One of the earliest hints arrived when Chris Dureiko was picking up her eldest son, Sean, from day care. She noticed the then-9-year-old's hands were red and bruised, as if he had a rash.
"[Then] I caught him one day washing his hands while counting for half an hour," recalled Dureiko, who lives in Irvine. "He was always extremely afraid of germs. If something would touch another, that thing would become contaminated and had to be removed.
"There was social isolation, constant hand-washing and showers. Eventually the school district had to take him out of a regular classroom because he couldn't touch the pencils or materials."
Even at age 6 months, Sean was unusually restless.
"His intelligence was normal and fine, but it was his behavior — he wasn't affectionate and basically couldn't be soothed. He would actually throw a lot of temper tantrums," Dureiko remembered.
Sean was later diagnosed with attention-deficit/hyperactivity disorder, or ADHD, bipolarism, obsessive-compulsive disorder and anxiety.
About one in five youths nationwide will have a diagnosable mental health disorder by the age of 14, according to research from the Children's Hospital of Orange County. Of the 20% of O.C. youths reporting the need for help with mental health issues, less than a third get that help.
Dr. Heather Huszti, chief psychologist at CHOC, says the need for pediatric services in the county is equivalent to filling three Angel Stadiums with kids who have a mental health disorder but only one of those stadiums receiving treatment.
"It's a really big problem when the bulk of the work comes in intensive inpatient or outpatient programs," said Huszti, noting that in 2014, out of 1,805 mentally ill kids and adolescents (18 and under) from Orange County, only 824 were hospitalized for treatment of psychiatric problems in their home region.
The rest were treated in Los Angeles, San Bernardino and other neighboring counties.
For adolescents (ages 12 to 18) with psychiatric problems, only 32 inpatient beds — at the UC Irvine Medical Center and College Hospital in Costa Mesa — are available in Orange County. That's one bed per 22,000 kids, according to information provided by CHOC.
For children under age 12, there are zero inpatient beds in Orange County.
This is where CHOC comes in.
In early 2015, the children's hospital announced plans for a program-heavy mental health initiative to address the crisis. At the center of the initiative is the construction of an inpatient psychiatric center for children 3 to 18 years old.
The innovative new center — under construction on the third floor of CHOC's research building, which is part of the campus in Orange — will be the first pediatric inpatient mental health center in Orange County.
It is expected to have 18 private rooms, an outdoor playground and multipurpose areas — for consultation, therapy, recreation and treatment — and will be the only psychiatric facility in California where parents can stay in the rooms with their kids, according to CHOC.
Construction started in September, and the unit is expected to open at the end of 2017 or by early 2018.
By working with a network of other hospitals (such as Kaiser Permanente, St. Joseph, Hoag and Mission Hospital), churches and community organizations, county agencies, health insurers, the Orange County justice system and board of education, CHOC aims to provide access to mental health resources and primary mental health care in the county to ages 3 to 18.
The annual cost of the program is projected to reach $16 million, and start-up costs are around $11 million, according to Andrea Hanigan, CHOC's senior public relations specialist.
The money for construction and operation of the initiative is coming from a state grant and local philanthropists, including George and Julia Argyros and Sandy Segerstrom Daniels, an owner in South Coast Plaza in Costa Mesa. About $15 million has been raised so far, Hanigan said.
The initiative's aim is to screen the children and intervene as soon as they get to the emergency department, as well as educate parents, pediatricians and others to recognize common signs of mental illness in children, avoid crisis and continue providing support after hospitalization.
The National Alliance on Mental Illness Orange County — the local branch of a nationwide grassroots organization that offers support to families affected by mental illness — has committed to working with CHOC on the educational part of the initiative.
"Having a loved one with mental illness often has barriers associated with beginning effective treatment — social stigma and misunderstanding, family shame, anosognosia [when someone is unaware of his or her illness]," said John Leyerle, executive committee president of NAMI Orange County.
"The goal is to emerge with robust tools to work together, to progress in the wellness journey."
Kimberly Chavalas Cripe, president and CEO of CHOC, said in a statement: "CHOC Children's is committed to taking a leadership role in creating a comprehensive mental health system of care for children and teens in Orange County. Together, with our partners in the community, we will address the alarming deficiency of mental health services, and make sure that children and families have access to high-quality care without stigma or barriers."
A longtime presence
Opened in 1964, CHOC was the first children's hospital in Orange County. It has since expanded to include a second campus (in Mission Viejo), four institutes (heart, neuroscience, orthopaedic and cancer), and a new state-of-the-art pediatric care unit and emergency department in the South Tower, which opened in 2013.
It also runs outpatient therapy clinics and employs on-site pediatric psychologists to treat the young patients with mental and behavioral disorders.
"Pediatric psychology is a specialty area. … We work with kids with medical diagnoses on the psychological issues that children with medical conditions are at higher risk for: anxiety, depression, adherence," Huszti explained.
But many a child's mental health struggles are not tied to a medical condition.
According to a 2014 report by the Orange County Health Care Agency, Health Policy and Research, the rate of child hospitalizations for mental illness (measured per 10,000 children) increased from a low of 11.3 in 2008 to 20.8 in 2014.
Cities with high rates of hospitalizations related to mental illness include Orange, Tustin, San Clemente, Laguna Niguel and Huntington Beach, according to data from California's Office of Statewide Health Planning and Development, although the reasons for this are not immediately clear.
"When a child needs to be hospitalized for psychiatric reasons, most often it's because they've threatened to kill themselves," Huszti continued. "Substance abuse and mental health-related issues are all reasons for being admitted, with a major [reason] being depression."
Other reasons for inpatient treatment cited in the report include mood disorders (including bipolarism), schizophrenia and psychosis.
According to CHOC mental health research, after accidents, suicide is the second leading cause of death in young people ages 10 to 24. Even for children ages 10 to 12, studies find suicide to be more and more common.
For Saddleback Church Pastor Rick Warren and his wife, Kay, these statistics have been painfully real. In 2013, their youngest son, Matthew, committed suicide after struggling with depression since early childhood. He was 27.
"Depression is a deadly illness. … Every single one of those of those deaths was preventable," Huszti said. But we don't talk about it because there's a stigma, because people don't seek treatment. People don't talk about their feelings. They aren't educated about it."
The Warrens' heartbreak sparked an important meeting the following year about pediatric mental health among the couple, Cripe, Huszti, CHOC's chief medical officer, Dr. Maria Minon, and business and healthcare leaders. That discussion became the groundwork for a new mental health task force, Huszti said.
FOR THE RECORD
12/28, 1:29 p.m.: A previous version of this story misspelled the name of the chief medical officer for Children's Hospital of Orange County as Dr. Maria Mino. The doctor's name is Maria Minon.
"We talked about creating the best system of pediatric mental health care in the country, and we needed a commitment … for someone to take on the care of children under 12," said the doctor. "We have a lot of wealth here [in the county]. Why can't we do the best that can be replicated throughout?"
Finding their wings
While celebrating the new inpatient unit, Huszti said her ultimate wish as a child psychologist is to push inpatient services back as much as possible, to avoid hospitalization for the patient altogether.
That means getting the youngsters treatment as early as possible.
"We want to develop a sort of coordination arm," she said, "where we recognize behavioral issues and get kids into services earlier. Like any other chronic illness, the quicker we can treat [mental illness], the less invasive it becomes … If I can intervene early, I may be able to change the trajectory and possibly even prevent [crisis] from happening."
When diagnosing, psychologists look at how pervasive a child's behavior is, the length of time symptoms have been occurring and how day-to-day functions are impaired. Then they decide what level of treatment the child needs.
"People think about childhood as being carefree — like, what do you have to be depressed about? You're a child!," Huszti said. "But the issue is that there are clearly biological and genetic components to mental health disorders. It's common for issues to be passed down."
For Isabella Chavez, an on-and-off patient of Huszti's since she was 11, years of therapy were key to improving her health.
The 24-year-old from Costa Mesa has suffered from medical symptoms (including autoimmune disorder, chronic pain and seizures), but was never given an official diagnosis for her physical ailments.
"It was scary, not knowing what I had.… When you look at mental health, a lot of people go right to the negative, but it's actually a very positive experience," Chavez, who shared her story at the CHOC Cherishes Children Gala in February.
(The gala, held at the City National Grove of Anaheim, was attended by community philanthropists and prestigious guests — including the Warrens, Segerstrom Daniels and country singer Keith Urban — and raised a record $2.6 million in support of the pediatric mental health initiative.)
"The doctors are like family to me. [They've] helped me come back to who I am," Chavez said. "I have my butterfly wings again."
As a teenager, Chavez was involved in the theater programs at South Coast Repertory, having grown up loving films and other entertainment. She finished her general studies at Orange Coast College in Costa Mesa, and wants to further her education in child development, hoping to help others in extensive therapy find comfort and an outlet through theater.
"When I'm onstage, I'm able to put all that anxiety and energy being held in and push it out into a character or a different world," Chavez said. "I'm worry-free, able to let go of my paralysis and the fact that I have an illness. As [Huszti] always says, even a tiny speck of light in the tunnel is still light — until there's no tunnel, only light."
But a patient's pain is also visited upon the entire family, as Dureiko can attest.
"As a parent [dealing with illness], you're feeling lost, overwhelmed and especially alone," she said. "When your child has a mental health diagnosis, it is not a casserole illness. No other parents will be coming to your house to give you a casserole — they avoid you. It was such an isolating experience."
Dureiko now serves as one of the vice presidents on the Board of Directors at the National Alliance on Mental Illness Orange County and is also one of the group's educators.
"I went through living hell as the parent of a diagnosed young child, and I had no support," she said. "It's great when, now, there are opportunities for parents to create community, share experiences, interact and discuss. Truly, parents need to know they have an advocate to fight with and for them."
Her son Sean is now 33, living in Japan and teaching English as a Second Language. The mother said he is keeping his illness in check after years of therapy and proper medication.