Expert: Libby Bonner - 5/27/2009

Question
QUESTION: Hello our 16-1/2 year old stepson was diagnosed with Bi-Polar and PTSD last year after attempting suicide. He was hospitalized for 4 months - they gave him 300mg Wellbutrin, 40mg Celexa, 200mg Lamictal and 60mg of Geodon.  In Feb. he lost 30 lbs so they put him on Megaccee for anerexia. Then 2 weeks ago he got drunk and took a lighter and burnt 14 different areas of his body.  We believe he did that to cover up that he had jacked off at his 14 year old male friends house when his 14 year old sister and his friend were on the computer.  A 4 year old girl was also going in and out of the game room.  My daughter and her friend told our son to stop but he wouldn't, his friend finally threw a blanket over him.  I admitted him to another psych hospital but do not want him coming back to our home as he also wrote that he wanted to kill the parents of a 12 year old girl he had met and that in a year and a half he would move to her state and marry this girl (she would be 13-1/2 and our son would be 18) - he has written several inappropriate letters about girls.  What is a parent to do?

ANSWER: I am so terribly sorry.

To do right now or tomorrow:  speak w/ the social worker on the psych unit about residential facilities where he could go directly from the hospital; he would be discharged to that facility.  You are looking for somewhere that he can stay long enough for everyone to have a very good idea about how stable this boy can get, can stay, if the meds are right and if the meds are taken.  At that point - other decisions.

Tomorrow or today: Been in hosp how long now?  Was he taking meds between the two hospitalizations?  What does this doc think might be best meds, and will he be in hosp long enough for people to be able to know?  And/or:  is your son a candidate for ECT, electroshock therapy.  It's done quite differently today and is used quite a lot, w/ very sick people and/or people whom meds don't seem to help.

And - if he is transferred to a residential place, do you have a choice of psychiatrists and/or ask about who provides psychiatric care there.

Soon:  find a NAMI affiliate and start attending.  nami.org  Much practical and emotional support there.  You can't do this for long without NAMI.  
 
Money:  he will probably qualify for SSI and for Medicaid [or whatever your state calls Medicaid.]  The place where he goes next probably will help him/you apply.   -----  But also, your own insurance may have provision to 'grandfather' him into your policy, because of his becoming chronically ill as a minor; look into it.  But still apply for SSI.

THE MOST IMPORTANT THING.  Privacy laws kick in big-time for pts over 18 -- psychiatric patients particularly.  Unless you are his guardian by then, or some other legal status, you will lose entirely the ability to know ANYTHING PSYCHIATRIC OR MEDICAL that he doesn't want shared.  You could call a psych unit, hunting him, he could be there, and they would say they weren't able to tell you that he was OR wasn't there.  NO INFO AT ALL, no ability to check him into a hosp, no ability to talk to his doc.  You MUST put yourself in a legal position to still keep track of his care, or to have him hospitalized.  Check w/ your state NAMI office about what they recommend, or call your atty, or one that nami.org or the state office recommends.

Again, re the social worker OR NAMI, local or state.  States differ considerably in their mental health services and how they are organized and accessed.  Find out how your state works.  For instance, are services the same in all counties [centralized], or not.  Are there state mental health hospitals where the very sickest patients go for treatment - where are they, how good are they, could your son go?  [There are, unfortunately, no good forever-care facilites anymore.]  Or - how many medical schools are there in your state and/or convenient to you?  You might want your son transferred there to be evaluated if you think there is anything wrong w/ care or treatment or diagnoses to date but, from what you write, I suspect he has already been to a med school or had very appropriate care elsewhere....though you have chosen to place him elsewhere this time, for reasons I don't know.  So maybe you do want to pursue options.

Another source of info for you [I mainly think about adult pts as I write] is your school system or your state dept of human services, re: is there a long-term facility for minors w/ a good reputation.  That's where he needs to go, I now realize.  We have a couple very good ones in this state...but I'm not sure the maximum time patients can stay, nor where they would go at 18 if still quite ill.

That's it in a nutshell.  I would encourage you to address your questions to any reliable online resource where the emphasis is adolescent mental illness.  I don't know of one, but I do see that at one time I put Child and Adolescent Bipolar Foundation on my Fave list.  At worst, it might have useful links.

None of my info/comments above are invalid, but you definitely want to move on now to someone w/ expertise w/ HS age patients.

Your son/stepson is terribly ill and I will be thinking of you as you seek solutions.   It's hard to feel sympathetic w/ the "bad" behavior of the mental illnesses, but I hope you, and other family, will come to realize that this behavior is WAY beyond his control.

I wish you good luck.



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

QUESTION: Thank you so much for your fast response!  We live in OK.  I took our son to Pinnacle Pointe in Little Rock, AR it was rated the 2007 Psych. Hospital by Arkansas.  They took him off of the Wellbutrin and Celexa and put him on 700 mg of Lithium and 10mg of Abilify along with his Lamictal and Megaccee.  Do you know anyone who has burned themselves with a lighter 14 times?  Do you know anyone Bi-Polar who has had homicidal thoughts?  He was at a PSYCH. hospital in Tulsa for 4-1/2 months and had received counseling but he is never honest with his feelings.  The recent therapists told us he has no real true "self-identity" and that he tends to "objectify" everyone and has no value on human life and that is why he can hurt people and it has no effect on him.  I had heard some of the info. once he turns 18, however, I am EXHAUSTED mentally and physically with taking him to all the doctors, counseling appts etc with his father and the rest of his blood relatives not helping at all. He told us he burned himself because he thought it was "COOL."  I am afraid if he comes home he will think it is cool to burn his sisters or burn the house down.  I don't want him back home even though I do care about him.  It is a difficult position to be in.  A detective came to our home last week and said if they had found our son here they would have called DHS to remove our 2 girls for "failure to protect."  I have done everything I can for him and to protect our daughters but am at my wits end and am stressed out.  I feel like I am in a horrible scary movie that just doesn't end.  He has no remorse for anything he has done and his answer is "he just felt like doing it."  I will check into NAMI - I am so thankful you told me about it.  The therapist called me today they want me to do weekly therapy sessions (with a therapist close to me) and then to drive there once a month but it is 600 miles roundtrip and I cannot afford to do it nor do I have the time as it is over 4 hours each way.  I have asked some of his family members to step up and help me, his one grandmother offered to help with the monthly counseling sessions.  I wish I could blink and this would all go away but I cannot see myself being in this situation with him for the rest of his life - it would put me in the grave too early and I cannot sacrifice the lives of our two young daughters any more than I have, it is not fair to them.  Thank you for all of your help and informative information.

Answer
He is now in Pinncacle, right?  This sounds like a much better choice of meds.  The celexa and wellbutrin likely made him worse.

Counseling is not of much use to patients UNTIL they begin to get more stable w/ the help of meds.  It's like trying to teach algebra to 2-yr-olds -- they have no way to "get it."

What does Pinnacle say about the Tulsa diagnoses, bipolar and PSTD?  I am not a doc, but I question the bipolar diagnosis; don't know enough about your son's situation to have an opinion about the PSTD diagnosis.  [Well, maybe I should pay more attention: the meds he has been switched to suggest that Pinnacle is at least testing whether or not the bipolar is correct.  If he responds to the new meds, they are thinking, maybe he IS bipolar.]  I would think the self-injury and the homicidal thoughts have more to do w/ one or more of the "personality disorders."  You need to ask the therapist, or your son's doctor, whether he has psychopathy or sociopathy, or some variation like that.  It would fit w/ objectifying.  If the answer is Yes, ask what the consequences are, and the long-term outlook.

Does anyone where he is understand that you can lose your daughters if he is discharged to home?  Have you asked the social worker about alternative placements, instead of home discharge?  Tell the social worker about the daughters; ask whether you can refuse his return to you.  Be sure to ask about residential therapeutic facilities for children and adolescents.

You may need an atty to guide you in whether and how you can refuse to have him back....  I think that your poor son is a danger to you and probably to society....  If so, that should get some court's attention. Again, try to find an attorney who has some experience w/ issues of mental health treatments, or placement of the mentally ill, etc.  Try nami.org or your state NAMI office, listed at nami.org.

Hang onto the one grandmother willing to step up.  You need an ally.  Either or both of you should try to see if one of these NAMI classes is offered near you:  One is called Visions for Tomorrow; the other is called BASICS, I think.  I'm not sure which one is used in OK.  You will encounter other parents and caregivers there w/ stories maybe even scarier than yours....but you will be in a permanent network then, because probably after the classes have ended, there will be an ongoing monthly support group.

I think your answer to them re counseling is:  I simply can't make that trip; can't because of money and time; can't because I am close to exhaustion; can't because my son will not be coming home.

Do you have any idea how long he might be in the hosp?  That's another question for the social worker.  DO make contact w/ the social worker there.  DO see an atty soon.  DO get in contact w/ NAMI.

I feel for you, and I know how strung out you are, with all questions and no answers, and feeling hopeless.  You will probably feel some better just giving them a firm No about traveling for counseling, and better also when you make a firm decision about his return home.  Two big sprawling questions will have been answered.  But then you need to set things in motion so that he is NOT returned home.

Ah -- here is a way to maybe get some fast facts.  Ask the NAMI-OK office, the state office, for the name or email address of anyone teaching the classes that I mentioned.  [You might, or might not, find names at the nami.org website.]  If they hesitate at all, see if they will give your name and email to an instructor, so that she can get ahold of you.....if they hesitate on anything at all, tell them that your son is a danger, and you have to quickly start finding somewhere other than home for him, that you need to find a legal means of not having him back.

I wish I knew why so many children and adolescents are so very sick these days.  It is just awful, and it is a hideous nightmare for the individual families involved.

Write again if I can help.