Expert: Libby Bonner - 12/29/2008

Question
QUESTION: I AM IN THE EXACT SAME SITUATION!!!!

My sister was just in an inpatient program at Alexian Bros. in Hoffman Estates, IL and they just released her today.  My parents told her she couldnt come home, but after hearing that the only options included a half way house with a 6-week waiting list (she had no where to be in between b/c she has no family or friends that are willing to take on the responsibly of her horrible behavior), the streets or a homeless shelter.

Out of guilt, my mom decided the only thing to do was take her in...the program she was in said it was impossible for her to go to a halfway house if she wanted to continue the 6 week program that they offer...since halfway houses have their own particular rules and curfews and she would not be able to go to the outpatient program.

right now, i am in my room (locked in, actually) and all i hear is my mom and sister yelling back and forth at each other b/c our family went out to a movie and she said she didnt want to go.  when we came back, we found out my brothers friend had come by to pick up the beer he had left her the night before and she was on his LAST BEER. she is on lithium and doesnt seem to find anything wrong with drinking.  

she has no respect for anyone in our family, and honestly, i am starting to question if i even love her anymore.  she is tearing my family apart and i dont know if i can ever forgive her for the things she's said, done and the financial burden she's put on my family.  

someone...anyone...help me and offer me any advice you can.  she needs to get out of our house so WE CAN LIVE OUR LIVES.

ANSWER: PPS - written after the PS, below, and the main answer, below the PS.

I have contacted wellness.com, who refers pts to the hosp where your sister just was.  I sent a complaint, and I have asked for an immediate reply.  It is unfair to you all that you are in this situation that is not fun for anyone, and terrible for your sister.

Also, until some sort of help arrives - pls, pls get the Woolis book - pls also see helpguide.org.  They have some of the very best material I have ever seen on 1] understanding bipolar disorder, and 2] families helping the ill person...what to say and do that makes things better for everyone.

Good luck, and pls keep me posted.
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PS - Written after main answer, below.  
This is almost the most important thing: your sister needs to be seen by a psychiatrist at least one, maybe twice, between now and the half-way house.  Urgently important.  Has Alexian arranged for that?  She is newly on lithium.  Doc needs to see if dose is right, needs to decide whether to add a second med.

I would also like to hear from your sister, if she would care to write to me.  I will try to help her do her best while at home, and encourage her to stay on her lithium, and to be hopeful.  I will NOT do anything or say anything to make things worse at home, and I will NOT be taking sides or bad-mouthing anyone.
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Your mother needs to write me, too.....BUT share this with her.

A parent needs to call Alexian Bros RIGHT THIS MINUTE to ask for help.  Tell them they can send someone out a couple times a week, or they can have the family in for some quick info and training; suggest that the family is headed their way to return sis to a sheltering environment.

Your sister is SICK - Alexian has some responsibility here, surely, to have put her in some helpful place, or to hang onto her til the halfway house opened up.

A parent needs to call an atty RIGHT AWAY to ask what can be done.

A parent needs to contact your state's patient ombudsman to report this.

YOUR SISTER IS SICK, AND IS A VICTIM OF IRRESPONSIBLE PROVIDERS.  [Alexian.]  Maybe your family's health insurance requires all mental illness be treated by Alexian, but they also, the ins co, needs to get a blast of info about this.

For all of you family members:  sit down and shut up.  Your sister barely has it together.  She will maybe argue, but less if YOU DON'T continue, or start, arguments.  RIGHT NOW, go the a bookstore and buy one or more copies of a book by Woolis called When someone you love has a mental illness.......you will all start coping better and most of the yelling will stop.

YOUR SISTER IS SICK.  SHE JUST GOT OUT OF A HOSPITAL.  SHE HAS SOME OF THE SAME THINGS GOING ON THAT PISSED OFF THE FAMILY BEFORE, BUT SHE IS TRYING TO GET BETTER.  She needs peace and quiet, she probably doesn't want to do a lot of fun things, movies, even.  Treat this person w/ some love, ignore most bad behavior [the halfway house will help w/ it - she is just w/ you temporarily].   Say to yourself, all of you, this kid is recovering from a MAJOR ILLNESS:  how should we respond to that?

She is NOT the same person who started at Alexian; give her a break.  If your Mom needs to leave to cool off for a bit, at a friend's for a couple days, that might be good.

Don't start, family, where you were before she went to get treatment.  This is a new ballgame, w/ new opportunities for everyone, not least your sister, who I hope can be restored to a better self and become again a happier person who is welcome in your family and who has a future to look forward to.

Fighting at home and all the bad stuff is going to make your sister sicker than before, and make it harder for her to continue getting better.  

Thank you for writing.


---------- FOLLOW-UP ----------

QUESTION: Thanks for your help, but she is attending an outpatient program at alexian brothers every day for the next like 6 weeks or so starting tomorrow (i think)--from 8am til 3pm.

She is 25 by the way, and my parents are struggling to pay their mortgage from all her damage (not just hospital bills, but the fact that neglected ot pay every single one of her bills, including:
-her apartment rent ($900/mo) which she BEGGED my mom to co-sign for b/c she has such horrible debt from thousands of dollars in unpaid credit cards
-her health insurance which she neglected to pay for 4 months and cost my mom $1200 just so she could admitted into the program
-her car insurance
-her credit card bills (up to about $6,000, but that's just my guess)
-etc.
I agree that she should stay home for these 6 weeks if there is no other choice and she seems to be doing better (with my parents at least, she still treats me and my younger brother like the scum of the earth) in the Alexian program so I want her to do the outpatient program there, BUT after that program, ARE THE ANY HALFWAY HOUSES ANYWHEREEEE IN THE COUNTRY (I think a chance in environment might be good for her) that you would recommend?  We dont have millions of dollars to send her away somewhere with horseback riding and rainbows, but we need her to get back into society with a steady job (she can never keep one and has been fired from the last 7 jobs she has).

i can't take it anymore. i am a prisoner in my own house.  i have to lock my door b/4 i gte int he shower so she doesnt steal my stuff (i found 11 of my brand new shirts with tags still on in her storage space in her room...so i had to put a PADLOCK on it!)

thanks for listening to me vent, and thank u for your help.

ANSWER: Your ratings and comments were very kind - I was rather blunt w/ you.

I had misunderstood, or mis-read your first remarks, and thought she was at home WAITING for a halfway house for several weeks, after which she would do the daily program that she is in right now.  Sorry.

I don't - and you perhaps either - know how much your parents understand about bipolar, or any other issues that will be coming up over the next weeks and months.

I would like to have your mother write me.  If she doesn't, or until she does, I am DEPENDING on you to tell her that we have written and that I have made these recommendations:

I hope they already have some idea about what happens at the end of this six weeks?  How much training/learning will be provided to them?  What are the likeliest residential possibilities that will be open to your sister?  Also, has the program already begun an application for Soc Security disability for her?  Or will they be helping her to apply for Medicaid [or whatever IL calls Medicaid.]  Will they continue to act as a social worker in her behalf: help her apply for all Illinois programs...food stamps, rent assistance, etc??

And - I don't know how far away you are - will she continue to see a psychiatrist in Hoff Estates, or will they help you find someone nearer?  --- How much will her own health insurance pay; what will it pay for?  Not all health ins will cover all mental health costs forever; sometimes will cover only a very small lifetime amount.  And so - how will the meds get paid for til Medicaid kicks in???  [Though lithium alone will be affordable, probably.]

It may be necessary and/or practical for her to get some services and/or classes from a community mental health center.  To find the two closest to you, go to samhsa.gov.

Still for you, Mom:  to get good help and support for yourself, go to nami.org to see if there is a good NAMI affiliate near you. Choose one that has a family support group and start going - you will get so much help of all sorts, emotional and practical.  If you will need to have ongoing contacts w/ your daughter, you will want them to be successful and less stressful.  Pls see if a NAMI group near you is offering Family to Family, a free 12-week class that will change your life.   Do get the book by Woolis called When someone you love has a mental illness.....it will help you every day, I promise.

Still Mom:  I don't know if you HAD to pay those bills; I'm sure you had good advice, and it's water over the dam now anyway.  But I do get it -- how angry you are about the whole mess.  However, you and the rest of the family have her under your roof for now, and you must help her keep getting better...by learning about bipolar, responding in helpful ways.  See helpguide.org    The spending, and everything else that caused everyone so much grief in the past, were illness symptoms, they really were....and almost every irresponsible disruptive thing that she has probably done for years.

Right now, the family can help Alexian help her get better.

And this, Mom:  the Woolis book + NAMI enabled me to love my daughter again, by getting rid of my anger and confusion.

Now, Ioni:  we can't get you older than you are, so let's go w/ the you that you are today.  Your job here is to try hard to minimize the automatic "i hate her" expressions that come to you.  You can still think and feel them, but try to help her by not voicing them to her, by not doing things that you know will anger or upset her.  She honestly is very, very sick.  Her behavior should improve over time as the medicine begins working, and time does some healing, and the Alexian program helps her learn new ways to be.

These are really difficult illnesses, for the whole family, and they are truly, truly miserable for the patient.

Now - print just the part of this that you want your mom to see and give it to her - if she won't go ballistic.  If she might, then how about your dad, or any close friend or relative who knows about your sister and who will see that your mom gets this info.

I wish your sister a steady recovery, and I hope for a better year ahead for your whole family.

---------- FOLLOW-UP ----------

QUESTION: Hi Libby,

Can you respond back to me at . I am Loni's mom.  I do need some guidance with applying for medicaid, rent assistance, food stamps, the works.  My friend, Evie Klein, (Pschologist) has been helping Danielle with SSID. (What a process)  I find myself getting so angry at Danielle.  I don't know why. I do understand that she is sick and in many ways is still a child. They diagnosed her with type 2 bi-polar disorder with borderline tendencies. I also think she needs a lot of love.  It's been really hard on my other 2 kids. Danielle has done some terrible things from stealing to lying to whatever.  The financial end is just one part. I am off to purchase that book tomorrow and do want to sign up for that program. What do you think of Al-Anon?  My husband has no idea how to deal with this. Danielle has one course left and she will finish college with an English Lit degree. She's very bright.  You have been wonderful to Loni.  She loves you.  Let us know if we can talk on my email.

Hugs to you. You said something I couldn't believe. You learned to love your daughter again. I so need that.

Thanks Libby!  You make "Giving Back" an art.

Sheila

Answer
I'm not sure how much of the above you may already have seen.  Hope nothing that might be new offends anyone.

Let me start by saying that I can think of 30 or more reasons, right off the bat, why you get so angry w/ Danielle.  Parent anger is usual and customary.  Of course, you are angry....as you ought to be, and as will be at least 1/3 of the participants w/ you at Family to Family.  They and you will be very angry initially, but one hopes none will be by Week 12.  Until a class comes up, you can be fully listened to, and can vent and vent and vent, at a NAMI family support group.  You can find affiliates at nami.org.  They also list Fam-Fam classes there, but are not always up to date.  I would contact your closest affiliate and/or the NAMI state office about a class.

I do have a couple of questions.  She has only just been diagnosed in the last few weeks?  If so, many problems and difficulties for several years, I imagine, and a long, difficult time for your family. If she has had earlier diagnoses, or contacts w/ docs or psycholgists, pls fill me in.
Your husband: has given up on it, or usually leaves this sort of thing to you, or -- ?  Do you need more from him on this? - something NAMI might help you with.
Question: what has Alexiam offered your family so far, re family coping?  Do they help in that way?  You must milk every possible service from them that you can, so get more info about services, if needed.  [Like, what sort of help will they be providing her after these 6 weeks; who will her next doc be and whose job is it to find one, etc.]

I know of Al-Anon and its purposes. Have never attended, so can't answer.  My guess is that the one for kids might somehow fill some needs for your younger children...since NAMI can't help much there, but I find it hard to imagine better support for you than NAMI.  That's not partisanship:  it's that mental illness and its wide-spread consequences within families is why NAMI came into being.  And it has no real competitor begging to help you.

Your best help over these next weeks and months is not me, though you may write multiple times, but LOCAL persons and agencies.  Mental health services vary so much by state, or even within states, that the most practical, critically important info lies near you.  You also need to build a support network [even if it is only the NAMI group] of familiar, welcoming familiar real people - not virtual people like me!!

Most typically, much of your ongoing services will come from a community mental health center.  Find the two nearest at samhsa.gov.  One of your questions:  "do you have a supported employment program?"  If only one does, choose that one.  I hope you will be able to have Danielle w/ a private, not center, psychiatrist, but pvt docs can provide access to center services by writing an order for specific services or for any/all services.  Typically, anyway.  I fervently hope they will assign a social worker who can guide you to the other services you need, help you apply, etc.  And a social worker might be scheduled to see Danielle regularly, which would be excellent.

They also likely will have some ongoing programs to work w/ borderline pts, for whom meds are not usually very effective.  My daughter, who has bipolar w/ borderline 'traits,' feels that her never-ends class there help keep her on track.  Otherwise, there is cognitive behavioral therapy [name has changed a bit; can't recall] but finding bona fide folks w/ actual training, exp, and a track record may be tough.

I call your attention again so helpguide.org.  Such a lack-lustre name, and so too bad:  it has excellent wonderful material for families who want to be part of the solution.

Docs. If/as your relationship w/ Danielle improves, it might be good to go w/ her to some of her appts.  It will keep all three of you on the same page and get her off to a good start.  Do get a Release signed by her while you are there, if she agrees.  No secrets spilled; just the ability to exchange info w/ the doc.  NAMI, or your friend, can explain more.

Therapists.  Should you be seeing one?  How are you doing?  Could be only a few times, if you need it.  

Lapping back up to your email.  Danielle's illness and personality disorder have caused her to do and say some terrible things.  We hope the real Danielle will gradually return - but healing, and learning, take a very long time.  The Woolis book will help you tremendously in your day to day life, as everyone learns new ways to think and be.    ----  She may remain somewhat child-like for quite some time.  This has likely been brewing even as she ways making her way through some develpmental stages, and they will have been interupted....I see that w/ my daughter a lot.

And, re Danielle getting less ill.  This is chronic, and so there will be disappointments and set-backs amidst progress.  But - be hopeful.

Here is my parting shot, for today.  Mental health services are underfunded everywhere and, even in states where things are done a little better, there will never be enough to go around.  So - this has been my philosophy, which I commend to you:  Since there is not enough, I will elbow and push shamelessly to get more than my share.....which will leave me, if I am lucky, w/ the bare minimum needed to help Leslie get better and stay better.  

Good luck.  Hope Woolis is in hand, that samhsa and NAMI will get contacted ASAP.  I am still here and not going anywhere, so I await anything you need to say.  I just can't, and shouldn't, be THE person you rely on.