Supporting someone in psychiatric care
August 30, 2012 9:38 AM   Subscribe

My brother is being admitted to an inpatient facility. How can I support him, and can you calm me down about the long-term picture?

My brother has agreed to be voluntarily admitted for psychiatric treatment. He proposed this while also verbalising the threat of suicide we've all known has been around for some time.

He's got a long history of depression (he's in his late 20s), not helped by a near-fatal head injury several years ago, and with a recurring element of addiction (currently just alcohol as far as I know). He's a very smart, highly sensitive guy who is often extremely angry but tends to be very close to animals, children and older people. He comes across as much stronger than he feels.

He didn't finish school and has a patchy work history due to not being able to cope, but every time he's taken a course or something, he's been singled out as extraordinarily bright. He doesn't care, though, and it feels like an extreme situation of failure-to-launch coupled with the apathy that comes from long-term depression. He has never been financially independent.

As support, he has some good close friends, me (older sibling) and my parents (divorced but amicable), all of whom love him hugely and are living reasonably addiction-free and stable lives. Depression and anxiety are common to the whole family.

So, two questions.
1. If you've been in psychiatric care or had experience supporting an inpatient, what would you recommend? Please assume he'll have as many visitors as he can have/wants to have and nobody's expecting miracles.
2. Long-term, I worry very much. I keep thinking that if only he could get over the hump, he'd thrive, but I don't know and I worry about (a) suicide, or (b) his welfare when neither parent can look after him. Any experiences, cautions or good news stories would be hugely helpful.

Throwaway email at
posted by anonymous to Human Relations (22 answers total) 5 users marked this as a favorite
I think it would be very very helpful - if the inpatient facility isn't already suggesting this - if he saw a neurologist. The personality changes resulting from head injury are a big deal, and if his stability is changing then his neurological status may be changing also (not necessarily in a bad way, but neuro changes tend to be hard to go through even if it's ultimately positive).
posted by Lyn Never at 9:51 AM on August 30, 2012 [3 favorites]

1. If you've been in psychiatric care or had experience supporting an inpatient, what would you recommend? Please assume he'll have as many visitors as he can have/wants to have and nobody's expecting miracles.

Have people show up and hang out like it's not big deal. Talk about politics, what's on tv, latest movies, what's going on in the visitor's life, etc. Bring him a stuffed animal. Are there kids in the family that he bonds well with? Bring them too, since he likes kids and animals.

He knows he is sick and probably gets tired talking and thinking about his illness all the time. So reminders that he's more than just a depressed person would be good. Bring his favorite books or movies or favorites foods, etc. Check that the facility will allow these things, before you tell him that you're bringing them. Disappointment sucks at a time like this.

2. Long-term, I worry very much. I keep thinking that if only he could get over the hump, he'd thrive, but I don't know and I worry about (a) suicide, or (b) his welfare when neither parent can look after him. Any experiences, cautions or good news stories would be hugely helpful.

Don't think of this as getting over a hump. This may be who he is, for the rest of his life, struggling with an illness. Love him as he is now and let him know you're there for him, always.
posted by Brandon Blatcher at 10:02 AM on August 30, 2012 [11 favorites]

For the long term:

Look for resources for "twice exceptional" kids/adults. Bright people who consistently fail to live up to their potential frequently have hidden or undiagnosed/unrecognized handicaps. The severity of the handicap is typically masked by the high IQ, which leads them to have "average" performance at best. For someone very bright, this is a form of torture.

For the short term:
Be sympathetic if he bitches about the inpatient care situation. It probably is as frustrating and ineffectual as he claims it is.

I spent ten days in a psychiatric facility in my teens. I found it frustrating and stupid and ineffectual. Only the director was bright enough to be genuinely helpful to me. In my case, I basically manipulated the system as a means to advocate for myself at a time when I was underage, thus had no legal right to advocate for myself or make important decisions about my own life. I got what I needed from it because it was a means to force relatives to deal with my problems, relatives who wanted to sweep the fact that I had been molested under the rug. I was not an addict or a chronic underacheiver. I was initially treated by people like I must be there because I was some kind of fuck up. After hearing my story, some people changed their tune.

I say that to say this: We all have a backstory. If there is something very wrong in our lives, there was almost certainly something important missed by the adults in our lives when we were still kids. Instead of blaming him, which you may not be doing but most people would, try to understand him as a victim of circumstance. He is probably more frustrated by his own history than you are. Seeing him as an innocent victim of circumstance is more likely to help you help him than the standard modus operandi of the world which is generally blaming and dismissive.

Best of luck.
posted by Michele in California at 10:15 AM on August 30, 2012 [3 favorites]

1. If you've been in psychiatric care or had experience supporting an inpatient, what would you recommend?

Seconding Brandon Blatcher -- have people come by and hang out, without talking about his depression as that will be the main topic of most of his conversations while there (with staff, social workers, doctors, and other patients). Bring thing with which he can occupy himself, books, movies, and such, but be sure to clear it with the facility first. From the few times I've been admitted, the biggest takeaway from the experience was just how boring being an inpatient at a psychiatric hospital is.
posted by The Great Big Mulp at 10:16 AM on August 30, 2012 [1 favorite]

Be careful about inviting visitors for him. Get his okay first. (I spent a week in a state hospital and was utterly freaked out by an aunt's coming to see me there. We weren't close and she cried and I wanted to hide under my bed.)
posted by Carol Anne at 10:18 AM on August 30, 2012 [7 favorites]

Nthing Brandon Blatcher. I spent months, years, filling my head with "if only he could get over the hump, he'd thrive." And he never did, and I wasted years obsessing over what I thought he should do, and not what the reality of the situation was. It probably didn't help him any either; he was well aware of his shortcomings. As BB says, this could be who he is, and all you can do is be supportive.
posted by Melismata at 10:20 AM on August 30, 2012 [1 favorite]

Talk to your brother about what he wants. Inpatient treatment can be emotionally intense. I was in and out for a bit -- no one was even sure if I would be able to be independent. But I've not been back inpatient in 15 years (knock on wood) and came through the other side.

At any rate, sometimes I did not want visitors, I was too wiped out and felt too raw to deal with other people. I tended to feel like I had to be "ok" for any visitors even if I was barely holding myself together.

When I was better, visitors that came to hang out with me helped reassure me that I was still "acceptable" to the outside world. Oh, and non institutional food was welcome :) (Warning: only to some extent though, I spent a lot of years in shock that anyone would want to socialize or work with me that was not also a psych patient. From my experience and talking to other psych patients, it's not an uncommon result of repeat hospitalizations. Inpatient saved my life but it also depleted any ego I had).
posted by Librarygeek at 10:33 AM on August 30, 2012

When you visit, keep it light. Also, you can help by observing: what I mean by this is someone I was close to was in the hospital for catatonic depression. They got him on some anti-psychotic meds and he seemed okay on the surface. When I visit him, he held his hands out in front of him, spaced apart, and said, "ooh, look at the colored plastic wrap, it stretches, can you see it?"

I alerted the staff, who quickly took him off that med and changed his course of treatment. So if you see any highly unusual (for him) behavior, like, "oh, I can fly!" I'd mention that to someone, as getting someone the right meds (if needed, I would assume they might be giving meds to someone with severe depression) and adjustments can take a while.

Longterm, see about getting him a solid diagnosis and consider urging (or helping) him to apply for disability, with the doctor's assistance. I know someone on disability for mental illness, and she got it easily due to the fact that she had been hospitalized a few times for similar issues, and she can't work a full time job, even on her meds. In some cases, they mandate that the money be disbursed by a caseworker or trusted family member, so that the person can't just blow a monthly stipend on booze. It depends on the severity of the condition. Being on disability won't cure him, but it will provide a monthly stipend and access to healthcare, perhaps housing discounts, etc.

Hopefully they'll find a good med combination that will help him out. I feel for you, it's hard watching a family member go through this. But be thankful he volunteered to be admitted, and didn't follow through with his threats of suicide. Also, take breaks for yourself, don't dwell on it all the time, as it will drag you down. Treat it as any other illness and do what you can within your limits, emotional and physical, to be supportive.
posted by Marie Mon Dieu at 10:40 AM on August 30, 2012 [1 favorite]

Also, nthing Lyn Never's advice about a neuro doc. Head injuries = anger in a lot of cases.
posted by Marie Mon Dieu at 10:50 AM on August 30, 2012

My brother was hospitalized against his will 2 years ago. He was a depressed, suicidal alcoholic on methadone. Total mess. What we did (his siblings) was be in contact with his social worker on a weekly basis, sent cards and care packages, called him often and supported his need for treatment.

We strongly encouraged his placement in a dual diagnosis sober living house after his discharge. We were unwilling to support him in any way if he went back to his old environment. That was a hard position to take but he needed to know that we would do everything we could to help him but he had to do his part. We did not require that he do any 12 step program only that he take his meds, see his shrink and live in a safe place.

Today my brother is clean, sober, on his meds, see's his Doc, still lives in his sober house, goes to a church he likes and sounds happier then he has been in years. The treatment of his depression and anxiety is vital to his ability to stay off drugs.

Good things can and do happen after people get the appropriate help. It is a stressful time for both of you and I hope for the best for you and your brother.
posted by cairnoflore at 10:57 AM on August 30, 2012 [1 favorite]

I am now working (again) doing admissions for inpatient psych. The first couple of days are rough. Any program worth their salt will have most of the day (8am to 4 or 5pm) scheduled for the patients. There are always groups (therapy groups, recreation groups, education groups about meds or relationships or any number of topics) going on, and patients are expected to participate in the groups instead of just laying in their bed all day. Visitation will probably be restricted to evening hours so as not to distract patients or cause chaos on the unit. They will see a psychiatrist for medication, and a therapist. They will be discharged with a plan for followup outpatient therapy or other resources that he needs. Encourage him to talk to not only the therapist and doctor, but also the nurses about how he's feeling and what's going on. The nurses can document any side effects of the meds so the doctor can read the information, and in some cases will call the doctor if things are severe.

Depending on how much alcohol he's drinking, he may go through alcohol detox. Detox is usually controlled with Librium and Ativan to control blood pressure and reduce the risk of seizures. If he's detoxing, he'll feel like crap for a few days and that's OK. He'll have to take that one tiny step at a time until he feels better. That is also when he needs to be talking to the nurses about how he feels so he can be medicated properly. He doesn't need to lay there and let his BP get dangerously high because he doesn't want to bother anyone. Detox also makes people really irritable and cranky, so he may not feel like seeing a lot of people during that time. When you do visit, ask him about his day. He might want to talk about who he's met or what he did, or he may want to know what you did instead.

I agree with him (or a family member) asking that he receive a neuro consult or set up an outpatient appt for neuropsych when he's discharged. A head injury can cause all sorts of emotional and personality changes, and lots of people will try to self medicate with alcohol or drugs. If his outpatient psychiatrist can be a neuropsychiatrist that would really be helpful for him.

I have also known several people who have been readmitted to inpatient several times before getting back on the right track. Relapse or readmission isn't a sign of failure...some people really need more than 5-7 days of inpatient (the typical insurance covered stay at one time) before they can structure their lives on their own. That's OK too. You may want to ask about partial hospitalization if he lives close enough to the facility...partial hospitalization is where they go to all of the groups and such during the day, but will go home at night to sleep. It is for patients who still need the intensive therapy and structure, but are safe staying at home instead of supervised at night. That might be a good "step down' option for him.
posted by MultiFaceted at 11:25 AM on August 30, 2012

I've been a psychiatric inpatient a couple of times during Really Awful Weeks when my depression got unbearable. If you want to talk to someone who's been there (though in a much less serious or long-term way), MeMail me, though it may be a few days before I respond since I'm travelling right now.

Basically, the short answer is that yeah, this probably isn't going to be The Turning Point when everything starts to go okay for him, because that really only happens in movies. It might still be really helpful. If he quits drinking, or gets his meds adjusted in a way that lets him function better, or learns useful things about himself that he can apply later, then hey, that's wonderful. And if they keep him alive through a rough patch then even that is really great. But it's unlikely that this is gonna be a point where you can just be like "Okay, that's taken care of, we never need to worry about it again."

To use a really tacky video game / fantasy movie analogy, therapy is less like fighting the final boss and more like leveling up or gaining a useful magic item. He's always gonna have to struggle with this shit. The goal is to equip him with a fuckton of good tools so that he's at least going into the struggle with a bit of an edge each time. And so if you can, try to be happy for him when he levels up, rather than being sad or disappointed that he's still struggling at all.

You can help by not treating him as a pariah, by keeping in touch while he's in there, by giving him chances to vent about it (inpatient therapy SUCKS, it's no fun even when it's going really well, you get lonely and bored and you're stuck in a locked ward with a bunch of crazy people and you have to eat hospital food, so if he's irritable about stuff like that it doesn't mean he's Failing At Therapy, it just means he's having a normal human reaction) and by being basically honest and decent with him if he wants to talk to you about the depression itself. If he's doing anything 12-step-y he'll want to talk to you about his drinking and how it's affected you, and you may as well just be honest about that too (which might include saying "it really didn't affect me much, it's mom and dad you need to apologize to" or whatever, you're not obligated to exaggerate just to give him some kind of scared straight experience).

You're not one of his therapists, you don't need to say or do anything special to Make It Work for him, you can just maintain the relationship you've got with him and (assuming it's a basically healthy relationship; it sounds like it is) that'll be helpful enough.

Oh, and bring books. And ask him if there's anything he wants photos of. And encourage other people to visit, maybe go along with them too to minimize the weirdness. There are a lot of people who will want to visit someone in the hospital but never get around to it because they feel vaguely uncomfortable, and visiting along with someone who knows the drill is way helpful.
posted by nebulawindphone at 11:51 AM on August 30, 2012 [2 favorites]

We have similar stories. My little sister is 29 with similar issues as your brother. However, she has had several suicide attempts and recoveries and has had several stays inpatient when things were bad. She is somewhat stable currently but usually has an event of hospitalization/attempt about once every year.

First, it is a great sign that your brother asked for help. Remember that he is probably in the safest place he can be right now. But he is not an invalid and asking him who he wants to visit is probably the best option. Empowering him with choices (even just if he wants visitors) is important so that he knows he has some control of his life, even while struggling.

I will just say to my experience: my sister was often irritable, angry and moody when hospitalized. Lashed out at me when I came to visit, and then become teary-eyed. I remembered not to take it personally. There was a lot of medication adjusting, and she was feeling vulnerable. The environment was uncomfortable and felt unsafe but she knew she needed to be there. Over the years, I knew I needed to set good boundaries, but I also knew that it wasn't the time to do it then. I needed to be stable for her.

I would suggest trying not to make assumptions about thriving (or not) or if this is a one-time hump (or not). I would focus on assisting your brother on getting by day-to-day. Try not to focus too far ahead. And as far as potential lost, I would suggest doing all you can to keep those thoughts to yourself. Some of the brightest people I have ever met have behavioral health conditions. It isn't measured that way. Thinking about what could have been is not productive. This is something I work on in my own life!

I would also suggest not worrying about the long term right now. Short term seems to be keeping you busy enough. I have a lot of experience with this so if you want to memail me, please do so. Best wishes to you and your brother.
posted by Kitty Cornered at 12:41 PM on August 30, 2012 [1 favorite]

The inpatient I supported eventually segued to a halfway house. (This was someone who'd been institutionalized for decades, back when that sort of thing was popular.) The friends I've had who've been voluntarily institutionalized are now out and stable.

Sorry to hear of your brother's troubles. It's encouraging that he tends to feel close to animals. (Are there any therapy animals in the facility? If not, do you have a family pet who could visit him, or could you make plans with him that once he's well enough for a day-pass y'all could go horseback riding or something?) In the long run, psychiatric service dogs or other emotional support animals can be super-helpful for folks who need extra monitoring and morale-boosting in order to live independently. They're protected under the Fair Housing Act, even in no-pets housing. And they can provide a very concrete day-to-day reason not to commit suicide.
posted by feral_goldfish at 12:45 PM on August 30, 2012

We supported a close friend through inpatient treatment in a locked ward. As others suggested, we just went and hung out, for a couple hours (basically the whole visiting time), and just chatted about stuff. We asked a little bit about how his treatment was going, but mostly he wanted to talk about the outside world and what we were doing. We talked about TV shows we'd seen recently, recited ridiculous portions of the plot of novels we'd read to make a minor point. Just dumb stuff because there was a lot of air to fill! But the important thing was just to be there and let him know that people cared about him.

We had a six-month-old baby at the time, and we took the baby with to visit (cleared first with the facility). He was not only the highlight of my friend's week, but he was the highlight of the week for pretty much EVERYONE on the unit. One thing I didn't realize was that the facility my friend was in had one visiting day room (which was as far as visitors were allowed in), and since people were boooooored, visitors -- especially new visitors -- were sort-of shared resources, so all the patients with day-room privileges wanted to at least say hi to us and chat with us a little bit because we were a novelty. The BABY basically had as many people to flirt with and chat with and build towers for him (we brought stacking cups) as he could possibly ask for. If you have children, visits from them are a definite bright spot for the patients. (Of course you may want to "pre-visit" without the kids and get the vibe, depending on their ages.)

The other patients were really respectful of the fact we were there to visit our friend and they weren't butting in or being rude, but it definitely, with the one big visiting room, had a general social feeling to it. I hadn't been expecting that, I guess because when I've visited people at the hospital before, it's been in their personal rooms, not in a day room. I also wasn't expecting that when it was time to leave, I suddenly felt nervous about the locked ward. It didn't bother me at all getting buzzed in or hanging out in the locked ward, but when we were waiting for the nurse to buzz us OUT, I had a brief moment of fear about the fact that I was locked in a psychiatric ward. Totally irrational, but having never visited a psychiatric facility before I wasn't sure what to expect.

My friend was really, really bored. Admitting himself to treatment was a wake-up call for him and he was really committed to working the program and getting better, but there were parts of it he found silly (some of the group therapy) or distasteful (some of the measures to prevent self-harm that meant they could hardly have anything in their rooms), and there were long hours of doing not much because, well, you're in a hospital. Your brother will probably be bored. Aside from visitors to break up the boredom, my friend appreciated pulp novels and fast food. (His depression crisis came bundled with major weight loss, so he had to eat a TON of calories every day he was there, and the doctor said fast food was an okay substitute for one of his high-calorie between-meal disgusting-tasting shakes.)

My friend has done really well since his inpatient treatment. It gave him a chance to press pause on a life that was spiraling out of control and have some breathing space to take stock and get a grip on things. He didn't come back out cured or go right back into his life -- he left his job permanently when he admitted himself, as it was one of his biggest stressors, and has only worked part time in the three years or so since then, in a different field. He's been in therapy continuously since then, though less often and less intrusively as time goes by. But his relationships came through intact -- his family and friends were all just so glad he got help, and it sounds like your brother has similar support -- and that was really important. Honestly, three years later, it's a little unreal to me to remember that he was in a psychiatric facility and in such a state of crisis, because he's doing so well and his depression is pretty well-controlled. Obviously there are lots of ups and downs for anyone coping with mental illness, and no guaranteed cure. But for my friend, pushing pause on his life and getting such intensive support and treatment helped him turn a corner and make substantive changes in his life that have let him maintain a healthier, more functional life since then. Of course we'll always worry that things might get bad again for him, but I think for him it was a really, really good experience that worked just about the best you could hope.
posted by Eyebrows McGee at 1:43 PM on August 30, 2012 [1 favorite]

Even if this is a voluntary admission, he may get really angry about being there about the second or third day and want OUT! The hospital was very particular about what items could be brought to the patient, no food, no spiral notebooks, no clothing with strings or laces. Everything was cleared before being given to the patient. Expect lots of shifting moods until the medications even things out.
posted by tamitang at 4:34 PM on August 30, 2012 [1 favorite]

I voluntarily admitted myself for severe depression during my second year of law school. Quite honestly, the experience of being an inpatient not only saved my life, but it changed my life. I was in a really bad situation that was not causing my depression per se, but exacerbating it, and being inpatient felt like an escape from all the stress of the world into a safe place. I can't stress that enough. For someone who's been thinking about self-harm a lot, being in a place where that can't happen can be a big big relief. I didn't feel bored or angry or alienated. I actually formed really close, if temporary, bonds with the other inpatients.

What helped me as far as outside people...I really figured out who my true friends were. People who will come to visit you when you're inpatient in a locked psych ward are your true friends. Bringing me lunch was a big thing. One friend brought me a gift set of nice bath products cause the stuff they have there is not very nice (maybe not as big a deal for a guy). Friends just coming, having someone come visit every day was a big deal. We didn't ever talk about why I was there or what was going on in there, and they did their best not to act freaked out about it, even if stuff that seemed freaky happened.

One thing that's really important is when you get out, that's a big deal. You feel really really vulnerable. You've been in this safe, controlled place and you're feeling better, but it's a fragile kind of better. I saw a few people during my week inpatient go and come right back. So the love and care and support can't stop when they get out, because that's the most scary time, even sometimes scarier than when you go in, because you finally get a little bit of hope that things might be getting better, and you don't want anything to blow that little flame of hope out.

If it makes you feel any better for the long term, I've had a long history of mental illness, going back to childhood really, and it's still a part of my life and will always be a part of my life. But after I went inpatient, I finally found the right psychiatrist, found the right meds, did a lot more therapy. I finished law school, and I have a good job and have built a good life for myself. There will always be a lot of humps to get over for people like me and your brother, that's the hand life deals people with mental illness. But don't write him off at 20, and don't expect him to ever get 100% better either. What I'd suggest you hope for is that he finds the right docs and the right meds and the right therapist, and learns to live a happy life. This is totally possible, no matter how unstable or messed up a person may seem at any age.

Feel free to mail me if you'd like to talk more.
posted by twiggy32 at 5:10 PM on August 30, 2012 [5 favorites]

Find out what the rules are for the facility. Some places let you bring food, some don't. Some places let you bring a stuffed animal or change of clothes, some don't. Some places let you have paperback books, some don't (yes, really.) Definitely check with him before signing up visitors. Try to pick people who are stable and can chat about normal stuff. If you can bring him food, for all that is holy BRING HIM FOOD. He may want a second pair of laceless shoes, or more socks or something (some places are too cold.)

He may be stressed about his online friendships or games or whatever - you almost never have access to a smart phone or laptop with internet. You may want to offer to reach out to let people know that he's not, you know, dead. Keep track of the kinds of news he likes - college football, maybe, or the current election cycle - so you can inform him of what's up.

He may discover that he's really really bored without the internet/friends/etc. If you can find a book like the old two-volume mini encyclopedias for kids, or a book full of trivia, that may be more helpful than something with an ongoing linear story.

You may have services in your area specifically geared to fill in for family members in terms of caring for someone with mental health disorders (there's one in my area which will even take your family member to the zoo or grocery store) or you may need to talk with folks from Mental Health America, NAMI, etc., about how to set that stuff up in an ad hoc fashion. There's lots of stuff out there.

Nthing don't think of this as "the hump." It's a bump in the road that might (hopefully) sort of shift him toward a better direction than he was previously heading in. But these are usually chronic disorders, and thinking in those sorts of terms is a lot more realistic.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 6:31 PM on August 30, 2012 [2 favorites]

I worked on an inpatient unit for a while recently. Visitors are great. You may want to get the okay before coming, in case he's having a rough day (depending on how intense his mood is). If you say you'll come, do what you have to in order to come. I had a ton of patients who were so disappointed by family members who either couldn't make it or made promises they never intended to follow through with in the first place.

If they'll let you, bring comfort food/snacks, things he enjoys, books, music, crafty type things. My patients often had game boys/PSP's with a variety of games to fill the time. At least where I was, the days were pretty busy but evenings were rather boring because most of the therapy and rec staff were 9-5'ers. Units can be chaotic places. Earplugs might be nice if he can have them, spending money if he has access to vending machines and the like is nice too.

I think visiting is the best thing you can do. Its hard enough to be depressed, and then away from home and the things that make you feel safe, and on top of that, being surrounded by other people who are struggling and perhaps stressful to be around. Try to be patient if he is out of it or sleepy due to meds, or just plain not in the mood. Scheduling phone dates can be nice if visits aren't practical. You're so great to be supportive of your family member, and wanting to be engaged in a positive way. I wish my patients had more family members like you!
posted by gilsonal at 9:13 PM on August 30, 2012

Also, while not an animal, a plant to take care of might be nice. Spider plants are a good, non-toxic plant that is pretty easy to keep alive.

Following the inpatient stay, keep in mind that the period following discharge is pretty intense. They feel better, but then are re-confronted with the stressful world they got to escape. A lot of patients might feel ambivalent about leaving the safety of the hospital. Freedom can be scary. Keep up the visits, and the empathy. Get him out of the house if you can. And expect that the general trajectory for a recovery looks more like a gradually ascending wave. He will revert to old patterns, make progress, give up, try again, etc, etc. Unfortunately its typically two steps forward, one step back. Focus on the effort, and empathize with how hard it is to deal with.

TBI's do a doozy on our ability to plan and regulate emotions. I wish I had a book recommendation, but it might help you to look into how even mild TBI's can affect our executive functioning, and give you some insight into his behavior.
posted by gilsonal at 9:23 PM on August 30, 2012

Forgot to add - coloring, crochet, and cards took up a lot of free time at the inpatient unit adjacent to my intensive outpatient program (almost everyone transitioned out through the IOP, so we got to hear a LOT about it.)

Mandalas were very popular - if the facility lets people color, you may very well make yourself half a dozen (or more) lifelong friends if you bring more colors or new pages. Some places let you have coloring pencils or markers, but other places you have to make do with crayons. Bring like five of the maximum variety - you know, 120 colors or something - when you come. They usually don't allow sharpeners; you might want to put them in bags since sharpeners are built into crayon boxes.

Check first before making purchases, because every facility is different. I mean, the one I was in let you have crochet hooks, which are basically on the top 5 list of things no facility lets you have, just after strings.

Make your own photocopies of the coloring sheets, or print them off from the internet - books are no use; only one person can use them at a time, there's designs on both sides of the page, etc.

(I'm not kidding when I make this suggestion. I brought "new pages" on CD-ROM on my second or third day of IOP the first time and they're still photocopying the ones I sent them, almost exactly a year later. All the crayons and markers and pencils in the IOP program were donated by current/recent patients who were annoyed at the lack of a budget item for pencils and markers and crayons.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 9:03 AM on August 31, 2012 [2 favorites]

Mod note: From the OP:
Thanks so, so much for your generosity with advice and suggestions, and to everyone who contacted me by email. I felt stupid for having suggested this was just a hump to get over, but actually, I'm glad I wrote it as I think that has been my expectation, and I'm working on adjusting that.

Unfortunately, my brother changed his mind at the last minute and did not enter the program. It's been very hard (it didn't happen smoothly) and we're hoping he can get to a point where he reconsiders.
posted by taz (staff) at 5:39 AM on September 4, 2012

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