Mental Health for a Teen in BFE
December 10, 2014 3:03 PM   Subscribe

Apparently, my nephew witnessed a friend commit suicide and is now falling apart. I'm 2500 miles away and his parents don't seem motivated to get him some help. They live in the middle-of-nowhere. How can I get him hooked up with some help?

I knew that my one of my 17-year-old nephew's classmates killed himself a year or two ago. But now it is just coming out that this my nephew was actually there when it happened. (Don't ask me HOW THE HELL my sister neglected to mention this as it seems to me, I don't know, kind of a big deal!) He's showing clear signs of being really screwed up by the whole thing (recurring thoughts about the event, plummeting grades, depression, lots of guilt). He clearly needs professional help. The problem is that my sister doesn't seem motivated to get it for him. They have few resources (she is a recent veteran with her own health issues) and live in the middle of nowhere outside Phoenix. I talked to him and he agrees that he needs help but doesn't "want to worry [his mom] or make her pay out of pocket." (Which rips my heart out to hear.) I contacted my sister and said, "I'm really worried about him. Tell me what insurance you guys have and I'll help find a therapist. If you don't have coverage, I'll pay for it myself." She said, "I'm worried too! I really need to make him an appointment" but refuses to engage any further and past history suggests that nothing is really going to happen.

So my question is two parts:

1) What kind of resources can I connect him with while I try to figure out how the hell to get him some in-person professional help? Online support groups? Helplines? A blog or book by someone who has been through something similar? At this point, I'll take anything.

2) How can I help get her help him get help? There don't seem to be any therapists anywhere near where they live and I don't see her driving him an hour to Phoenix for therapy. But maybe there's a solution I haven't thought of yet. Have they invented Skype therapy yet (only half joking!)?
posted by anonymous to Human Relations (13 answers total) 1 user marked this as a favorite
Go through the school. They should be able to provide support services at school during classes. He should have a counselor and you can call with your sister and see what they would recommend.

Also, I might know a few....dozen family therapist types in Phoenix. Where in BFE does he live? I mean Phoenix is kind of an urban sprawl and places like Chandler which were BFE when I was a kid, are now just another neighborhood. Hell, even Apache Junction is a place now.
posted by Ruthless Bunny at 3:15 PM on December 10, 2014 [3 favorites]

Skype therapy totally exists. Here's one random example in Arizona.
posted by three_red_balloons at 3:15 PM on December 10, 2014 [1 favorite]

As someone who tried and failed to get therapy by seeking support from other relatives and their friends when I was 16-17, I will tell you this: You likely can do nothing official for him because you are not the parent. And he likely legally has zero right to self-advocate and make such decisions for himself. No therapist would talk to me without explicit permission from my parents. The fact that I had lined up relatives and friends willing to a) pay for it and b) make sure I had transportation to and from appointments in spite of not having a driver's license was not relevant.

So you kinda need to get mom on board here to do anything like therapy.

Having said that, I would personally suggest he read the web comic Questionable Content from the beginning. One of the characters in it has a history of having witnessed a suicide, starts out a mess and gradually gets better. I read it because I was molested and raped as a kid, have had lots of high drama in my life and I find it helpful for me in terms of trying to find less drama-y paths forward.

Best of luck.
posted by Michele in California at 3:25 PM on December 10, 2014 [5 favorites]

If this is a hill you are willing to sacrifice your relationship with your sister over, I think a year or two later is the point where you say, "Either you get this done or I will force the issue."

I am sympathetic because your sister is likely a victim of the Phoenix VA know, she is an adult with choices and he is not.
posted by Lyn Never at 3:39 PM on December 10, 2014 [2 favorites]

Once he is 18, if you are willing to pay for it and all that, that's a totally different ball game and you can totally support what he wants, as a newly minted legal adult. Yes, it may have negative consequences for your relationship to your sister. If you think that is the lesser evil, then one possible plan is to help him somehow hold on until he turns 18. It is the magic number that makes things go from "you have no right to decide that for yourself" to "you have every right to decide that for yourself."

And I did once totally give the double birdie to what the rest of the world likely thought I should do in order to back a recently minted adult in finally coping with their crap in an empowered way when the parents were a big part of the problem. I got kinda burned. I have no regrets. As far as I know, they still live and their blood is not on my conscience.

Best of luck.
posted by Michele in California at 3:49 PM on December 10, 2014 [1 favorite]

Umnn, clearly needing psychiatric help is a medical issue, correct? And she is not getting him the medical treatment? Wouldn't that be considered neglectful child abuse? Maybe put it to her in those terms.
posted by Sophont at 4:43 PM on December 10, 2014

Regardless of whether you can get him a therapy appointment (which I doubt for the reasons others have stated above), I suggest you make sure he knows helplines are not just for people at risk of suicide themselves. They are frequently free to call and some are open 24/7. Here are some categorized by subject, including grief and loss:
posted by mismatched at 5:32 PM on December 10, 2014 [3 favorites]

So I don't see the situation regarding your sister's consent as being as dire as other people do. Yes, she'll need to consent to your nephew being treated. But she doesn't sound opposed to therapy, just overwhelmed about how to start. If you can get the ball rolling, hopefully she'll give her consent.

Maybe start by talking to your nephew some more. One thing you can do is just be there for him. Make yourself available over IM, Skype, etc. Check in with him. Let him know there are people he can lean on besides his mom.

You can also (gently) talk to your nephew about his reasons for resisting therapy. He doesn't want his mom to pay, but you can reassure him that you're happy to cover the costs and that it won't be a hardship for you (if your finances are tight, maybe he doesn't need to know that). And when he says he doesn't want his mom to worry about him, you can remind him that his mom would feel better knowing he's getting help.

(One other nice thing about Questionable Content: it shows the characters going to therapy, and the treatment having a useful effect in their lives. However, there's also a flashback to the events of the suicide, which could be triggering for your nephew.)

And one other little thing: Your sister isn't telling you who her insurance company is, but does your nephew know? When I was 17, my mom had given me an insurance card to carry in my wallet (in case of emergency).
posted by Banknote of the year at 5:53 PM on December 10, 2014 [6 favorites]

I would suggest at least trying to get him in the same exam room as his pediatrician or family doc. It would not be bizarre at all for a 17 y/o to take themselves to a doctor on their own. It's at least a starting point, and from there his doctor might be able to guide him to counselling resources in addition to considering medication, if warranted, to assist with whatever symptoms are most intense (insomnia, repetitive thoughts, anxiety). Just the simple act of sitting and speaking to someone would be cathartic. It sounds like his folks are checked out. Mental health services tend to be lousy almost everywhere, rural or not, so a first contact with his doctor may be a better initial option. And it may not be that expensive, frankly.
posted by docpops at 8:31 PM on December 10, 2014 [1 favorite]

When I went through some serious depression/mental health stuff, particularly in my late teens, it would have helped incredibly if people would have actually talked to me about some things that happened instead of walking on eggshells and/or sending me off to a professional for a brief appointment every couple weeks and never otherwise discussing it with me at all, as if it were so shameful that it couldn't be mentioned. It just had the effect of making me feel isolated on top of everything else. He's probably in a lot of pain and it's not healthy for him if his mother "neglects to mention" this terrible thing that happened to him and leaves him to process it on his own because she doesn't want to deal with it.

"Therapy" is the standard response for so many issues but speaking from experience there are so many therapists out there and you could waste lots of time and money going to someone who isn't helpful. Believe me, I have done this through many, many, many not-useful cognitive behavioral type sessions of challenging my ways of thinking, when in fact I really needed validation and support to deal with toxic, abusive people and help with processing traumatic events from the past.

Since your sister is a veteran she may be aware of PTSD - would suggesting that might be the concern help to frame this in a way she can understand? What about looking for those specific types of resources (PTSD/trauma) for your nephew? I am not qualified to diagnose anyone of course, but this certainly seems to be a traumatic event he's dealing with. And that is a specific type of professional help that's needed - someone who deals with trauma issues, not just any therapist. There are plenty of books available on the subject as well as online forums. I am not familiar with the support for veterans' families that is available but I'm sure there must be leads there as well.
posted by citron at 10:06 PM on December 10, 2014 [2 favorites]

If you or your sister has access to an Employee Assistance Program (EAP) through work your nephew can totally call them and get some help over the phone, plus a referral for in-person or online sessions with a therapist.
posted by Coffeemate at 7:32 AM on December 11, 2014

There's a warm line in AZ at 602.347.1100.
posted by WeekendJen at 9:22 AM on December 11, 2014

I apologize if my comments above sounded like I was suggesting that getting your sister's cooperation was guaranteed to be some horrible or insurmountable issue. All I meant was that I have tried exactly the thing you are talking about and it did not fly because we did not have parental permission. And it has occurred to me that it might be useful to you to detail what needs to happen here with regards to that legal piece.

I will suggest that you can and should do the legwork in terms of researching providers in the appropriate geographic area. You can do that without talking to sis about anything. Put together a list with some brief notes about who seems conveniently located and who seems good and who seems affordable and so on.

If your nephew can get you the name of the insurance company, call them and/or check their website. The magic phrase you need is "third party authorization." You can call them and request a blank copy of their third party authorization and instructions on how to fill it out. Fill out as much of the third party authorization as you can. If at all possible, fill out every field except where she needs to sign and date it.

Talk to a lawyer about a medical power of attorney. I have no first hand experience with medical powers of attorney, but I think that is the thing you need in order to be able to make healthcare decisions for your nephew.

Put all your paperwork together in a packet and either mail it to sis or hand carry it and put the pen in her hand if necessary. Not in an ugly or manipulative way. Be super careful to be respectful and supportive about how you handle this. But sometimes people in serious crisis just need an Easy Button. Given her status as a recent veteran, I am suggesting an Easy Button option here.

Make sure you present this in terms of "I made you this list of providers. You can call and make him an appointment if you wish. But if you just have too much on your plate, I can do that for him myself, but first I need you to sign a couple of things so I can do that." Do not try to take away her control of the situation. But do let her know that if making these appointments herself is too much for her, you are happy to take care of it, but, thanks to HIPAA etc you can't do that until she signs a couple of things.

It might help to pick up a copy of "Getting to Yes." It is a quick read. I will not recommend anything meatier than that because if this doesn't happen fairly quickly, your nephew will turn 18 and all this paperwork will no longer matter. But try really super hard to have a come to jesus with yourself and find a way to not feel blamey towards sis. Try hard to believe in your heart of hearts that she is a good parent, she is a good person, she is simply someone who paid a high price for serving her country and is overwhelmed by events. Make sure that any written correspondence or phone calls avoid blaming her, accusing her or making her feel like a bad parent. Emphasize that you are sympathetic and trying to be supportive. If she reacts badly, back off and don't argue it. Find a way to say it in a way that doesn't upset her, if at all possible.

If the worst case scenario happens and she gets upset and will not cooperate, the back-up plan is to do everything in your power to be emotionally and practically supportive of your nephew for the next few months until he turns 18. Let him know you are trying to arrange mental health services. Let him know that due to his status as a minor, this is complicated and it may not be something you can arrange quickly. Do everything in your power to convince him that you are not making excuses. Many people who say "I wish I could help but I can't" really mean "I have a good excuse and stop bothering me." Make sure your words and deeds match up and he clearly gets the message that you care, you are doing all you know how to do, and if you are unable to successfully jump through all the hoops required to arrange this while he is a minor, the minute he is 18, it will be tons simpler and you will at that point make good on your promise if you can't do it sooner. (Since it sounds like you have a bit of money to spare, slipping him a few bucks now and then so he can buy a CD of his choosing or order a pizza without bothering his parents may go a long way towards helping him hold out for a little bit longer and can serve as a token of good faith, helping him believe you really are not just full of hot air.)

Make sure that when you talk to your nephew about this, you in no way imply that his mother is an obstacle or uncooperative. Make sure you blame HIPAA and the federal government and the laws of the world and the fact that it is legally complicated. Do nothing to undermine his relationship to her. If he accuses her, remind him that she is simply overwhelmed, she has a lot on her plate and so on. Take the position that sometimes life is just too hard and sometimes people just don't know how to fix it. Do your damnedest to not make him feel like she is a bad parent. Sometimes we just fall down. When we do, it is really nice if people help us to our feet and brush us off and ask if we are okay instead of the seemingly more common response of kicking us while we are down.

Best of luck.
posted by Michele in California at 10:59 AM on December 11, 2014 [2 favorites]

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