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Psychiatry & Psychology--General/Nephew needs psychiatric care?! How do I help?

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My 13 year old nephew recently made up a disturbing story, accusing a friend of his parents of raping his little (8 year old) sister and making him watch. He went into graphic detail and had all of us convinced enough that we were ready to call law enforcement. Then when we approached his mother (my sister) about it she said he was probably lying, that he had made up stories like this before, several times, just about himself rather than his sister. This was the first time it had involved her. So we talked with his sister about it, being careful not to "suggest" anything to her, but asking if anyone had ever touched her on her parts that her underwear covers, or anything else that made her feel uncomfortable like that, and she clearly had no clue what we were talking about, and had not shown any behavioral signs that anything unusual had happened. Eventually my nephew admitted it wasn't true. He didn't seem remorseful at all- but said he was sorry- but it was more like he knew he was supposed to be sorry so said that he was. I'm obviously very relieved that my neice wasn't violated, but also very concerned about the implications of this regarding my nephew's psychological state. We were told through a school diagnostician that he was on the autism spectrum. My sister has had him in some therapy and on some kind of medication because he had run away a number of times, and this therapist said he was bipolar, but my sister said she has yet to mention his story telling to the therapist. The therapy he's in is at some sort of clinic because they don't have insurance and can't afford to pay for care. I'm also concerned that my sister seems to be taking it all very lightly. I'm needing advice as to getting her to understand the seriousness of it, and that I'm not just overreacting to an innocent childhood lie. I Also need to find out what kind of resources might be available for low income families for something more serious like this- because when I suggested to her that she try to move up his next therapist appointment and address this immediately, she said they won't do that- that they're doing good to even get their usual appointment. And I don't know how much her seeming offhand approach may simply be because she doesn't think there are any resources to do anything about it and is overwhelmed with not knowing what else to do. Please help me figure out what to do. If I can bring her some information about resources she can access, hopefully she'll jump on it and take action. Otherwise I'm very concerned about my nephew, and also my neice, not knowing how much they may be alone together unsupervised, and if he may be a danger to her or even to himself or anyone else. He's not in public school- but enrolled in homeschool as far as I know, though I don't know how much supervision he gets on that either. His sister is in public school. I've seriously considered calling CPS, but hoping there's some way to handle it without having to go down that road. I Apologize that this information is all so scattered- I'm just trying to make sure I don't leave out anything that might be pertinent info. Thank you for any advice you can give.

Answer
Your nephew appears to be in the community clinic, which, unfortunately, may be all there is if the family has no insurance.  There may be a "Family Service Agency" in your area that might work on a sliding scale, or a medical school nearby where the psychiatry department will take some training cases, but otherwise mental health care is pretty poor.  CPS will do little to nothing if the mother is bringing the boy to all his scheduled appointments -- they won't have many resources either. If may be that a number of family members need to emphasize to your sister that she has a bed, and growing, problem. Certainly, this incident needs to be brought to the attention of the therapist as quickly as possible.

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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