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Psychiatry & Psychology--General/Brain Injury with Pscychiatric Behavioral Issues

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Question
Hello,
I have sister who is 49.She has a brain injury from car accident when she was 5. We live in Philadelphia area.She has lived with parents her whole life. She is legally blind,and has left hemiparesis. Cognitively high functioning , but has periods of major self harm episodes like cutting,swallowing items like paperclips when she reaches an extreme state of anxiety over something as well as impulse control issues and when this happens she wants to get away and will be physical if you try to stop her.This happens maybe every couple years, and she will end up at pscych facility. We have been doing fairly well and she has been going to day program for brain injury with intent for residential living as we just got commcare waiver. Unfortunately, she had major episode last week. Ended up in regular hospital, try to get away and hit security and cut herself than fell and got stitches.No psychiatric hospital will take her. No brain injury facility will take her. We are told she is a liability and they don't take people who self harm. BRain injury place and pyschologist has washed their hands of her. What are we supposed to do?? She can't be only brain injured person who acts out periodically? We are desperate as a family . I appreciate any thoughts or suggestions you may have.

Answer
There is no easy solution here. So please excuse me for being blunt in this short email: of course, if this were face to face I might have the luxury of being less shocking in my suggestion.

This is not something a family or individuals can handle; only the state has the resources to handle this type of situation.  This means family members, like hospitals and the like, must say they can no longer be responsible, can no longer care for her, and when she is admitted somewhere they have to be clear to those in charge that they will not be taking them home and the state MUST place her somewhere. They need to stop visiting for some time, stop taking phone calls from the facility -- the family must, for the time, abandon her. She gets admitted to a hospital, you pack up all her clothes and other property, you deliver them to the hospital, and you go on vacation for month (and I do mean get away, or they will send people to your house).

The usual problem I have is the parents saying, "I will not abandon my child," even though they also do not have the resources to take care of the adult child, and so the state breathes a sigh of relief and just walks away.  Your parents (and you) have the right to walk away, the state does not, but the state will continue to walk away as long as you accept responsiblity.  For a half century you have tried to care for her; to be blunt, it is not working now.  You need to walk away.

Once you walk away, the state has no option but to find a placement, and let me reassure you that they will.  You may not like the placement, but they will.  At that time, you can re-insert yourselves into her life but beginning to visit, bringing her favorite foods, etc.

In the long run, this will be much better for your sister.  The short run, however, will be hell for everyone.

Psychiatry & Psychology--General

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Daniel S. Harrop, M.D.

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Dr. Daniel S. Harrop received his B.A. and his M.D., both from Brown, and his M.B.A. from the Edinburgh Business School, Scotland. Board-certified in adult and geriatric psychiatry, he is a past president of the R.I. Psychiatric Society and a member of the Committee on Medical Quality of the American Psychiatric Association and the Committee on Continuing Medical Education of the R.I Medical Society. He serves as a consultant to four of the top five major medical management companies, including OptumHealth/United Healthcare, Magellan Behavioral Health Services, ValueOptions and APS Healthcare, and maintains a private practice in Providence, R.I. He also serves as chief psychiatric consultant on the Medical Advisory Board at the R.I. Workers Compensation Court. He was formerly on the faculty at the medical schools at both Brown University and Harvard University.

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