Expert: Libby Bonner - 1/21/2010

Question
Dear Expert,
My daughter is 21 years old. She was diagnosed with bipolar when she was 16. Borderline personality disorder "tendencies" was a secondary diagnosis. It has been an up hill battle with my daughter. She has been hospitalized several times and spent almost 18 months in residential treatment out of state--all this was when she was a minor-15-17. She showed signs of problems earlier in her life,but we did not know enough to intervene sooner.
She had a baby boy 4 months ago with an abusive boyfriend. After trying to make things work with her boyfriend, she left him after his abuse to her (punched her in the face) and her baby--hit the baby and threatened to throw the baby over a cliff. Police reports, restraining orders filed, etc. During her time with this guy, they spent a year moving from place to place living off people. The day the baby was born, my daughter was getting this guy out of jail in the morning. Once the baby was born, she has left the baby several times with his mother and times with people she hardly knew. When the last abuse cycle occurred, she came to us for protection. We have taken her in with the baby. However, for the last two months, she will take off for days at a time, not tell us where she is. She doesn't even ask about the baby. A social worker became involved because of the abuse to her baby. She refused to meet with him following his several phone calls to her phone. When she returned the last time, we told her if she leaves again for days at a time, we will not let her back into the house. The social worker agreed that given her volitile behavior, these conditions were necessary for the protection of the child. She stayed with us againf or 5 days and then left through her bedroom window with a text mail to my cell saying "she left." She has been gone a week now. I text her cell phone to ask her of her whereabouts and she answers she is OK, but won't tell me where she is. Today, she is saying she wants to come home..she is sick and throwing up. She says she is staying with a friend. I told her briefly that she needs outside psychiatric and counseling help..that we were not qualified to help her at this point. I texted her that I love her and want her to seek help.  I have tried to find help for her today--calling NAMI for example.  She is getting help from the county for her and baby and food stamps--these will stop soon if she is not really with her baby. We have been advised by social services to get guardianship and we are in the process of doing the paperwork with Catholic charities helping us. I am extremely worried, anxious about her. I want to welcome her back with conditions--although conditions and setting limits have not helped for years. I worry she is getting sicker and sicker--with her mental illness.She has gotten 3 tatoos over the last month--a large one on her back and one on each wrist that are noted to be gang affiliated. She has denied gang affiliation when confronted. Her ex abusive boyfriend is in a gang. I feel that I need to continue to try to help. Advise, please. Thank you for reading this.  

Answer
You are getting guardianship of your daughter?  What plans are there for the baby?

I hope you will get completely involved with NAMI - they are going to be your lifeline.

You are right not to let her come home.....no one would benefit and your homelife would get worse.  You were wise to tell her that you are not qualified to help her; keep repeating that to her.  It's a good message for her to hear.  Insofar as a mother's heart can, I would keep inquiries about her whereabouts and activities to a minimum, wouldn't initiate many inquiries, and I would not display a great deal of interest in tales of illness, true or not.

There are NO conditions that you would set that she can or will meet.  She is irrational, maybe on drugs, and NOT amenable to rational discourse.  I do know how worried and anxious you are, but she is, truly, entirely beyond your help right now.

Stay focused on those things where your actions will make a difference, and stay focused on taking good care of yourself.

This might help w/ the legal side.  Go to treatmentadvocacycenter.org.  They support involuntary out-patient treatment, and have a page per state showing what is permitted where you live.  It may guide some of you thinking.

How far are you from a university w/ a med school?  There is a new talk therapy used w/ borderlines, and they may have someone there who is trained in it, or know of others nearer you who practice it.  There is also a good new book on borderline....I will have to look up both and write back.

You mentioned trying to find help for her today.  The most helpful Yellow Pages listings might be Human Services or possibly clinics.  If there is a United Way that covers your area, call them to ask for the names of any on their list who deal w/ social issues:  mental and emotional; counseling; shelters; homelessness, etc.

Do you have a community mental health center?  Is there anyone there who could advise you?  That is a likely treatment source for her.  She needs a doc, a therapist, a social worker, a caseworker, etc.  You might want to get familiar w/ programs/services, costs, waiting lists, etc. Not sure what her situation is re payment.  Their clients are usually on some sort of disability...could be a barrier to getting her treated......unless she is already SSI, w/ her long history?

The other money question worth pursuing is whether she can be grandfathered onto your or your husband's health insurance, since her illness is chronic and predates her turning 18.

I hope, if you need it, you will try to access some counseling for yourself.  Or give yourself some breaks:  take a leave from some obligations, if possible.

I will write again w/ the borderline treatment info.

BACK AGAIN.  THE TREAMENT METHOD is called dialectical behavioral therapy, and is related to cognitive behavioral therapy.  A source that I checked mentioned that it is often used in group settings, which might be easier to find and less expensive than single-pt therapy.  If you will go to amazon.com and look up books by Randi Kreger, you will find the very popular Stop Walking on Eggshells, and a couple closely related to it, by the same author.  I found the reader reviews to be very helpful.     ----  However, though any may be of some help to you right now, I wouldn't plan to have her in your home again until her situation is much different, and she is in some sort of treatment.  They may help you now in your communications with her, or even in making plans and decisions about her.