When Your Adult Kid Won't Get Mental Health Services
September 5, 2018 3:20 AM Subscribe
Asking for a friend. Her 27 year old son recently had a rough breakup and it brought a lot of anxiety and depression and some mood destabilization to the surface. Two weeks ago, the son went to the ER for worrisome panic, was discharged, and it was recommended he attend a day program. The son has said he'll look into it, but he's done nothing.
In general, the son has been able to deal with his life's issues with sporadic therapy and medication and has been able to live a functional and generally happy life.
After the ER, the son told my friend he was on a waiting list for a day program, and my friend told him she wants to respect boundaries so is only asking for confirmation when he starts the program, and of course she's really pleased he's taking steps to feeling better.
The son called her last night to say hi and in the conversation mentioned he had not yet called his therapist for a referral.
My friend is pretty aware and understands she has no control here. All she can thinks she can do is to ask him to please get evaluated because she loves him and it's possible he could be happier. Or check in with his own therapist for an evaluation when he's not in crisis.
But she is starting to think that until he actually gets help, she can't really chat with him because she knows he's not well and he's avoiding therapy.
I have no advice for her and have come to you. What can she do to ease her own mind? Is there anything she can do to help her kid? How can I help my friend?
In general, the son has been able to deal with his life's issues with sporadic therapy and medication and has been able to live a functional and generally happy life.
After the ER, the son told my friend he was on a waiting list for a day program, and my friend told him she wants to respect boundaries so is only asking for confirmation when he starts the program, and of course she's really pleased he's taking steps to feeling better.
The son called her last night to say hi and in the conversation mentioned he had not yet called his therapist for a referral.
My friend is pretty aware and understands she has no control here. All she can thinks she can do is to ask him to please get evaluated because she loves him and it's possible he could be happier. Or check in with his own therapist for an evaluation when he's not in crisis.
But she is starting to think that until he actually gets help, she can't really chat with him because she knows he's not well and he's avoiding therapy.
I have no advice for her and have come to you. What can she do to ease her own mind? Is there anything she can do to help her kid? How can I help my friend?
What can she do to ease her own mind?
Might your friend consider getting therapy for herself? It's a tough situation and your friend could use some support. On the off chance that her son is refusing help in defiance against her, therapy for herself could also help illuminate that.
posted by redwaterman at 4:56 AM on September 5, 2018 [3 favorites]
Might your friend consider getting therapy for herself? It's a tough situation and your friend could use some support. On the off chance that her son is refusing help in defiance against her, therapy for herself could also help illuminate that.
posted by redwaterman at 4:56 AM on September 5, 2018 [3 favorites]
Best answer: "But she is starting to think that until he actually gets help, she can't really chat with him because she knows he's not well and he's avoiding therapy."
I...what? No, that sounds like a bad plan going forward. Cutting someone off because they don't follow the health care ideas that you have for them isn't helpful in the slightest, I'd tell your friend. The son may have a myriad of reasons as to why he didn't seek therapy right away, but saying you can't talk to him until he goes into formal therapy after a "worrisome panic" (what does that mean? He wasn't put in for a 3-day, so it doesn't sound like suicidal ideation, as it's handled in the ER) just sounds like tough love gone awry.
The son is an adult, and the best thing I can think of is to be supportive and encourage him to take advantage of whatever health options he has available, but don't cut him off because he's not following the mother's preferred plan of action.
posted by xingcat at 5:57 AM on September 5, 2018 [19 favorites]
I...what? No, that sounds like a bad plan going forward. Cutting someone off because they don't follow the health care ideas that you have for them isn't helpful in the slightest, I'd tell your friend. The son may have a myriad of reasons as to why he didn't seek therapy right away, but saying you can't talk to him until he goes into formal therapy after a "worrisome panic" (what does that mean? He wasn't put in for a 3-day, so it doesn't sound like suicidal ideation, as it's handled in the ER) just sounds like tough love gone awry.
The son is an adult, and the best thing I can think of is to be supportive and encourage him to take advantage of whatever health options he has available, but don't cut him off because he's not following the mother's preferred plan of action.
posted by xingcat at 5:57 AM on September 5, 2018 [19 favorites]
I'm in a similar situation... through getting therapy myself (which I would recommend to her -- being the support person in this scenario is HARD!), I was able to realize that nagging will not work. She told him once, he heard her, he is choosing not to take action. It's incredibly frustrating to watch someone suffer when you think you know what the solution is, and if they would only do what you want them to do then everything would be better.
What you can do is be present for that loved one, listen to them, and let them live their own life and make their own decisions. I think avoiding contact while he's unwell is not going to be helpful - it's another form of nagging. It's not going to get him to do what she wants him to do.
posted by Fig at 7:06 AM on September 5, 2018 [3 favorites]
What you can do is be present for that loved one, listen to them, and let them live their own life and make their own decisions. I think avoiding contact while he's unwell is not going to be helpful - it's another form of nagging. It's not going to get him to do what she wants him to do.
posted by Fig at 7:06 AM on September 5, 2018 [3 favorites]
Best answer: As someone who is mentally ill, I could only dream of a parent caring this much about my mental health and well-being. So right there, your friend is ahead of the curve.
That said, day programs and other intensive care are expensive and life-disrupting. There could be good, practical reasons why Son is not in a place to pursue that right now. Since he sounds like an independent adult, she will need to respect those reasons.
Hard seconding everyone who has said she needs a therapist herself. Watching a loved one struggle is challenging, and the more self-care she does, the better she will be equipped to be there for her son when he asks her to be.
posted by coffeeand at 7:13 AM on September 5, 2018 [6 favorites]
That said, day programs and other intensive care are expensive and life-disrupting. There could be good, practical reasons why Son is not in a place to pursue that right now. Since he sounds like an independent adult, she will need to respect those reasons.
Hard seconding everyone who has said she needs a therapist herself. Watching a loved one struggle is challenging, and the more self-care she does, the better she will be equipped to be there for her son when he asks her to be.
posted by coffeeand at 7:13 AM on September 5, 2018 [6 favorites]
Best answer: Is your friend in touch with NAMI? That is THE organization for helping parents navigate this kind of thing.
posted by FencingGal at 7:22 AM on September 5, 2018 [1 favorite]
posted by FencingGal at 7:22 AM on September 5, 2018 [1 favorite]
Intensive outpatient programs can be great. They are also, yes, expensive and very difficult to schedule around holding down a job, and can require one to give up one's current care providers to start over with the program's - in short, I heartily recommend them to people in crisis, but based on the scanty info here, it sounds like quite possibly overkill for his situation. Staying in therapy seems like the key thing here, and certainly discussing the recommendation with his regular therapist, who will know better than we (or his mother) can whether an outpatient program is actually a useful recommendation for him at this stage, or would be more destabilizing than helpful.
Your friend is on the right path as far as thinking about how to take care of herself and set her own boundaries as well as respecting his, but she could use some guidance in doing that. I tend to think that cutting someone off from one of the support systems they do have is a fairly last-ditch move. If talking to her son is harming her in some way, then yes, absolutely, cut him off if she needs to do so to preserve her own stability. If she just thinks that's the way to hammer home what she thinks he should be doing? I wouldn't recommend that as a good move. Unlikely to help, may in fact be harmful.
Therapy for her is a great suggestion, and that therapist can help her figure out what reasonable and appropriate boundaries are in her situation. It would possibly also be really helpful to her to find a support group for family members of people with mental health issues. Those support groups can be hard to track down but if she can find one, she might find it to be a very good outlet for talking through her feelings with others who have been there and understand what she's going through.
posted by Stacey at 7:27 AM on September 5, 2018 [2 favorites]
Your friend is on the right path as far as thinking about how to take care of herself and set her own boundaries as well as respecting his, but she could use some guidance in doing that. I tend to think that cutting someone off from one of the support systems they do have is a fairly last-ditch move. If talking to her son is harming her in some way, then yes, absolutely, cut him off if she needs to do so to preserve her own stability. If she just thinks that's the way to hammer home what she thinks he should be doing? I wouldn't recommend that as a good move. Unlikely to help, may in fact be harmful.
Therapy for her is a great suggestion, and that therapist can help her figure out what reasonable and appropriate boundaries are in her situation. It would possibly also be really helpful to her to find a support group for family members of people with mental health issues. Those support groups can be hard to track down but if she can find one, she might find it to be a very good outlet for talking through her feelings with others who have been there and understand what she's going through.
posted by Stacey at 7:27 AM on September 5, 2018 [2 favorites]
Best answer: In general, the son has been able to deal with his life's issues with sporadic therapy and medication and has been able to live a functional and generally happy life.
It sounds like he’s got things under control. And speaking from personal experience, that sometimes entails allowing yourself to be uncomfortable until you’re ready to deal with a therapist or a group or anything else.
My advice for your friend would be "Don’t push the river", and probably to look into some short-term therapy for herself.
posted by Tell Me No Lies at 8:42 AM on September 5, 2018 [3 favorites]
It sounds like he’s got things under control. And speaking from personal experience, that sometimes entails allowing yourself to be uncomfortable until you’re ready to deal with a therapist or a group or anything else.
My advice for your friend would be "Don’t push the river", and probably to look into some short-term therapy for herself.
posted by Tell Me No Lies at 8:42 AM on September 5, 2018 [3 favorites]
Best answer: Her 27 year old son recently had a rough breakup and it brought a lot of anxiety and depression and some mood destabilization to the surface.
It's a rough breakup. People with mental health issues are going to be worse off compared to their normal the same way that everybody else is worse off compared to their normal during times like this. I've never done a day program for my anxiety crud, and I honestly can't imagine doing so. Unless we mean "recently" like six months ago, which it doesn't sound like this is the case, he needs time for this grief process the way that anybody else does. More intensive care is useful when someone's actually a danger to themselves, but just being a mess is not itself that. Of course he's not okay! He just had a bad breakup! It needs to be okay for him to be not okay for awhile without that by itself being the crisis. If he's not improving significantly within a month or two post-breakup then that's some room for concern, but I don't see any reason to take a hard line on this right now.
Of course he could be happier, but the thing that's made him unhappy is not something within anybody's control right now. Breakups like this suck for everybody and take time to get over. If he's not unsafe or in danger of losing his job at this point, it's time to relax and let time do some of the healing. Therapists are great, I totally believe in therapists, but they're an expensive way to process grief when the wounds are still raw.
posted by Sequence at 9:36 AM on September 5, 2018 [6 favorites]
It's a rough breakup. People with mental health issues are going to be worse off compared to their normal the same way that everybody else is worse off compared to their normal during times like this. I've never done a day program for my anxiety crud, and I honestly can't imagine doing so. Unless we mean "recently" like six months ago, which it doesn't sound like this is the case, he needs time for this grief process the way that anybody else does. More intensive care is useful when someone's actually a danger to themselves, but just being a mess is not itself that. Of course he's not okay! He just had a bad breakup! It needs to be okay for him to be not okay for awhile without that by itself being the crisis. If he's not improving significantly within a month or two post-breakup then that's some room for concern, but I don't see any reason to take a hard line on this right now.
Of course he could be happier, but the thing that's made him unhappy is not something within anybody's control right now. Breakups like this suck for everybody and take time to get over. If he's not unsafe or in danger of losing his job at this point, it's time to relax and let time do some of the healing. Therapists are great, I totally believe in therapists, but they're an expensive way to process grief when the wounds are still raw.
posted by Sequence at 9:36 AM on September 5, 2018 [6 favorites]
Best answer: "But she is starting to think that until he actually gets help, she can't really chat with him because she knows he's not well and he's avoiding therapy."
If this is for her own sake, as in, the way he speaks or behaves causes her deep distress and for her own mental stability she can't do it, that is absolutely her boundary to set.
BUT, the condition for renewed contact in that case can't be "you get the exact mental health care I demand." It would have to be something more like, "as your mother, it causes me incredible pain to hear you talk about [distressing thought/action]. I cannot have conversations with you where you bring [distressing subject] up repeatedly."
If his behavior is not distressing -- that is, if he generally sounds OK and functioning (albeit sad and anxious) -- and it's just that she feels he is not following someone's directions ...that sounds like an anxiety of her own that she needs to resolve internally.
I will say that several people have, over the years, cut me off completely during mental health crises. I was hurt at the time, but now recognize that they acted to preserve their own mental health and were well within their rights. The relationships have not been restored to their previous states, but they exist in a new form now. Your friend should know that making a break like this may be an irreversible change even if it is not necessarily a change for the worse.
posted by We put our faith in Blast Hardcheese at 10:58 AM on September 5, 2018 [4 favorites]
If this is for her own sake, as in, the way he speaks or behaves causes her deep distress and for her own mental stability she can't do it, that is absolutely her boundary to set.
BUT, the condition for renewed contact in that case can't be "you get the exact mental health care I demand." It would have to be something more like, "as your mother, it causes me incredible pain to hear you talk about [distressing thought/action]. I cannot have conversations with you where you bring [distressing subject] up repeatedly."
If his behavior is not distressing -- that is, if he generally sounds OK and functioning (albeit sad and anxious) -- and it's just that she feels he is not following someone's directions ...that sounds like an anxiety of her own that she needs to resolve internally.
I will say that several people have, over the years, cut me off completely during mental health crises. I was hurt at the time, but now recognize that they acted to preserve their own mental health and were well within their rights. The relationships have not been restored to their previous states, but they exist in a new form now. Your friend should know that making a break like this may be an irreversible change even if it is not necessarily a change for the worse.
posted by We put our faith in Blast Hardcheese at 10:58 AM on September 5, 2018 [4 favorites]
Best answer: my friend told him she wants to respect boundaries so is only asking for confirmation when he starts the program, and of course she's really pleased he's taking steps to feeling better.
My partner has a son about that age with somewhat more serious mental health issues that he manages. His son is compliant with medication stuff but not always with "suggested" therapy stuff. That is basically how mental health stuff works a lot of the time, you're up and you're down and everyone tries to do the best they can. However, support networks are very very important.
What I am hearing your friend saying is that she wants to respect his boundaries, only she basically doesn't. What I hear your friend saying is that her son not getting more intensive therapy is causing her some sort of anxiety that is interfering with her life. Mental health stuff often runs in families. Your friend could probably benefit from one of the NAMI support groups that are specifically for helping family members of people with mental illnesses come to terms with the "It's a marathon not a sprint" aspect of all of this.
I think if you want to help you can be supportive of your friend, encourage her to keep in touch with her son (he's calling her? that is great! He is honest with her? also great) and maybe offering to go to a NAMI support group with her because it sounds like she could use some help.
posted by jessamyn at 12:37 PM on September 6, 2018
My partner has a son about that age with somewhat more serious mental health issues that he manages. His son is compliant with medication stuff but not always with "suggested" therapy stuff. That is basically how mental health stuff works a lot of the time, you're up and you're down and everyone tries to do the best they can. However, support networks are very very important.
What I am hearing your friend saying is that she wants to respect his boundaries, only she basically doesn't. What I hear your friend saying is that her son not getting more intensive therapy is causing her some sort of anxiety that is interfering with her life. Mental health stuff often runs in families. Your friend could probably benefit from one of the NAMI support groups that are specifically for helping family members of people with mental illnesses come to terms with the "It's a marathon not a sprint" aspect of all of this.
I think if you want to help you can be supportive of your friend, encourage her to keep in touch with her son (he's calling her? that is great! He is honest with her? also great) and maybe offering to go to a NAMI support group with her because it sounds like she could use some help.
posted by jessamyn at 12:37 PM on September 6, 2018
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One ER visit for panic (not depression, or suicidality ) but panic is... Well within the norms for functioning with a panic disorder . And in full blown panic one really does think they are dying.
Sounds like a recent emotional event happened. To consider next steps, questions like is he employed, eating, sleeping? Is he having suicidal thoughts? The more things change from his baseline the more concerned to be, but also being very upset two weeks after a break up can be well within the range of normal.
Unless there is something going on not mentioned here, it may just be a good idea to provide wanted emotional support and keep opinions on therapy to oneself. Nothing written here send off alarm bells that this person needs to be in a day program ASAP.
(Note history of a pevious suicide attempts wound change my answer towards more treatment is better sooner than later)
posted by AlexiaSky at 3:35 AM on September 5, 2018 [13 favorites]