When should a hospital take a suicide threat seriously?

[welcometowitsend]

So difficult child has been home for a few weeks and has been decent to get along with and hasn't gone overboard with wanting to go out and do stupid things - just normal teen outings that kind of thing. So, it's been pretty good.
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You might recall that when he came home he asked me to look into getting an psychiatric assessment done (he thinks he is depressed and may have aspergers) so I took him to the family doctor to get a referral - seems we have to go through a paediatrician first to get to a psychiatrist. Fine - she gives me an urgent referral and then I beg the paediatricians office to give me an appointment earlier than November (not kidding) - I get August 11th which will have to suffice. In the meantime I am phoning around looking for counsellors and private assessment options where I will pay out of pocket (gotta love our Canadian health care system which is not two tiered - such bullcr@p - pay out of pocket and get in now or wait 6 -9 months) but we are willing to do what it takes.

So, Sunday night I am in bed sleeping as is easy child. husband is away on a trip. Apparently difficult child starts having suicidal thoughts for no reason. Nothing went wrong, nothing set him off, just starts feeling like he is either going to hang himself or slit his wrists. Thankfully he went on FB and 2 of his friends talked him out of it. He came to me the next morning and asked to go to the hospital - so off we go to the hospital for some help. Crisis workers does an intake interview with difficult child - I am not allowed in the room and she won't even speak to me to get background on him. I figure the psychiatrist will do this when he comes down. So we sit and wait from 9am until 4:00pm for the psychiatrist in an area guarded by security. Child psychiatrist shows up and again wants to speak to difficult child in private - fine. Doesn't speak to me at all - calls me into room about 10 minutes later and he berates difficult child in front of me for using suicide to get his own way - what??!! Tells him that they won't be doing anything for him and that he should go to Chapters and buy Life Strategies by Jay McGRaw and a couple of other books and basically to grow up and stop this nonsense. I was in the room with the man for all of 2 minutes and I was furious with him. This guy was such a jerk!

So, he up and leaves without even having a conversation with me, the crisis worker tells me not to let difficult child out of my sight, to lock up all sharp objects and to lock up all medications in our home. Huh!? Really? If you think I need to do this why are you sending him home? And is locking this stuff up going to stop him if he really wants to die? There's plenty of ways to do it. Apparently the 'crisis' is over and that if he really wanted help then we should have called an ambulance the night before. Ok, I kind of get that but difficult child says that when he is in that mood he doesn't want help he just wants to die. He doesn't want to talk to anyone. How can I take him to the hospital at 2am when I am asleep and have no idea what is happening? When he is in a more rational frame of mind he does want help and does want to talk. Ugh.

Today he is feeling better. He slept for about 4 hours last night (seems he can go on very little sleep now and had zero sleep the night before) and wanted to go to school today - he has a drama thing to do and he loves drama class. He seemed pretty happy and ok so I sent him to school. The school is aware of what is going on.

OK, so I understand that difficult child is not an immediate danger to himself but I really don't know when he might become one again. So, I will continue to try and find someone to do an assessment on him - hopefully prior to the appointment with the paediatrician. And I bought the dang books and now that school is out (in 2 days) I will start working through the books with difficult child to see if I can help him develop some coping mechanisms.

Our mental health system sucks - I have had 3 different guidance counsellors and my sister who is in the health field and suffers from depression herself tell me that they think this kid is either depressed or bipolar - and no one is listening!! I called the mental health hotline to see if they could help point me in the right direction for quicker help and I got a busy signal. I called the counsellor recommended by the hospital and the high school (same guy and I hear he's great) - he'll call me back in 2 to 4 days. I called Canadian Mental Health Association - left a message - says they'll call me back in 2 days.

I guess if it is urgent I will have to go back to the hospital - someone told me (who has a niece in and out of hospital and jail with mental health issues) that they don't admit on the first visit to hospital but that they have to admit for 72 hour observation the second time. Great - let's just hope he comes to me next time. This wasn't the first time he's felt like this or thought about this. He has researched it online - he won't o.d. because he doesn't want to risk vomiting up the drugs while unconscious and failing at it. He says he will likely slit his wrists because it will only take a couple of minutes for him to go unconscious and he'd be dead before we could get him medical help. He had this conversation with me like it was a normal every day conversation. I just don't understand this kid. I'm just sick.

I have to admit that I have moments where I go back and forth and think that sometimes it's just teen drama and maybe he's not serious and then sometimes I think he really is serious and he's crying out for help. I just don't know what to think and I'm so tired of riding this roller coaster he's on. I'm riding it with him and I just want it to stop so we can get off and go back to our old life before all this started.

 

[Liahona]

I'm sorry. It sounds serious to me. I'm not a professional. If it were my child I'd be having a fit about how he was treated at the hospital. I also wouldn't want to go back to have difficult child berated by that horrid dr for 72 hours. Don't know what a better choice would be though.

difficult child 1 makes suicide threats at least once a month. He never has a plan. Its always to get out of work or a consequence of his bad behavior. Yours has a plan. Its not connected to anything outside his own mind. And he wants help for it. That is the only good thing in this mess.

I hope he gets the help he needs soon and that you can stay sane until then. This must be so hard for you.

 

[JJJ]

Can you get to a different hospital? Make it clear to difficult child that he must tell the docs that he is actively suicidal, that he does not WANT to kill himself but feels that he might HAVE to do it.

 

[welcometowitsend]

Thank you for your replies.

husband and I are very nervous about his state of mind. husband just got home from a trip tonight and difficult child seems to have been in an ok mood today. We a had a talk with him about his state of mind, how he feels, is anything causing this (i.e. is it situational?). Here is how he describes himself.....

He says when he is in a normal frame of mind he is content - not happy but not suicidal. And he is rational and would never consider suicide as an option. I guess he is just 'ok' and that is a good day for him. He says the suicidal thoughts can start and last anywhere from 20 minutes to several hours and they start for absolutely no reason at all. He or his friends talk him out of his feelings and then he says it's like he resets himself and waits for the next time it will happen. He describes himself as a ticking time bomb. He has never threatened me with suicide because he is angry or frustrated with a rule or something he can't do - he did leave home because he didn't like our rules but never threatened suicide. He doesn't/won't even come to me when he feels this way. I've asked him to change this and he says he will do his best. Apparently this has been happening off and on for months and I only just found out it was this serious when I took him to the dr.'s last week - but then he said that he hadn't felt that way in a while and was doing much better - until Sunday night/Monday am. I don't have much experience with this kind of thing other than my own teenage angst which was nothing like this and my sister but she doesn't get into nitty gritty details with me. I don't know if this sounds plausible or convenient, Know what I mean??

I have a feeling I'll be up again most of the night checking on him - hopefully he sleeps tonight so I can too. I really don't know how he stays awake the way he does. I could try another hospital but my understanding is that unless he is an 'immediate' threat to himself or others then they won't do anything - and if he won't come to me when he is an immediate threat to himself then I'm at a loss as to what to do.

Thanks for your support

 

[buddy]

I'm in shock how you were treated at the hospital. I have brought Q in four times now I think to the crisis unit and they talk to me first every time. I ask to leave so they can talk to Q so he will tell them more if he wants to. They then talk privately to me. THey say to come any time I am concerned just to give things a cool off time even if he doesn't need to be inpatient but each and every time they agreed to admit him if I was nervous. I am just shocked you were treated that way. I mean even posters and commercials say to always take a threat seriously.

What did he think he was trying to get out of in the middle of the night anyway? Not like he said it in the middle of your telling him to mow the lawn or get a job!

I hope you can find an alternative. I might call and see who is on duty next time I consider taking him, sounds like this doctor is a waste of space.

 

[aeroeng]

The fact that he can tell you in such details what and when he is feeling things is a major sign. The Dr. was totally incompetent. I am angry enough to consider having a lawyer at least send him a letter. My difficult child did use suicide as a method of manipulating us. However, his ER doctor took it very seriously. The Dr. asked him detailed questions to determine how well he had thought it through, and when faced with the possibility of getting admitted to the hospital, difficult child squilled like a pig. He explained all if his strategies, and it was clear he had not thought anything related to how to kill himself, only how to get mom upset. Even after this confession the Dr. never berated him or told him to grow up, he took the approach that the attempt to manipulate us was a sign of mental illness and referred us to a day program. This event did discourage difficult child from using suicide to manipulate us (the intelligent difficult child found other techniques - ug).

Could you find a key word or action that he could use to inform you. It probably is difficult to talk about in the heat of the feelings, but if he could say a one word code word or significant action, he could use to convey that an episode is active. You might wish to have shifts with husband as you must sleep to help him. When he is clam talk with him to find out how detailed his plans are. Is it a general wish or a thought out effective plan. And yes even though it won't totally stop him, removing possibilities and making it harder might make a difference. I would call the Dr. daily looking to see if someone cancels and if you need to go to the emergency room again, find a different hospital even it it requires a longer drive.

 

[welcometowitsend]

I definitely will make sure difficult child never sees that psychiatric again - even if it means travelling an extra half hour to the next closest hospital. His behaviour towards difficult child was totally inappropriate and I don't even understand it because of course he wouldn't talk to me or anything. Even my sister said that she is meeting a new psychiatrist for an assessment (she needs her medications reworked and knows it because she is not coping well) and the office said for her to bring someone close to her like her spouse so the spouse can speak about her moods and behaviours and her therapist is calling in via phone as well. And these people won't discuss my 16 year old with me?

I also got hold of a nonprofit mental health association yesterday and I'm going to get difficult child to do an intake interview. They don't do assessments or anything but they will help us navigate the system and get him the help that he needs. Basically it's like having a case worker or advocate for him. When I told them what happened at the hospital they knew who the doctor was without me even telling them his name. Guess they've heard it before. That man should not work with children or anyone with mental health issues for that matter.

So I called the school this morning and they were good enough to delay his English exam until Friday - that way he only has a guitar exam today, science tomorrow and English on Friday. Takes some pressure off. Quite frankly I don't even care about the exams anymore but I think if he fails these 3 classes he might just get more depressed. Unfortunately, instead of being thankful difficult child went off on me because I won't get him to school until 2:00 for his 2:30 exam. He wants to go hang out with his friends instead of practicing for his guitar exam and studying for his science exam tomorrow - and if he doesn't do really well on this exam he will fail the course (same with English, I think). I explained to him that he needs to take advantage of this reprieve and study for his exams but on top of everything else he is so impulsive right now. He knows he will fail and he is worried about failing and doesn't want to fail but he can't seem to get himself focused on the task that needs to be accomplished unless I am constantly helping him do that. I left to go to easy child's school to spend some time with her and help her with her math (their Special Education department is pathetic so I go to her school for 45 minutes every day and do math with her during the French period). When I got back he had calmed down and apologized to me for his behaviour. That was nice to hear.

I called the private centre to look into the private neuropsychologist assessment for him again this morning - apparently I am on a wait list but the secretary is going to talk to the dr.'s and get back to me with a timeline for him to be seen. I know neuropsychologist's take several sessions to assess so I told her I really want to get the ball rolling on this asap and I told her the situation as it is now. Hopefully they will help me out and get him in quicker.

I don't know if it's because I'm exhausted or what but I feel like I'm as up and down as he is right now. I am so back and forth with the depression/suicidal thoughts as to whether it's the real deal or manipulative but I know I can't take any chances. I think what bugs me is that I believe there is a mental health issue but I also believe that there's a part of him that is getting a kick out of the attention and is enjoying watching me worry and fret over him. Does this make sense?

 

[InsaneCdn]

I also got hold of a nonprofit mental health association yesterday and I'm going to get difficult child to do an intake interview. They don't do assessments or anything but they will help us navigate the system and get him the help that he needs

GREAT plan. Because anybody other than a parent being on your side, generates far more response.

I told her the situation as it is now. Hopefully they will help me out and get him in quicker.

Most places end up with cancellations on regular appointments - and will use these to speed up other cases "in the queue", usually on some basis of need.

You're on the right track.

 

[carolinwaxhaw]

Dear Witsend: Yes, I agree with the others. Please take your son's threats VERY seriously. Statistically boys are more successful than girls. He is a little similar to my daughter who has Mood Disorder-not otherwise specified at present. My daughter is 13 and is in a PRTF after two attempts and some attention seeking behavior. Praise him for seeking support from you and your husband and take him AGAIN for evaluation even if he is not actively feeling suicidal. I am not certain an ER doctor would prescribe medications for him (does he have a psychiatrist???) perhaps his current medications need to be tweaked or changed or something.

I will pray for you and your son.

Carol
mom to difficult child #1 - Daughter #1 age 13 - in PRTF; Mood Disorder-not otherwise specified; Celexa, Lamictal, Seroquel
mom to difficult child #2 - Daughter #2 age 9 - at home
(both adopted)
mom to difficult child#3 - my son, Jeff - 2/15/75-8/12/04

 

[carolinwaxhaw]

Witsend - one last thing - my 13 year old daughter had a suicide "threat" in 12/31/10 and hospitalized for 5 days and 6 nights; all well thru 11/2/11 when she took an overdose of baby aspirin at school. She was taken to a hospital here in NC that does not have adolescent psychiatric services so their patients are medically cleared and then "evaluated" by "Daymark." Daymark is HORRIBLE. This woman who is a Psy.D. told me I could take my daughter home less than 6 hours after an attempt. I was appalled and told her NO - we will spend the night here in the ER - - then she got nasty with me and said if I was not willing to make a safety plan. I told her OF COURSE I AM WILLING TO MAKE A SAFETY PLAN - but is it going to be ENOUGH??????? Just horrified by that!

My daughter was admitted; diagnosis on 11/12/11 and then used soft scissors on her wrist at school on 11/15/11. She went to diff ER for evaluation and admitted again thru 11/23/11. (attention seeking but dangerous!!!) We had another issue on 12/6/11 when she posted on FB that she was hurting herself (when she was not) and we went back to the same "bad" hospital and another "Daymark" professional evaluated her and said I could take her home. I showed him the text messages and he said - o.k., you can take her home at 6 am!!!! I called the prior good hospital and spoke with Access for 2 hours (I was also LISTENING!!!) and he said to bring her there and also tell the ER doctor that he would be responsible for my daughter's safety if discharged, etc. Then the Daymark "jerk" came in to WAKE ME UP at 4 am to "talk" and berate me - asking if I wanted my daughter committed and suggesting I need therapy myself. I told him I may very well need therapy but it is not the issue now - the issue is my daughter's safety! aaarrrgggghhhh these mental health professionals can bed horrible. I have had further issues with nasty people at the state hospital as well.

Pretty happy with where she is at now but soo sooo sad and missing her and wish she was HOME.

All the best to you and your family. Don't let "professionals" put your son at risk.

Carol

 

[cubsgirl]

I once was having active suicidal thoughts. I went to the local hospital and they poo-poo'ed it and called my psychiatrist who told them to let me go home with an increase in one of my medications. My friend who brought me to the ER immediately took me to another ER where they admitted me and kept me for a week. I think you should go with another ER if you are concerned.

 

[welcometowitsend]

Carol - Thank you very much for sharing your experience with your daughter with me. It helps to learn from others experience.

I want to thank all of you for your support.

The therapist (R) that was supposed to be awesome and was recommended by both the school and hospital called me today - and he really is awesome. He took the time to talk to me for quite a while and showed remarkable insight into my son and his behaviour. He said he totally understood what difficult child was saying when he said he flips in and out of suicidal thoughts and when he's in them he just can't be rational. He also pegged difficult child as very intelligent and a quick thinker based on what I was saying - which is very true. He said to me that I need to monitor him closely, communicate with him and assess his mood often. He felt that the situation is pretty urgent and that he needs to be seen by a psychiatrist asap - days, not weeks. Of course he knew who the child psychiatric at the hospital was and he wasn't impressed by him either. I'm to take him back to the hospital or another hospital if difficult child gets bad again. He can't see difficult child for 2 weeks but recommended a psychiatrist that may be able to see him quicker. So I called the psychiatrists office and they want me to get in to my family doctor tomorrow and get a referral faxed over. Initially the secretary said 4 to 6 weeks but I told her the therapist (R) said he needs help in days not weeks so I think she is going to see what she can do. Please pray I can get him in next week.

In the meantime I got a call from a psychologist (dr B) at the other centre that I had a call into and they can see him July 10 to start assessing him - but they can't prescribe medications and the therapist (R) thinks he needs them based on our conversation so I took the appointment and told her to pencil difficult child in and I'd call to confirm by Friday - so I'm hoping to get into the psychiatrist before July 10 and get that confirmed by Friday - then I could cancel with the psychologist.

After my conversation with the therapist (R) I no longer doubt what my son is saying, no longer believe it's attention seeking behaviour. R asked me if difficult child was happy manic at times so I think he suspects bipolar - guess we will find out. There were things that difficult child said that sounded odd to me and I wondered if they were made up attention seeking things or if this was the reality of someone with severe depression. When I mentioned them to R he validated what difficult child was saying completely. I am hoping to get difficult child in to see R soon - he is great, down to earth and someone a teen could really relate to. He asked me to call him back as soon as I had gotten the doctors appts lined up for difficult child and let him know what was happening.

Thank you for your thoughts and prayers.

 

[welcometowitsend]

Got difficult child to get to sleep by midnight last night and he slept through until 7:00 this morning. Guess 3 nights with virtually no sleep was enough. I checked on him 3 times through the night and it seems he did sleep through.

When I went into his room to get him to shut things down and go to sleep I discovered 2 books of matches on his nightside table - most of which had been lit off and the remnants were sitting on the table. That and a pocket knife. So, I took the knife and what was left of the matches away from him. He was pretty amicable about it and didn't even argue with me about it. It was so easy it was kind of weird. Like maybe he doesn't care because he has a stash somewhere else?

I think while he is at school today mom is gonna do a thorough 'cleaning' of his room.

 

[SuZir]

Sorry to hear your son's situation is so dire. I hope you will be able to get him started with appointments etc. quickly. Also sorry you were unfortunate enough to have so bad doctor while in hospital. That really hoovers.

Is there a way he could make up the courses he may fail later and which you could tell him about? While school is not a real concern in situation like this, it may be a big thing for your son. It is often really difficult for the kid to see a big picture and he may have a lot of angst over failing in school, even if he is not admitting it, and if you could in any way help to lessen that angst, it could be valuable. This is something I think we adults often forget. Kids are not good at prioritising and can stress a lot over something very small when the real problem is in totally different scale.

 

[welcometowitsend]

Suz - thank you. I did talk to him about school and told him I wasn't worried about the courses. He has always said he wants to do a victory lap so he is opting to take an extra year to graduate anyway. Mostly because the school he is in offers so many great courses. I suggested to him that next year he spread his courses out so he takes more 'interesting' courses that usually offer less homework - like auto mechanics or photography and that will allow him more time to focus on doing well in courses like English and Math. If he spreads his grade 11 courses out over 2 years it will be easier on him.

He says he did very well on his guitar exam so he will pass that. He had his science exam today and thinks he did well enough to pass the course. He has his last exam tomorrow - English.

My mom came over today and helped me clean out his room. We went through and removed all ties, belts, ropes, that kind of thing. I found matches that he'd lit off so I took all matches, found a lighter and removed his multi-tool and a couple of pocket knives. The knives he had from before all this started. The matches concern me a lot. Is this a symptom of something? I don't know.

So his pig sty is now nice and clean and safer than before. I was a little worried that he'd be mad at me for being in his stuff but I was respectful of his belongings and he understood the reasoning behind the stuff I removed from his room and seemed ok with it.

Got the referral to the psychiatrist today and mentioned the matches to the secretary on top of everything else - she was going to consult with the Dr. and get back to me. Hopefully I will hear something from her tomorrow. I've got to call the other place back and let them know if I'm going to take the appointment with the psychologist or go with the psychiatrist. I'd rather go with the psychiatrist for 2 reasons - 1 - she can prescribe medication if needed and 2 - it's covered under our provincial health care plan and the psychologist isn't.

I'm taking extra magnesium to help me stay calm - started hyperventilating today a couple of times and I've been shaking too. Signs of a panic attack, I think.

 

[Bunny]

It sounds like the psychologist that you called has a good head on his shoulders and that is exactly that you need right now. I hope that you can get him into the psychiatrist soon. I agree with the psychologist that it sounds like he needs some kind of medications to help keep him stable. I think that what helps him is that is able to tell you so clearly that he is feeling in those moments when the suicidal thoughts flip on. That can only make things clearer for everyone who is trying to help him. Good luck. Let us know what happens when he can get in to see the doctor.