This is so challenging. My daughter has been at a PRTC for about 3.5 months so far. She REALLY needed a secure level of care as she had been hospitalized 9 times in the past 12 months for recurring suicidal ideation, self-injury and reluctance to seek help when she felt herself slipping into a serious depression. She was actually denied admission to several less "secure" placements as her suicidal risk was so great. Now that she has been at the PRTC for 3.5 months, I think she is getting VERY frustrated because for the first time in her very tumultuous brief psychiatric history, she cannot "call the shots" in her care. Previously, she could keep it together and appear to be much better long enough to get discharged. Then, she would be able to last about 3-6 weeks without a crisis. I guess the placement is a success in some respects because in 3.5 months she has only had one very minor SI episode (seemingly for attention). And as her therapist pointed out, she has not been acutely suicidal, although she at times will score VERY high on the Beck Depression scale. She is supposed to stay at this program for 6 months, then step down to a Level 3 program (not secured) until we see that she can handle the less restrictive environment before going to perhaps a therapeutic foster home in our area, then finally, home. We are a very good family - no abuse, drugs, divorce, etc. So - it is very hard to figure out why she has all of these issues. Today she told me over the phone that she is WORSE than when she went in. She said she was NOT suicidal when she 1st went there (she was at an acute hospital awaiting placement for several weeks prior), but she is now! She seemed so much better to us on our last visit about a week ago - but she says now that she was thinking the whole time of jumping out of car because she wants to die. She said she now is getting an eating disorder, becoming oppositional and all kinds of issues from being there. She says that she needs to move to a Level 3 now! Yikes! I am terrified that she will convince/"snow" the staff enough to get discharged to a lower level of care and then she might end her life. But what if this highly restrictive program is really making her worse? Any hospitalization carries the risk of your child mimicking the maladaptive behaviors and attitudes of the other clients. I am alerting her therapist and case manager. But I am VERY conflicted about whether or not it is appropriate/safe/ok to even consider moving her to a less secure placement when she appears to be so volatile. I ask myself if I (as a presumably normal, healthy person) were sent to live at that facility for 6 months with a lot of dysfunctional kids - how would I fare? I think I would be stressed, but I would persevere. But can an emotionally sensitive 14 year old really withstand repeated hospitalizations and being so far away from her family and still come out ok? Is this just a phase of her "recovery" that she will pass through? She has admitted to being highly manipulative in her past year of hospitalizations.... I fear I am weakening under the pressure to do the right thing for her! My husband and I know she needs this program... but we both are very nervous when she starts to speak this way. Any insight?