Expert: Libby Bonner - 6/3/2008

Question
My son is 28 years old. This is a very long story, but I'll condense it.  After many years of ups and downs, job losses, legal problems, alcohol abuse, constant marijuana use my son hit bottomed and was threatening suicide. he ended up in 3 psychiatric emergency rooms in one week begging for help, but each time the psych. on call determined he was just manipulative due to drugs. He was mainly on alcohol, marijuana and aderol abuse. He was never diagnosed and therefore was never on the correct meds in my opinion.  He agreed to enter rehab in California and after 30 days of success he flipped out and they sent him to the hospital there. he has been in the psych ward under lock down for 3 days and has been diagnosed as bipolar. He is on depakote 1,000 mg per day.  as of today, they are intending to release him. he has no where to go.  we (my ex and me) have told him after the last downward spiral that he could not come home, that we would not offer him a place to live. we were told to do this as we were told we were enabling him.  so, right now, he is going to be put out on the streets with nowhere to go. the rehab will not take him back (I'm out 7,000 dollars for that)  am i doing the right thing not letting him come home? I don't want him to do something to himself, but I also don't want to enable him and have him go back to his former ways. I'm totally at a loss.  He has only been on the depakote for 3 days, so obviously it has not taken effect.  My main question is, with people like this even though they are 28 should you just say, "you're on your own" and have them become homeless, or should I send him money to fly home and give him a place to live?  He has not been able to hold down a job for a few years. Thank you for your help, I'm at the end of my rope.

Answer
These are additions to my earlier remarks, written in haste. See below: asterisks.

It's likely that he has been ill for years and that much of the 'bad behavior' was really symptoms of his illness.  It's common for bipolars to have delayed diagnoses.  It's also common for them to try to get relief from their illness through substance abuse, "self-medicating."  He probably 'flipped out' during his apparently successful detox/rehab because he again was left w/ no "meds," and his symptoms once again became intolerable.

This is such a usual story - I hope you won't blame yourself now, with hindsight and better information.   

I hope you will be able to get him home and give him a place to live - though not w/ you....that's a pretty tough situation.  Any other housing would be preferable.

His other continuing need will be to get plugged into mental health care and classes/training and patient support groups.  In NAMI-speak, by the way, pts prefer to be called "consumers," and you will see that language throughout NAMI messages.

The care and training would likely come from a community mental health center, where he may also be assigned a social worker to help him regularly w/ problems of daily living.

How to get a psychiatrist?  You can get care via a mental health center, but a private doc is likely to be preferable - they are likely to be available more flexibly than the every 30-60 days appts common to centers.  When pts are being stabilized, or meds are being changed, you need more frequent access - or at least to the psychiatrist's nurse.

As for his expenses.  Someone can help him make an application for SSI, or - if he has been employed for 40 quarters [doesn't have to be continuous employment, but does have to be employment that  withheld taxes] - he might eventually qualify for SSDI, which might be a larger amount.  Ask your local NAMI to explain or contact a Soc Security office, and/or ask someone from  a local office of your state's Dept of Human Services.

Check also to see how soon SSI or SSDI would connect him up to Medicaid and/or Medicare.  If there is an interim period when he is without health insurance, there may be free clinics where you live, or large hospitals may offer some indigent care programs.  Some manufacturers will give free meds....see pparx.org

You'll have a lot of learning to do, but NAMI can help.  Most parents have useful experience w/ the resources in your community and are glad to share.

If no NAMI, call United Way to see what agencies might have applicable services, and then follow up.

I had mentioned privacy.  Because he is an adult, it is common for families to be completely unable to get info about their child....unless the child has signed a Release of Info naming them as an OK contact.  You seem to have accurate current info on what's going on, so perhaps Release/s are already in place.  Do try to get them w/ every one of his providers once he is home again; the releases may have to be renewed annually.

NAMI has two programs for consumers.  One is a class called Peer to Peer, 6-8 weeks, not sure, and it's free.  A new program, Connections, also free, is weekly consumer meeting led by a trained consumer.  It's really important that he have peer contacts.

NAMI also has a fabulous, free, 12-wk class, Family to Family.  I hope that you will be able to take it when you are ready.  It will give you much info, contact w/ other parents, and tools to use to help your son effectively - parents rave about this class.  It has helped thousands.   Good to have your ex take it at some point, once  he begins to have some belief that this is a very sick kid who was "bad" pretty involuntarily - his bad behavior arose out of mixed-up brain chemistry.

It's also possible that your son may be able to work, at least part-time, once he is feeling better and is stable on meds, and it's possible that support will be available from the community mental health center, or some other agency, to help him find and keep work.

***************************

I wish I had more time but am rushed.  Here is a short answer and will send more ASAP, possibly later today.

The bipolar diagnosis has changed everything.  Your irresponsible, etc., son [for whom tough love, etc., might have been good] turns out to be your son with a "serious and persistant mental illness" and may need 'help' of various sorts for some time.

IF he is still in the hosp, contact the Cal NAMI state office and see if they can give you the name of an atty there who could maybe intervene in the release.....though I doubt it; son was probably in on a "72-hr hold."   Nami.org may also have atty names.  Whether in or out, ask state office, or contact a NAMI affiliate in the city nearest to him to see whether there is any agency capable of stepping in right now - to house him, or guide him to help or whatever.

You also- here's a good idea - can check online Yellow Pages for Crisis Lines where he is. They might have better immediate help even than NAMI.

Gotta go soon.  Use a credit card and get him a place to stay until you get a better plan, and also find a way to get him some MacDonald or other GIFT CARDS.  Pick a motel w/ food close by and get him coupons for wherever is close.  

If you and he are on the outs - and there is someone that he likes better right now - have them be the one to apparently make these arrangements.  Be sure he has a way to get to the motel.  Ask hosp social service: nearest cheap motel, et.c

Think you should get him back near you - we'll talk.  Someone may have to fly out to come back w/ him.  He's not functioning very well right now, probably.

Last thought.  Crisis line or hosp soc serv probably/maybe the best bets to identify the nearby motel, how to get him there, etc.

Good luck.  More later.  Remind me to address privacy and docs and mental illness.