Refusal to see psychiatrist

Discussion in 'General Parenting' started by seriously, Dec 20, 2011.

  1. seriously

    seriously New Member

    So difficult child 2 has refused to see any kind of medical doctor for more than 3 months now. Including a psychiatrist and his gastroenterologist.

    Every appointment I have made for him - with his agreement mind you - he has refused to attend, usually the day of the appointment making cancelling a big problem. I have been able to get out of any late cancellation fees so far but the last one was going to be $100 which would be devastating to my budget.

    So I told him I was not going to make any more appointments for him. If he wants to go to the doctor he can let me know and I will help him make the appointment provided he is clear that he cannot cancel it or refuse to go.

    He has no psychiatrist right now. He has refused to see anyone, new or old, since his discharge in September. The only medication he has been taking is Seroquel. He decides daily how much he is willing to take = usually 50 mg but sometimes 75 mg. But he is nearly out of it and we have no refill rx. His pediatrician gave us one refill but said he would not do more than that since it should be ordered by a psychiatrist. We passed his message on to difficult child 2.

    I started pointing out to him that he was running out of Seroquel 3 weeks ago. Last week my wife reminded him and he said then he would only take one tab (25 mg) instead of 3.

    Two days ago I asked him how much he wanted and he said 3 tabs. I mentioned that only left him about 7 tabs and then he would be out. He again said he would only take one.

    I saw my psychiatrist last week. She used to treat him too. We always talk briefly about difficult child 2 and when I told her about the Seroquel she said she supposed she could do a refill but it was dicey since she hasn't seen him in nearly 6 months. I told her that he knew he was running out but was refusing to see a psychiatrist. Since he is taking so low a dose (normal therapeutic dose is around 150 mg) it wasn't likely to cause side effects when he stopped - except that he will probably go back to having trouble sleeping every day instead of just 3 days out of 7.

    I told her I felt it was time for natural consequences to happen and she said she agreed.

    Maybe we will end up with him back in juvie or psychiatric hospital for Xmas or New Years. I feel like a bad mother but I am secretly hoping for that, just so we and his sister would have a respite from his difficult behaviors.

    Yesterday He didn't go to school - didn't even make an attempt. But overall (until the cookie monster scene at 1 am) he had a relatively good day and was helpful, moving boxes and helping with cleaning so we could set up a Xmas tree today.
  2. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I think you are right to have him face natural consequences with failure to see his medical doctors. He is old enough to know he needs to see them to stay healthy. He knows you go to the doctors. He understands what this is all about. If he cant sleep maybe he will decide he needs to see the doctor. Good luck.
  3. DaisyFace

    DaisyFace Love me...Love me not


    So, basically, difficult child 2 is treating docs and medications like a game...

    Yes - let him face the consequences of running out of the medications....and let HIM call to request the refill...and let HIM hear how they cannot prescribe medications because he hasn't been seen in so long...

    Both of my kids have prescriptions medications - and I put them in charge of refills (keeping an eye on them, of course). THEY know they are getting low because THEY are the ones taking the medications. When THEY need a refill THEY are the ones to call.

    DS is very good about keeping on top of this - so he talks to the doctor about medications at every appointment, and when he needs a refill he just calls the recording at the pharmacy.

    difficult child - not so much. She skips her medications a LOT. So I have HER call the psychiatrist's office and explain it...

    I'm trying to make sure they learn that keeping up with medications is a responsibility - and not a game to play with parents or docs.
  4. buddy

    buddy New Member

    Yeah, medication non compliance, not a choice at my house either.... He only resists once in a while, yesterday being notable (he doesn't do it with me, but gets so much interaction out of t hem for it at school) and so he is home today (he LOVES school but the natural consequence because since there was something wrong, I had to call doctors, get new medications for another problem and explore all issues that are making it JUST TOO HARD (a little bit sarcastic here) to do the right thing in the first place). No way no how he is not gonna take his medications and not go to doctor and if he ever refuses that, then he will have help getting there as you are doing.... It is the one thing that keeps him at home and I sure hope I never face that.... uggg so sorry
  5. Star*

    Star* call 911


    Well after years and years of medications - and I'm talking like 65 plus different kinds of medications? Our son finally said absolutely, positively no more medications. His thoughts were scattered but we told him if you want to get off medications then we need to have a legitimate reason why. We'd compromise. You can have one or the other but not all three. See being a teenager should have some privleges about making choices for yourself and your own body. BUT becoming an adult also comes with making adult choices, and that means telling other adults the whys and wherefores like adults are required to do. So while we try to balance learning that our son is no longer FIVE but fifteen - he has to understand that if he wants to be treated like an adult - he has to start behaving like one -NO halfsies. Meaning - FINE - no medications - let's sit and talk about the reasons you don't want for taking them and "I don't wanna, Because, Whatever, I just don't, None of your business, They make me feel icky' are NOT adult answers.

    In with that - the compromise for us was "okay here's the thing - We will agree (not WE WILL ALLOW) that you're old enough to decide not to take your medication for a period of time and see how it goes;(meaning we're going to monitor your behaviors and we actually HOPE that you do better without them) however since you CHOOSE (another key adult word) not to take your medications as your parents we feel there needs to be some type of stress management to replace the medications you refuse; so you WILL attent therapy once a week for the full hour INSTEAD. NO if ans or butts. AND because you are choosing to not take medications and such we'll forgoe the gastroenteroligist until you tell US you need to see him, but any cancellation of appointment fees made for him will be charged to you. (ALL SIGN CONTRACT). He gets a copy, you keep a copy - like an adult deal.

    Our son jumped on that deal - and while he tried a few times and balked a little at going to the therapist and a couple times literally got up and walked out of the therapists office once there? The therapist was WAY more clever than we were at holding that childs attention. So once there? With the help of our ADULT deal - we were able to use that to build on - and to this day our son still refuses to take medications. Oddly enough - he's 21, and KNOWS the medications would help him. None of them that I'm aware of would make him feel weird - just help him - and he STILL refuses. So if he chooses to be miserable and live life on his own ridiculous terms - so be it. Three pills a day keeps me very happy and able to not sling a Seattle Slew of names at him for ignoring his depression & making such poor choices. I just know they are his choices - and the consequences are also his - in spades.

    Hope this helps.
  6. gcvmom

    gcvmom Here we go again!

    Have you asked him if he's considered what might happen as a result of this? Whether he's realizing he could end up in crisis again? Or does he just not want to discuss anything at all with you at this point?
  7. seriously

    seriously New Member

    Discussion is a rare event. He is very reactive and defensive so it's hard to really talk to him about anything including what we're fixing for dinner. LOL

    I think he is taking a vacation on the Egyptian Riviera at the moment and thoroughly resisting any information that might interfere with his enjoyment of the view. "De Nile" is a popular place at this time of year I hear. I wouldn't know, not having that luxury.

    We are just starting family therapy with the Juvie Diversion Treatment program. It's FTT so it's a very structured format and I'm not sure if this particular issue is suited to that approach. I plan to bring it up at our appointment next week.

    He is seeing their therapist about once a week. She says he is friendly but very resistant to doing "therapy" or therapeutic activities. So far there seems to be little progress on that front and he's been working with her for several months. I would be very reluctant to do anything that even smelled of coercion (from his perspective) with respect to his attending his sessions with her. But Star's suggestion isn't necessarily a bad idea and I'll tuck it away for possible future use.

    He is currently refusing to enter into any contract of any kind with us about anything. We negotiated a contract with him over his Xbox and his boots. He signed the contract but then refused to give up the boots as agreed. We had to have the police come out twice to take the boots away from him (steel-toed). After he signed the contract he immediately refused to give us the boots and got violent so police were called and they made him give them up. Several days later he snuck the boots out of our room when I was in the shower and forgot to lock our bedroom door. When we discovered it, cited the contract and insisted on their return he blew up again and police came again. They told him if they had to come about the boots again he was going to juvenile hall and it was not a joke.

    It's taken about 3 months but things have settled down a little. He's stopped fighting us over the terms of the contract (has to attend at least 4 hours school to get any Xbox time each day and give up the boots due to safety issues) but will not do any contracts about anything.

    It's not exactly that he doesn't want to take the medications Star. He is taking the Seroquel voluntarily, which surprised us. And he has agreed that he will probably have a lot more trouble getting to sleep if he doesn't take it. He doesn't like that idea but it's not enough to overcome all the weight on the other side of the teeter totter.

    First of all, he doesn't want anything to do with doctors. I can't really blame him on that one - he's had more doctoring in 16 years than most people have in 2 lifetimes. :( He would be happy to never see another doctor the rest of his life. which is not in the cards but he is going to push it to the limits I think.

    Besides that he doesn't want anyone pressuring him to do any introspection, challenging him to grow beyond where he's at right now or insisting that he take some personal responsibility for his health.

    psychiatrists tend to insist that you report your symptoms and current state of being on a regular basis which requires a certain degree of self-awareness. They usually demand that you make at least a token attempt to think about your situation and take baby steps to help yourself get better. He doesn't want to do any of those things. Plus starting with a new psychiatrist means talking about his history - medical and psychiatric. HUGE resistance to that.

    As for the GI - Jean you know that could kick him in the butt with virtually no warning. And I'm pretty sure he's already having warning bells going off but he is not admitting it. He was home most of last week with nausea and intermittent vomiting for no apparent reason. He's fatigued, had one episode of bloody stools that I know about, he's having more and more frequent episodes of moderate belly pain after going at least 2 years with none at all to the point he's having pain 2 to 4 days a week over the past month. I mean pain that has him doubled over hardly able to walk for periods up to 3 or 4 hours long. His labs 8 weeks ago were good but I haven't been able to get him to do labs again since then. Hoping to do that next week. Not that good labs is any guarantee with Crohn's.

    Getting him to GI is more important to me than getting him to the psychiatrist at this point. But I'm not sure it will do any good even if I did get him there. I honestly don't know if he will cooperate with any treatment short of an emergency hospitalization for a GI blockage or perforation. Darn, stupid kid. Many bad words.

    Time will tell. Perhaps I am just borrowing trouble with the GI stuff and he's just experiencing the consequences of what he is eating. I think his current intake consists of turkey hot dogs, hot dog buns, peanut butter, Safeway pomegranate cereal, pasta, milk, apples and oranges. And sweets on the rare occasions when we have any.

    Hope things are better with your crew.

    Happy holidays by the way.
  8. gcvmom

    gcvmom Here we go again!

    Poor kid. Poor mom! You are in that proverbial hard place.

    I can say that we've been there done that with difficult child 1 -- the hostility, the oppositionality, refusal, etc. He was depressed and also had a health problem he was hiding. He's doing MUCH better now, but it was a hard hump to get over last year for all of us. During that time I took him back to see his old therapist because of all the issues going on. He went along for the first two appointments, but by the third one he refused to get out of the car to go in. He was really mad at the world that day. I went in without him and explained what was going on to the therapist. We sat and talked for about 10 minutes, then the therapist said if difficult child 1 wouldn't come to him, he would go to difficult child 1. So I led him out to the car, unlocked the door and he and I both got in the front seat. difficult child 1 refused to speak to him, so therapist just talked to me about difficult child 1 but his comments were carefully constructed as were my replies so that difficult child 1 would hear what he needed to hear and would have heard had he gone in to the appointment in the more traditional way.

    It must have worked because the following week, difficult child 1 went in voluntarily. And throughout this I was in touch with the psychiatrist who was helping me figure out some medication adjustments that were clearly needed. We've been fortunate in that difficult child 1 has only refused medications a few times, but because of how he felt because of that decision, he hasn't done it again. I've agreed with his assertion that we can't force him to do anything. But I am also very quick to point out that he is the one who suffers the consequences, and I always ask does he really LIKE how he feels when he's off his medications? Does he like the drama that usually ensues? And since he doesn't like what happens, these reminders are usually enough to squelch the rebelliousness on this front.

    I hope your difficult child 2's birthday today is as nice as possible, given the circumstances. Sometimes you have to let go of what you want for them and accept that you just can't make it all as special as you'd like because so many of the factors are out of your control. It IS sad and frustrating, but it WILL pass.

    Hope your family has a peaceful holiday!