Utter Frustration

[butterflydreams]

My difficult child is being discharged on Thursday. I found out this morning. We went from no pressure to discharge him last week to we are going to discharge him Thursday. They said they are waiting until Thursday because they know I am concerned about him coming home and that my daughter is scared to have him home. So they want to have a family counseling session tomorrow with the 3 of us. As of last week they still didn't even have the records from the partial program that documented the psychosis. This doctor doesn't believe that my difficult child was having hallucinations or the violent homicidal thoughts he was having before being admitted to the other facility in March. Well, duh! He has been on Abilify since his March admission! Last week, she took him off the Abilify because she said she didn't feel he needed it. Just great! Take him off it and send him home. I understand they are an acute facility and if he isn't acting acute (which he is on good behavior) then administration discharge him. Because of my concern for him being able to maintain at home, they are keeping him on the waiting list for Residential Treatment Center (RTC) (it's a several month waiting list that I know of). If he has to be admitted again, it will be an automatic wait for Residential Treatment Center (RTC). I was told before that the counselor and the caseworker at the psychiatric hospital both felt he was a candidate for Residential Treatment Center (RTC) because he has had 3 hospitalizations in just over 6 months. The counselor had told me 2 weeks ago, not to worry about him coming home any time soon, and now this!

I have a phone call into his other doctor letting him know they are discharging him (he doesn't have privileges at the state facility) as well as to set up an appointment. I also have a phone call into our family counselor to set up an appointment and to let her know what is happening.

My daughter is going to flip a gasket when I get home and let her know what is going on. She is scared to be home with him. Frankly I am too. She has told me before that she can't live there with him. There really isn't any alternatives either. I really don't know what is going to happen. She was just getting settled down. I am glad that she has an appointment with the psychiatrist next week for herself (same doctor as difficult child so he is well aware of how difficult child affects her.

I am just so stressed right now.

Christy

 

[smallworld]

Christy, I'm sorry everything is changing so quickly.

What medications is difficult child taking? Nothing, or is he still on Seroquel, Prozac and Daytrana?

 

[butterflydreams]

Thanks. Yes, he is still on those. I asked about the Prozac this morning, because when she had put him back on it week before last, she put him on 10mg, he had started out at 20mg before and then was on 40mg from Oct. to March. She asked how that worked out, I told her in the beginning it seemed to work and then it was like it didn't work at all. She said that the dose would need to be increased. She would up his dose to 40mg today and then the other doctor could monitor it and adjust it from there.

I am just so frustrated that she isn't seeing the behaviors that put him inpatient. I am going to take it one day at a time and hope for the best. I just know that my daughter is going to flip out tonight when I tell her.

Christy

 

[slsh]

Christy,

I'm so sorry. Unfortunately, this has pretty much been how admissions have worked for us - stabilization, which is relatively easy to get in a controlled setting, then discharge. It's especially frustrating when you're dealing with a psychiatrist who doesn't get what our difficult children are really capable of.

For your daughter, I'd work on coming up with a safety plan for her. What can she do when she's feeling unsafe with her bro? Does she have a safe/secure place in the house to go, or a friend's house? Does she have a cell phone or portable home phone so that she can call for help if needed? I'd really try to empower her in terms of what she can do to be safe. She (and you) cannot control difficult child's raging but you both *can* get a safety plan in place so that if things get out of control, you both know what to do.

Weeburt and Diva (my pcs) were 5 and 3 when thank you left for his first Residential Treatment Center (RTC) and even at that young age, we had a plan in place. thank you's been home for 2 very short attempts at living here since, and again both times there were safety plans in place. The last time involved keyed locks on a door leading to their rooms - pretty extreme but necessary. I can't say it made living with a raging difficult child less emotionally traumatic but I do think there was at least a small amount of peace of mind knowing that physically, they were safe.

I hope you're able to get some supports in place - respite, crisis team, something. I'd really force that issue at the family session as well - there needs to be a concrete plan, and caseworker and counselor at psychiatric hospital *should* know of resources and be able to get you hooked up.

A gentle hug.

 

[muts80]

Ok, question for you ladies....when you sent your difficult child's to psychiatric hospital, what behavior were they having? The reason I'm asking is because I wonder if the behaviors my difficult child is having is severe enough to be concidered "reasonable" for admitting into psychiatric hospital. My difficult child was baker acted twice in 2007 because he was trying to hurt himself by punching his nose to the point of bleeding, and threatening a 2 month old baby that he was going to "hurt her if she didn't shut up (crying)" Once at the psychiatric hospital, he did the same as your difficult child's...great behavior while there, and discharge after a few days. SOOOO FRUSTRATING!

 

[Wiped Out]

Christy,

I'm sorry. We have had the same experience with difficult child's most recent hospitalization. They sent him home and had only changed one of his medications by 5mg-big help. NOT! I think it is important as Sue mentioned to have a safety plan in place. I'm glad you have calls in to his psychiatrist and therapist. Gentle hugs.

 

[slsh]

Muts - the usual criteria for admission is if they present a "danger to themselves or others". thank you's had 2 admissions for bad reactions to medications, but 20+ for suicidal/homicidal ideation (either thoughts that he's voiced or actions).

psychiatric admissions are not like medical admissions, which to this day I still have a hard time wrapping my head around. It's not so much about treatment, although medications can be tweaked. It's about stabilizing so that they're no longer a danger, with the assumption being that there's ongoing outpatient treatment and interventions. You don't get a "cure" with a psychiatric admission.

A lot of kids do really really well in the hospital. I think it's a combination of structure, newness, and attention. I actually once asked thank you's psychiatrist if they could just make a demand or two of him while in the hospital so staff could get a taste of what we were dealing with - he chuckled and said not to worry, they knew, but again the whole point of hospitalization was to stabilize so they weren't going to make any demands.

thank you is such a frequent flyer now at hospitals that I think they provide him with a sense of safety and security. There have certainly been a number of admissions that he's intentionally provoked. Has made me wonder if we made a mistake in admitting him so many times but realistically, we really had no choice.

It's definitely an imperfect system but I'm not sure how it could be made better, other than more community-based services that are accessible for families (crisis team and respite for example, which do not exist in my part of the world).

 

[Sara PA]

Just because that doctor decided to up the Prozac to 40 mg doesn't mean you have to give it to him when he gets home. Frankly, I wouldn't put any faith in a doctor who decided a kid didn't need a drug because he didn't have the symptoms for which the drug was prescribed. That's like people with high blood pressure stopping their medication because their blood pressure isn't high anymore.

muts80 -- my son was in his mid teens when he was admitted to the phos but he had a suicide attempt in the middle of a psychotic rage. He spent almost as much time in intensive care for the suicide attempt as he did in the psychiatric unit. All they did was add Lamictal, tell him over and over again he had to be responsible for his actions and sent him home. Frankly, it was a totally worthless experience and no matter how bad he got in the following months, we never bothered sending him back. (I must always add that he is an only child and no one but me was in danger from his violent rages. What was the point in sending him somewhere where he was treated as though his psychotic behavior was a choice? Eventually I learned it was the antidepressant making him psychotic. My choices likely would have been different had other children been in the house.)

 

[susiestar]

Christy,

when our difficult child was hurting his sister, we got her an alarm. She wore it around her neck when she was at home. I also put an alarm on the door and we moved thank you into her room for a short period of time. This was years ago, but they still sell the personal alarms. It let husband and I know to come running.

We also had many many nights where she slept in our bed. Either between husband and I, or husband slept on the floor outside difficult child's room, or on the couch.

Both sleeping with mom and having the alarm helped a LOT.

Is there a relative or close family friend she could stay with?

I am also sending a PM to you.

Hugs,
Susie

 

[TerryJ2]

Christy, I am so sorry. You've gotten some GREAT advice here from people who have been there done that, especially about making a plan with-your daughter, and taking care with-the medications. It doesn't sound like this release is timed very well.
I hope your talk with-your daughter goes well.

 

[smallworld]

Christy, you should be aware that SSRIs like Prozac can cause hallucinations as a side effect. Your difficult child may have been doing better because he was taking Abilify and he had been taken off Prozac. You may be going round and round because the very medications the psychiatrists keep giving him are making him worse. Just something to think about.

 

[Christy]

Christy,
I'm late to reply but a wanted to offer my support. Sounds like some good suggestions fro dealing with a tough situation have been given. I hope things go well but definitely make sure at your family meeting that a plan is in place if difficult child acts out violently. Will they take him back if this occurs? Do you need to go through the ER? Let them know that you do not intend to allow your daughter or anyone else in the family to be hurt.

((((hugs))))

Christy
(another one!)

 

[butterflydreams]

Just because that doctor decided to up the Prozac to 40 mg doesn't mean you have to give it to him when he gets home. Frankly, I wouldn't put any faith in a doctor who decided a kid didn't need a drug because he didn't have the symptoms for which the drug was prescribed. That's like people with high blood pressure stopping their medication because their blood pressure isn't high anymore.

Sara,

When I do hear from his regular psychiatrist, I plan on asking him to give him something different as well as let him know that she took him off the abilify. I am going to be calling him again in a few minutes.

Christy

 

[butterflydreams]

Thank you everyone for wonderful advice and support! Now onto answers:

My daughter does have some security plans in place. We are placing a keyed lock on her bedroom door. She has a cell phone and she can call my boyfriend who lives about 1 mile away if necessary, grandma and grandpa live like 25 minutes away. I will also be talking with her on what she will need to do.

I have to register him at the local school (even though school is out June 4th) on Friday, so he will be gone from the house until about 3pm. If he is home after school is out in June, I am going to look into Boys and Girls Club or something like it for him.

I am definitely going to talk to his regular psychiatrist about his medications and see if he will switch him to something other than prozac since he was the one who took him off of it to begin with.

What happens if he becomes unstable? I have to take him to one of 2 emergency rooms for an evaluation. They only take admissions from the emergency room. The other place which was covered by my insurance before it was used up has their own assessment process and you don't have to go to the emergency room.

I am going to be setting up some very specific guidelines of what is going to be expected regarding boundaries, school, behaviors, not hoarding, etc.

Thanks again,

Christy

 

[Sara PA]

When I do hear from his regular psychiatrist, I plan on asking him to give him something different as well as let him know that she took him off the abilify. I am going to be calling him again in a few minutes.

Christy

That's another thing about putting a kid in a phos.....the doctor who's going to treat the child for all of 5 days or so starts messing with medications, often with little or no input from anyone. And then the child leaves the phos and goes back to his regular doctor who likely makes more changes. All those changes in such a short time just aren't good.

on the other hand, my son had his private practice doctor when he was hospitalized. Unfortunately, despite being a board certified child and adolescent psychiatrist, she couldn't recognized an adverse reaction to an antidepressant to save her -- or my son's -- life.

I am going to be setting up some very specific guidelines of what is going to be expected regarding boundaries, school, behaviors, not hoarding, etc.

If your son could change those behaviors simply because there are rules, then he likely doesn't have a medical condition and shouldn't be taking medication. If that's the case, he's bad, not sick. If his behavior is the result of an adverse reaction to the medication, all the rules in the world won't fix things.

 

[butterflydreams]

That's another thing about putting a kid in a phos.....the doctor who's going to treat the child for all of 5 days or so starts messing with medications, often with little or no input from anyone. And then the child leaves the phos and goes back to his regular doctor who likely makes more changes. All those changes in such a short time just aren't good.

on the other hand, my son had his private practice doctor when he was hospitalized. Unfortunately, despite being a board certified child and adolescent psychiatrist, she couldn't recognized an adverse reaction to an antidepressant to save her -- or my son's -- life.

My son's private practice doctor was his doctor at the last psychiatric hospital, but doesn't practice at the state hospital where he had to go after insurance ran out.

If your son could change those behaviors simply because there are rules, then he likely doesn't have a medical condition and shouldn't be taking medication. If that's the case, he's bad, not sick. If his behavior is the result of an adverse reaction to the medication, all the rules in the world won't fix things.

I am saying the rules thing because the hospital has said to set him up with guidelines of what is expected of him. I really don't have high hopes because his track record says differently. But I am doing what they have instructed to kind of follow what they have been doing in there. He has never been one to be able to adhere to guidelines. You give him a homework assignment for example and he doesn't will sit and stare at it and not know what to do with it or where to start. Also, like if you say to him "you need to take a shower after dinner" he totally won't get it. His regular psychiatrist believes he has emerging bipolar (which runs in the family), pathological grief, anxiety, and ptsd. He will start seeing his private psychiatrist again in 2 weeks.

christy

 

[Sara PA]

I am saying the rules thing because the hospital has said to set him up with guidelines of what is expected of him. I really don't have high hopes because his track record says differently. But I am doing what they have instructed to kind of follow what they have been doing in there. He has never been one to be able to adhere to guidelines. You give him a homework assignment for example and he doesn't will sit and stare at it and not know what to do with it or where to start. Also, like if you say to him "you need to take a shower after dinner" he totally won't get it. His regular psychiatrist believes he has emerging bipolar (which runs in the family), pathological grief, anxiety, and ptsd. He will start seeing his private psychiatrist again in 2 weeks.

christy

Yeah, we went through that when my son was hospitalized. He had to write up a contract saying what he was going to do to be a better son and I was suppose to do something or the other. It was ridiculous. My son was in the hospital because he tried to kill himself and the wise people in charge require a behavioral contract before they sent him home. Huh???? Of course, that's because having loaded him up with medication only to have him get progressively worse, the doctor's only other explanation was parent (read "mother)-child conflict. So we made up stuff to put in the stupid contract and I took him home vowing never to waste our time and money again.

If your regular doctor suspects emerging bipolar he should get him off the antidepressant. Antidepressants aren't bipolar medications and can trigger a version of bipolar known as antidepressant induced mania/bipolar.

 

[Christy]

Christy,
Is your son home? How are things going?