Release from Phospital?

[On_Call]

difficult child has been in psychiatric hospital for more than 3 weeks. During that time, he has been completely taken off his seroquel (which means, no more lithium or seroquel in his system). He has had no serious problems and has been doing well for most of his stay.

When he was admitted, there was one doctor on duty who was here for a month. He has since left and there is a new doctor in his place. I have no idea how long she will be there, but it is so frustrating to be in the position of "overlapping doctors".

It's strange because difficult child has regularly been going to out patient appointments at the same facility and his collaborative day program is at the same facility, as well - and this is causing some kinks to say the least.

New psychiatrist on duty called me yesterday morning at work. Said she had extensively reviewed difficult child's inpatient file and had met with him. She said she felt he was becoming "too comfortable" with inpatient life and that because he had been having no problems, she wanted to look at a Tuesday discharge. No problem, I said, but what about collaborative day? Are they going to take him back? Have you spoken with his outpatient doctor? She had not talked to outpatient doctor and had no ideas regarding the collaborative day situation. Suggested I call coll day coordinator, which I did.

I left messages for him, for difficult child's social worker (on site) and for his outpatient psychiatrist. I received calls back from all of them and nobody knew what the other was doing. I was giving THEM the information. Each told me that was not my job, etc. I told them I was TOLD to call them. Jeesh. If it's not my job, why was I asked to do it?

I don't mind making calls, but we cannot have a discharge plan without the school situation settled and without support plans in place. Been there, done that, got the t-shirt, don't want to do it again.

I told collaborative day coordinator that none of them were "holding hands". He tells me there are rules of ethics that bar outpatient from having too much influence where inpatient doctor decisions are concerned. And, it is still his opinion that collaborative day did not want to accept difficult child back into the program because difficult child had been so negative about returning (he hates it there and doesn't mind saying so). Not to mention that when he called our sd, they said they still felt that collaborative day was the best placement for difficult child and that they 'knew he would be there longer than we had anticipated'.

GRRRRR!!!! :grrr:

Heaven forbid we all get on the same page and in the same room for an hour to really decide what is best for difficult child and to make a workable plan for discharge and for his survival after inpatient stay. They have all promised to work on their "parts" of the situation. I am assuming that a CSE meeting will be immediately called, but am not sure of the outcome considering the opinions of all involved.

Sorry this has turned into a bit of a vent, but at this point I am so frustrated. :hammer:

Thanks for listening.

 

[Alisonlg]

Oh hun!!! How stressful and frustrating! I'm so very sorry. I hope everyone can get on the same page soon so you have a good discharge plan in place that can help difficult child be successful post-discharge! ::::

 

[On_Call]

Well, I found out yesterday from social worker that on-call inpatient psychiatrist is firm and pushing for Tuesday discharge - with our without the education portion of the discharge plan in place. So, they are trying to also rush a CSE meeting in on Tuesday morning - just before discharge.

They will still not give me any idea if they are willing to accept difficult child back in coll. day program to finish out the school year. I will be going into this meeting blind.

Social worker suggested I attend the meeting at the psychiatric hospital and CSE chair will attend via speaker phone, if she cannot make the 45-minute drive to psychiatric hospital. I usually attend at the CSE office with the psychiatric hospital on the line. Weird, but I think it is because I may need to argue points with the psychiatrist and with coll. day coordinator and they feel it would be more productive with me attending on that side of the call.

Overall, I just think that the situation is unfair to difficult child. It is only right that we have the best, most secure and balanced discharge plan in place BEFORE discharge, wouldn't you agree???

UGH!!

 

[branbran]

I can so relate. My daughter has been in 3 different hospitals, with the same chaos your going through now. There is never a straight answer or more than 5 minutes on the phone, if your even lucky enough to get a call back. (you never get them on the first try - always the voicemail) Become a thorn in their side, annoy them until you get the results you want. Keep fighting the good fight.

 

[ALogan3]

Frequently our difficult child's do very well in a structured setting. And when they come out~~~~~ wham~~~~meaning the lack of medications~~EEK!

I believe they are remiss in having no discharge plan upon discharge but we don't even have a p-hospital anymore so I guess......

APPLAUSE for doing all you can do on your part.

Prayers
and
Hugs,

Andrea

 

[timer lady]

Jamie,

While the "ideal" discharge plan should be in place, many times it isn't. Many times for insurance purposes or the need for a bed for a more acute patient.

That's the reality of mental health care in the U.S. Having said that, do your best to get an idea on the school piece before discharge.

Any advocates in the county mental health system there you can use? Do you have any educational advocates in your area?

 

[On_Call]

I think that it will all work out. Oddly enough, I ran into the director of education at phospital last night during our trip to WalMart. Weird, right? Weirder still is the fact that as a teen, I babysat for this lady for several years (summers included) while she worked. She had 3 difficult child's, so I have often thought that that is where my training began (lol).

If there are education advocates in the area, I have not found them in all of my research. It's frustrating to say the least.

I guess in the past, everything in this arena has been smoothed out and ready long before discharge. This inpatient stay has had a lot of bumps and idiosyncrasies, beginning with the fact that the psychiatric hospital right now is working with consulting doctors who seem to be working a month or so at a time, so we have had to endure overlapping personalities and opinions. The psychiatrist who just came on reads difficult child's chart as stable and believes it is not necessary to keep him inpatient any longer. She doesn't care that the education component is not in place and believes that can be worked out later. I guess I just thought, from past experience, that this should be worked out before discharge. Ideally it should be, but I can see that it's not always the case - it just was in our experience.

The education coordinator said the CSE meeting has been scheduled for Tuesday at 3:00 p.m. and that I should attend at the psychiatric hospital. They will have our sd CSE chair attend by speaker phone. The psychiatric hospital recommendation is what husband and I want - difficult child to finish out the last few weeks of this school year at collaborative day program, attend the extended school year program and then go to the 8:1:1 program at another sd that our sd originally planned for him to attend in the fall. It is now, apparently, our sd's firm belief that difficult child belongs in collaborative day program for the unforseeable future. That is not coll. day's stance and not ours necessarily.

Could be a battle, but I think that finally we and the staff at the psychiatric hospital are on the same page - even difficult child's outpatient psychiatrist is attending the meeting, although it is not normally done that way and she will be stepping on the inpatient psychiatrist's toes - so all in all I guess I shouldn't complain.

Wish us luck, though, could be a bumpy afternoon. Not looking forward to it.

 

[WNC Gal]

As a parent who is new to these psychiatric issues (only for past 9 months) - I am frequently stunned at how much my daughter's quality of care seems based upon my involvement. I don't just mean attending treatment team meetings and educating myself about her diagnosis(es). I feel (at times) that I have a new full time job and I have to be completely devoted to every aspect of her care whether it is researching placement options, requesting medical records from her numerous hospitalizations at various places, assembling a concise, chronological history of her various inpatient, outpatient and suicidal episodes as well as a carefully documented calendar of all of her medication changes (by the five psychiatrists who have taken care of her). And I think because of my HUGE investment in her care (I do have a "never used" degree in psychiatric), the treatment team makes decisions based upon that. Such as - in January, they recommended that we bring her home to be homeschooled - instead of pushing her to attend a TBS (therapeutic boarding school) where she could easily get "kicked out" for her self-injurious and suicidal impulses. Well - that worked for about a month and half at a time (in between suicidal crashes and acute hospitalizations) but it took a huge toll on her siblings, my husband and I and even my job (we home-schooled her at our office). I think it was a TERRIBLE mistake for them to release a chronically suicidal 14 year old girl back to the challenging environment of home-schooling (when she is accustomed to public school and her social circle) - especially when she has a proven track record of NOT disclosing when she is crashing and NOT confiding in her therapists.

I have no problem with continuing to be the "super parent" as long as it is not compromising her care - my husband and I are NOT qualified to treat and cope with this level of illness. We are relieved to be on the verge of getting her placed at a PRTF.

we'll still continue to work hard - to keep in touch with her frequently - to continue to offer therapy to her younger siblings to be sure they are coping ok, and to work closely with the program in family therapy. We even do on-line courses in parenting and relationship skills at FamilyIQ - even though we are very patient, loving and definitely not the CAUSE of our darling child's issues. We will be pursuing DBT skills training too as this is supposed to be VERY effective with Borderline (BPD) behaviors.

I know better, but for the past nine months (through all of the frequent emergency craziness) I have not been taking very good care of myself. I only exercise about once a week, sleep horribly, and find myself eating junk and comfort food to soothe myself. Perhaps when she is finally settled at a PRTF, I can resolve to begin taking better care of myself.