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Objectives: Mental health disorders (MHDs) are major public health concerns with increasing risk of morbidity and mortality among children. Oral health problems (OHPs) are receiving attention as associated comorbidities. This study assessed the burden of oral health problems in children aged 3-17 years with MHD in the United States. Methods: Cross sectional analyses was performed using the National Survey of Children's Health database 2016-2017 containing information of 60,655,439 children. Weighted survey binomial logistic regression generating odds ratio for association between MHD and OHP were calculated. Weighted dose-response models captured incremental effects of MHD severity on oral health conditions. Population attributable risk (PAR) to quantify proportions of potentially avertable OHP as a result of intervention targeted at different levels of MHD severity were estimated. Results: Prevalence of OHP among those with any MHD was 22.5 percent. Children with MHD were more likely to be non-Hispanic White, living in poorer households, and having private health insurance P < 0.001. Dose-response analyses showed children with mild MHD were 85 percent more likely [OR = 1.85 (95% CI: 1.47-2.32)], and those with moderate/severe MHD 93 percent more likely (OR = 1.93, 95% CI: 1.50-2.49) to experience OHP, compared to children without MHD. Population attributable risk (PAR) revealed that if mild and moderate/severe MHD were improved by 75 percent, OHP would be averted in 152,206 children with mild and 255,851 with moderate/severe MHD, respectively. Conclusion: Our results suggest that disparities persist among the pediatric population with MHD who suffer OHP in the United States.

The management of borderline personality disorder (BPD) can be difficult, and specialized psychotherapy remains the core component of treatment with the most robust evidence. Dialectical-behavioral therapy and mentalization-based therapy are the most studied and commonly used among the specialized psychotherapy treatment options. Pharmacotherapy has more limited evidence and should be used primarily to address specific symptom alleviation. Inpatient hospitalization should be used cautiously to minimize unintended, unproductive consequences. Day hospital or intensive outpatient programs are good alternatives between hospitalization and routine outpatient visits for many patients. Because the rate of nonsuicidal self-injury is high among people with BPD, safety assessments by clinicians are an ongoing part of treatment and often involve family and loved ones. [ Psychiatr Ann . 2020;50(1):24–28.]

For patients with mental illness who require hospitalization, the process of admission to inpatient care involves an assessment of medical status and assurance to the receiving facility that the patient is medically stable and suitable for transfer. An increasing number of facilities have developed checklists that need to be met for a patient to be accepted. Referred to as exclusionary criteria, these include a collection of physical findings, laboratory values, and medical conditions that might prevent a patient from being admitted and thus receiving the appropriate psychiatric care. Inpatient facilities have the flexibility to set their own acceptance criteria—a process that is unregulated. In parallel, emergency medicine has a differing philosophy regarding the need for medical clearance and stability of the psychiatric patient. These two requirements and workflows often conflict. Exclusionary criteria are ideally meant to protect the patients by promoting proper use of resources, and making sure medical issues are adequately addressed; however, those same criteria promote rigidity and focus on absolute laboratory values and diagnoses rather than clinical pictures, which may be contributing to the difficulty of accessing already scarce inpatient care resources and increased emergency department boarding currently sweeping the nation. Furthermore, inflexible checklists contradict the guidelines issued by several national organizations, which promote the need for customized flexible assessment of patients with severe mental illness who are awaiting inpatient placement. [ Psychiatr Ann. 2018;48(1):51–57.]