mental health is how we are going to make this happen," Koli says.