Please help me help my daughter
August 19, 2015 8:00 PM   Subscribe

Please tell me there is something we can do to prevent Daughter from being released from the hospital in her precarious mental state. I am literally afraid for her life.

Not the kind of problem one should take to the internet, but you all are here and no one else is taking calls. Long, I know, but there is no short version. Will apply all common sense caveats re “you are not my doctor/lawyer/whatever”.

My daughter has been deteriorating rapidly over the past several weeks. After finding yet another reference to suicide, her father and I initiated a court-ordered evaluation through the state's attorney on Tuesday and she was taken to a suburban hospital that afternoon. We were told that once she was admitted, she would be evaluated within 24 hours and an appropriate treatment plan would be developed. This would be followed by a hearing one week later, at which Daughter would be represented by a lawyer. Instead, we learned today that Daughter is cooperating, which means that the doctor assigned to her—who just met her—makes the decision about whether she is held for treatment or released. Issue: Daughter presents very well to strangers. Because of this, her dad called her new doctor to give her background information, but the doctor says she cannot talk to us. (We were told that she can, in fact, take this info into consideration, she just can't talk to us about Daughter.) Daughter called to say might be released tomorrow.

My concerns for her began in early May when she failed to show for an event she had been planning to attend for months and did not return calls or texts. When I finally reached her, she was uncharacteristically short-tempered about the multiple calls and texts. She mentioned that she had wrecked her car and that I should be more understanding of her stress (related to an accident I wasn't even aware of).

The day after that call her dad learned that her car had been found by CA police at the bottom of a 200-300 foot embankment, had rolled at least once, air bags had deployed—fortunately, no sign that anyone was in the car at the time. The police noted that the accident would not have been survivable. When asked, she said she had, in fact, been in the car, was alone at the time, no other car was involved, and that she climbed back up to the road afterward. I suspected I wasn't told some important details regarding the accident and she tended to be evasive and short with me in calls throughout May and June.

I figured I would wait until I next saw her to press for information about what was going on in her life. Unfortunately, that turned out to be July 8th, the day she was first admitted to a psych ward in a suburban Chicago hospital—the result of a 911 call made by her boyfriend (irrational behavior, including suicidal references). She returned to boyfriend's apartment when released and was back in the hospital 5 days later—following days of absolutely irrational and hostile behavior and direct talk of suicide. She was released after 3 days and moved to St Louis to stay with a friend, with the stated intention of getting help there. Within 48 hours, that friend was calling me saying that Daughter needed to be out asap. There was another 911 call in St Louis—again initiated by Daughter's talk of suicide, but she was not admitted. I picked her up in St Louis and spent Aug 1 – 10 with her in a hotel while her dad and I looked into options. Her boyfriend had her until she went to the hospital.

Re her behavior
  • It seems that "hostile" is her default setting. She interprets things in the worst possible light, e.g., a change in plans becomes "you lied to me when you said...". Has accused those trying to help her of stealing from her and sabotaging her plans. It's impossible to answer the charges because she just keeps loudly repeating herself, rather than listening to the response. (This applies to friends and family. With strangers she tends to be unusually, overly friendly.)
  • Often doesn't seem aware of how horribly she has treated those around her, e.g., just a few hours after a very hostile scene with a friend that ended with Daughter saying "fuck you" as she slammed the door, she asked for friend's number because she needed a ride.
  • Has trouble following through on basic plans, e.g., a central preoccupation for the month has been e Daughter go through her things (which fill a 10' U-Haul truck) and sort what she wants to keep from what she will give away or store. This has been the source of multiple meltdowns and arguments because she is overwhelmed by every aspect of the project—literally incapacitated by anxiety when she attempted to unload the truck. There is no way she could hold a job.
  • Is often incredibly self-centered and makes no apologies. Since her life has been "so awful", she feels entitled to put herself first.
  • She has always been physically affectionate, but now she tends to pull away from hugs and has told me not to touch her a couple of times when I attempted to put an affectionate, supportive hand on her shoulder.
  • Sleep has always been a problem. What's new is how little she sleeps. Her friends assumed she was taking more than her prescribed dose of Adderall, but that's not so—if fact, she has Adderall left over at the end of the month. Also new—she even has trouble falling asleep when she is very tired and insomnia makes her truly miserable.
  • Finally, and most worrisome, she has very upsetting, depressed moods. I've held her while she sobbed about being lonely and "looking for a home and people who love [her]". Occasionally talks of not seeing a reason to go on with life.
And I cannot over-emphasize that things seem to get worse by the week.

Last week her dad reported that Daughter (finally) talked about the accident that destroyed her car on May 2. His words:

She described at length, and in lucid detail, how the car left the road, fell off the cliff 300 feet, rolled over several times, strewing all her most important belongings over the cliff. The roof was partially torn off. The air bags deployed. She was hit in the face, causing serious bruising that was apparently never treated medically. She was unconscious at least twice, once possibly for a long time. She crawled out of the car through the roof.

She then asked the Mountain, what was the best way to climb up. And the Mountain answered her, “Through the bushes.” She climbed through some bushes which helped her gain footing. She fell back several times, 40 feet or more she said. Finally she reached the top and described feeling, with her outstretched hand, how the pavement felt.

Needless to say, it seems she should at least be evaluated for possible head injuries.

She has said several times that she wants help, but changes her mind before arrangements can be made. And the more hostile she becomes, the more resistant she is to the idea. She sent me this text on Aug 6: “sorry I'm being so ungrateful I need help. Please mom.” She's been pulling away from me since then. Sent me a text after being admitted to the hospital yesterday: “I just need you”, which when she was at home was our code for “just come now, don't ask any questions”. When I called her she launched into a hateful rant about how awful I am.

The issue, as I mentioned, she presents very well to those she doesn't know and who don't know her. For example, she was taken to the ER in St Louis following talk of suicide, and released without being admitted to the psych unit. I called the hospital--incredulous at the notion that someone in such a precarious state would not be admitted, especially considering that her doctor and people who knew her had called with background information. The woman who made the decision mentioned (among other things) that Daughter claimed that she made the reference to suicide simply to get to her roommate (paraphrasing--I don't remember the exact words). Daughter must have amazing powers of persuasion.

If she is released soon I'm quite sure she will disappear from our lives. She is homeless and has no money, over the past couple of months she has alienated her closest friends and has grown very hostile to her father and me. She will, no doubt, immediately try to return to the farm somewhere in CA where she has been living with people who—we have reason to believe—have not been treating her well.

We are waiting to hear from her psychiatrist, which might take days. The state's attorney—who had convinced us that this was the way to go—is of little help now. I'm not ready to accept that there is nothing I can do.
posted by zombies puppet to Health & Fitness (22 answers total) 4 users marked this as a favorite
NAMI Helpline
posted by pH Indicating Socks at 8:18 PM on August 19, 2015 [9 favorites]

If at all possible, figure out how to record on video some of the irrational behavior. Then you have proof.

Any and all doctors should be able to listen to you - and read/view whatever information you give them, though if she's an adult (which is sounds like she is?) they won't be able to share any information with you.

Good luck and my prayers.
posted by stormyteal at 8:34 PM on August 19, 2015 [3 favorites]

I'm so sorry, this must be absolutely terrifying.

I think it would be worth physically going to the hospital and asking to speak directly with the person overseeing her care, while you build a case (from your daughter's past records, with doctors who know her better) for at least temporary conservatorship/guardianship.
posted by cotton dress sock at 8:37 PM on August 19, 2015

Do you have a psychiatrist who previously treated her, emails or voicemails, anything? You need documentation or proof. And at the same time - don't hide this. Call your family and your friends and say your daughter is in crisis and you are terrified and need support. Ask for help so if things get better you won't need it and if they get worse, you won't be alone. Most people won't understand but the few who have Been There will be invaluable during this hard time.

Call around law firms that handle involuntary commitments and see if someone will take your case or provide a consult to explain your legal options where your daughter lives.
posted by dorothyisunderwood at 9:20 PM on August 19, 2015

When my brother was committed I dealt with the hospital social worker. The person listened to my concerns about the treatment we felt he needed (more than 2 days inpatient) and really helped facilitate him receiving help with SSDI and aftercare placement. I never talked to his Doctor.

Getting a Doctor on the phone can be lots harder than a social worker.

Good luck. You are in a very difficult situation.
posted by cairnoflore at 11:14 PM on August 19, 2015 [2 favorites]

Trying not to thread-sit--responses/answers to comments so far:

Daughter is 26--has already instructed doctors not to release info about her. We cannot begin to understand why her new doctor refuses communication/information from her dad. I'm going to try to reach her tomorrow.

We went to the hospital when she was taken to ER and met with the ER caseworker for at least an hour regarding Daughter's history. We left feeling that, finally, someone understands and will see that Daughter is cared for. Unfortunately, the caseworker is not part of the behavior unit staff. While I'm sure her notes follow my daughter, her advocacy apparently does not.

Re evidence: we have excerpts from a journal that includes a suicide/good-bye/apology note, in addition to disturbing information about her life/friends (?) in CA. We tried to avoid having copies of this material in the court records--hoping that we could just testify about what we read, but we were told to include the copies. Her boyfriend testified in court, as did her dad--their statements were enough for the judge, so I was spared from that awful scene. The records included detailed information about the past couple of months, including the accident.

The psychiatrist she has been seeing for a couple of years submitted an affidavit. Truth be told, until recently she just saw him briefly every 3 months for Adderall and Xanax prescriptions. Her dad and I started lobbying him after the first psych admission for more help and advice and he's been responding (albeit, often slowly).

Re guardianship: it takes time. And in her current state of mind, I'm very sure she will take off the first chance she gets.

Thank you for comments so far. I know this is an especially tough ask. We've spent the past several weeks looking for ways to get her evaluated and treated. As time passes, she slips further and further away from us. I don't know how to respond when people say that if she doesn't want treatment (as if she can make such a rational decision these days), there is nothing we can do. How can I possibly accept this answer?
posted by zombies puppet at 11:25 PM on August 19, 2015

I'm a nurse at an inpatient psychiatric facility.

As the doctor told you, since your daughter doesn't want you to be contacted by them then they cannot talk to you at all.

Having said that: your daughter could be very very wrong about being discharged tomorrow. If she's not safe, this will be noticed and recorded. This information will be acted upon. She's not the only one who presents well to strangers; in an ideal world, psychiatric healthcare workers are trained to take this into account.
posted by RainyJay at 11:57 PM on August 19, 2015 [9 favorites]

My heart goes out to you -- I was in a very similar situation with my son. It is so terrible, for everyone.

But I have to agree with those telling you that if she doesn't want treatment, there's nothing you can do. You may be able to have her committed involuntary, but not for long, and you can't do anything to make her better. There isn't a "treatment" that she can be given and be free of her demons. The most you can do is try to get her into a safe place, and if she doesn't want to be there, she won't be there for long.

You want -- you need -- to go into great detail about the things she's done, the things she's said, so that others will understand. But her life is in her hands. That said, seeing a psychiatrist only briefly to refill Adderall and Xanax for "several years" is a huge red flag. A really, really bad thing for someone with a shaky grip on life.

In my son's case, he had to make a serious attempt on his life before we could find a hospital room and mental health care just to stabilize the meds he'd been self-medicating with. It's been 8 years, he's solid and happy (and not on any long-term medications). I'm only telling you this because there are good outcomes from awful situations; no guarantees, but it happens. I genuinely hope it happens for you and your daughter.

Some final notes:
1) With the HEPPA privacy laws in effect, it's very hard for even family members to get information about adults. You're not being stonewalled; the health care workers are really limited.
2) If there's any way to find a room and have her enter voluntarily (sounds unlikely in this situation, but worth trying) it would be far better than involuntary measures. Those stay on your record forever, and can have a devastating effect later.
3) Even if everyone agrees with your assessment, there may simply not be a place to put her. Here in Washington State dozens of people with acute mental illness were being held in hospital ER rooms for up to several weeks, until the court specifically forbade it.
posted by kestralwing at 12:05 AM on August 20, 2015 [1 favorite]

I work with young adults who have emotional disabilities and I've had several students develop absolutely needs hospitalization NOW characteristics, and it can be near-impossible to force them to get the help they need if they're over 18.

The short answer is you can't do much for her. At 26, she needs to be an active danger to herself or to others and as noted above even then, she may not be involuntarily committed because there aren't enough beds for emergency care. She may be held in an ER for 24 hours then dismissed.

What you can do is contact NAMI, and get resources for yourself. You are not alone in this most terrible situation and they can point you toward resources that will help you. They can also help you understand what legal options you have to get her committed. Honestly, they will have ALL the answers for you.

I can't imagine how painful this is and I'm so sorry you're going through this.

(I do want to add that even though you note she presents well, most workers in the mental health fields can see through a good presentation.)
posted by kinetic at 5:29 AM on August 20, 2015 [8 favorites]

I'm so sorry you and your daughter are going through this.

I am not a physician, and I'm not trained in medical diagnosis, and of course as you understand, no one can diagnose your daughter over the internet. I am, however, a neuroscientist, and a few points about the situation as you've described it stand out to me. One of the most common sites of injury to the brain during a car crash is the orbitofrontal cortex, a part of the brain lying just above the eyes. Common symptoms of orbitofrontal injury include abrupt changes in personality, inappropriate responding to social cues, difficulty making even simple decisions and initiating or completing tasks; additionally, the senses of smell and taste are often impaired. However, abstract reasoning, language skills, and general intelligence are typically preserved, and people with orbitofrontal injuries will often show no obvious signs during, e.g., conversation with a stranger.

That your daughter's mental health issues seem to have begun with the car crash, combined with your bullet points 1-4 (especially 2 and 3), sounds very much like a case of possible orbitofrontal damage. (Though, of course, there are other possible explanations, most of which I am probably not aware of because I am not a clinician; you understand the caveats.) If your daughter has seen a neurologist, I am sure they have considered this possibility, and would be able to make an informed diagnosis (probably on the basis of an MRI). If she has not seen one, I hope she will.

I wish I had some advice for what you can do, but I'm afraid I don't. I only hope that information about this possibility might help you to consider your options and/or to communicate with your daughter, her friends and family, and, if she finally allows you to, her physicians. The silver lining, if there is one, is that the difficulty in following through on plans that you described may also make her less likely to actually follow through on her suicidal thoughts. Whatever is wrong, I hope she's able to get the treatment she needs and that you can have your daughter back.
posted by biogeo at 6:33 AM on August 20, 2015 [13 favorites]

As the doctor told you, since your daughter doesn't want you to be contacted by them then they cannot talk to you at all.

I don't believer this is legally correct. Your daughter's doctors cannot reach out and contact you, but if you call them, they can listen to whatever it is you want to communicate to them. They just cannot give you information in return.
posted by merejane at 8:59 AM on August 20, 2015 [6 favorites]

Based on what other posters have said, above, your point of leverage might be the car accident. You might tell the hospital that she was in a car accident, recieved no treatment, and has experienced a drastic personality change since then. Provide the police report or the towing report or photos of the car -- whatever you have.

Don't detail the we-said she-saids -- your best hope may be "this person walked away from a car accident, likely with a head injury, and hasn't recieved any treatment! She hasn't been assessed for a traumatic brain injury!"

Try to reach anyone - doctor, social worker, you might need to talk to whomever at the hospital is in charge of "patient satisfaction".

"I know that she is an adult and there are privacy laws. I just want to alert the care providers that she was in a serious car accident in May, never received treatment, had major personality changes and may have a traumatic brain injury."
posted by vitabellosi at 10:14 AM on August 20, 2015 [12 favorites]

I'm with biogeo here - the fact that these changes were so abrupt and began immediately after this (quite horrific) crash strikes me as the buried lede here. This might not be a psych issue but rather a medical one - is there any way to get her to see a neurologist or a neuropsychologist?

I just wonder if traumatic injury coupled with a prolonged lack of recuperative sleep could be behind all of this?

I wish you the most luck -- keep fighting.
posted by lock sock and barrel at 10:19 AM on August 20, 2015 [8 favorites]

You might try calling the hospital and asking to speak to the social worker or nurse in charge of your daughter. They may not be there on the weekend, but it's much more likely they'll be there than the doctor will be. If you are able to speak to the social worker or nurse, you might want to emphasize not only the car accident and likely TBI but also that your daughter is homeless and does not have a safe place to be discharged to.
posted by jaguar at 1:24 PM on August 20, 2015 [1 favorite]

They may not be there on the weekend

Sorry, it's not the weekend, is it? I have the day off and got confused. Sorry for any confusion! It's still worth calling the social worker.

posted by jaguar at 5:45 PM on August 20, 2015 [1 favorite]

Thank you all for comments and information—still following through with some recommendations. Here's the latest:

Daughter was not released on the 20th. Yesterday, she said she would be released on Monday, which I can only hope is also wrong. She told me this morning that she is supposed to be working on her "discharge plan" this weekend. Surely, someone will review the plan to ensure that it is, in fact, realistic, right? Because what she's working on falls somewhere between wishful thinking and flat-out fiction.

On the plus side, she has agreed to an MRI. She's already convinced that she's just fine—agreed to this simply to get us to STFU about the issue. Has also agreed to stick around for a couple of weeks while we arrange for this and appointments with dentist and optometrist. Unfortunately, that isn't nearly enough time to deal with the alarming changes in her behavior.

I sent info to the doctor who refused to return calls to Daughter's dad and I opened with "Daughter did not receive medical care following a serious accident in May..." No idea if she took it into consideration or, for that matter, even read it. I'm very concerned that "presents well" could end up being a contributing factor in her suicide. Btw, she claims the suicide note was written weeks ago (as if that would be a comforting thought). I know that is not true—not that anyone's asked me.

I'm very concerned that going through this horrible court-ordered evaluation process was not worth the pain.
posted by zombies puppet at 11:32 AM on August 22, 2015

Thanks for updating us; I've been thinking about you and hoping your daughter gets the best treatment she can. For what it's worth, this stranger on the internet thinks you're doing the right thing. I'm sure it must be extremely frustrating not to be able to get any information from your daughter's doctor, but I think it's very likely that the doctor is making use of the information you provided. Psychiatrists, in particular, often make use of patient history from friends and family in making a diagnosis and/or treatment plan. The doctor is ethically and legally not permitted to contact you or your daughter's father about her case without her permission, but that doesn't mean she can't use the information that you provided, and I do think that you were right to make sure she's aware of your daughter's untreated head injury.

Best of luck. If it turns out your daughter does have a neurological issue, and you need any help understanding what's going on, please feel free to memail me.
posted by biogeo at 9:10 PM on August 23, 2015 [2 favorites]

My understand is that the discharge plan is reviewed by the entire team; it's basically a checklist of all things that need to happen logistically for her to be discharged. This sort of thing technically starts when she first gets admitted.

This does not mean she's getting discharged the same day.

If she's misrepresenting/misperceiving discharge dates and such to this extent, then she's probably not presenting well. She's being treated for what is happening, not for what she wants people to think is happening.
posted by RainyJay at 5:08 PM on August 26, 2015 [1 favorite]

Thank you all for taking the time to respond and especially for noting that we need to lead with the new info about the accident—will do that the next time she's hospitalized, which I'm afraid is inevitable—and also for recommending an MRI. Here's an update.

Daughter was released on Monday 8/24. Time line review: ~6:00 pm Tuesday 8/18—admitted to psych unit; ~11:00 am Friday 8/21—notified of Monday discharge. So, after weeks of hostile, irrational, worrisome behavior so extreme that we sought a court-ordered evaluation, these folks had her working on her discharge plan 2 days after the local police brought her to the ER.

Daughter authorized communication the weekend prior to release, so I sent a detailed letter to the doctor beginning with the information about the accident. And I spoke to her counselor for almost an hour Monday afternoon before she was released (counselor had not seen the letter at that time—as far as I can tell, the information was not considered at all), who I admit did an excellent job of diffusing my anger during the call. It came back in spades within hours. Highlights:

Diagnosis: Bipolar, PTSD, BPD. How seriously should I take a diagnosis made by someone who's spent maybe 2 hours with Daughter, possibly considerably less? Fwiw, I can read the DSM and I have the advantage of knowing her history. I agree with BPD and PTSD, but I have some questions about Bipolar.

Some of her more extreme behaviors were attributed to issues with her medication—including not taking as prescribed. For example, Daughter reported that Xanax had been taken from her. I was aware that she could be loosey-goosey regarding taking her meds (Adderall and Xanax), but did not think that could possibly explain her extreme behavior. Plus, only a fool would have taken her Xanax from her, i.e., didn't happen. And the behavior continued after her meds were changed.

They recommend that she go to an out-patient therapy program, but Daughter isn't interested. No kidding. We already knew, of course, that she didn't want the intensive therapy she needs—hence, the court order. At every hospital admission we have been told that an essential part of the process is coming up with a plan for moving forward*. The process of getting there, e.g., challenging her when her plans aren't realistic, is a natural segue to discussing therapy options—at least it had been when she still talked to us about future plans. We can't take that confrontational tack with her any longer because she's shut us out. However, someone new —who holds the literal key to the door—could use this to their advantage. Or, more correctly, could have used this. (*Shame on us for continuing to believe this.)

Post-release plans are not, in fact, realistic and include returning to workplace in CA, despite concerns regarding safety (that she had been raped). Counselor said that Daughter told her things 'hadn't gone that far'—yet she referred to being raped in writing at least twice and has also talked with boyfriend about this many times. I should have asked Counselor 'how far' things need to go before it's abuse and/or makes this not a healthy place for Daughter.

No referral for MRI because the doctor did not see evidence of a recent head injury. How do you detect a change in personality/behavior when you aren't aware of the 'before' picture? Told Counselor that I said something was wrong with her before I knew she had been involved in a serious accident. Also, Counselor surprised to learn the accident was in May, despite the fact that the date is included in the info we submitted to the court. Daughter told her it was 6 months ago.

On the plus side, daughter did not immediately take off and for the most part she was over her anger when she was released—no doubt at least partially explained by the new prescriptions for olanzapine and Thorazine, which keep her in a semi-zombie state. (I'm still waiting for her doctor to return my call about adjusting her meds.)

Also, she has agreed to have the MRI. Too bad that wasn't taken care of at the hospital because we've been told it will take 6-12 weeks to schedule this—after we get a referral, of course.

I an effort to keep her from returning to CA, we're getting her an apartment, arranging for the family and PTSD therapy she's requested, and of course, the MRI. Still hoping we can determine what accounts for this tremendous change in her behavior. If the changes/damage cannot be undone, we hope to get her everything she needs to live a full, independent life. From what I've seen so far, it's going to be a long, uphill battle.
posted by zombies puppet at 5:28 PM on September 7, 2015

So sorry to hear that things weren't better resolved before her release and that your views and information wasn't better taken into account. Hang in there and best of luck with things like a speedy MRI. There was a great Fresh Air podcast recently with some of the latest on BPD, which could be worth a listen.
posted by salvia at 10:05 PM on September 7, 2015 [1 favorite]

I'm also very sorry that things unfolded in this way. Your daughter's willing to do family therapy, though? That sounds very positive (to me, at least).

For the MRI - in my area, it's possible to be placed on a waiting list for cancellations. You have to be ready to go quickly, though. I wonder if that might be available to you?

Also wishing luck to your daughter, and to you and her father. (It's very clear that you're committed to doing everything you can for your daughter - but please, take care of yourself, as well.)
posted by cotton dress sock at 2:10 AM on September 10, 2015

How incredibly frustrating. It's too bad that it sounds like there wasn't a neurologist on the team that handled your daughter's case at the hospital. It sounds like you're doing all the right things given the cards you've been dealt. I can only echo the others wishing you luck and offering moral support.
posted by biogeo at 9:13 AM on September 10, 2015

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