"Lost in the Storm": Slate article about local child with suicidal depression

[Anonymous]

Anonymous wrote:The standout, to me, is the lack of national or state standards for psychiatric care----- which should BEGIN _ not end_ with medical evaluation. Medical evaluation isn't mentioned once in the article and I bet not one of the many "professionals " she and her daughter have seen, including the inpatient hospitals, did any medical evaluation. She should be tested for the known biological causes of anxiety and depression, first.
But no one in the psychiatric community has any long term benefit from doing so.

After, and ruling out biology, there needs to basic standards of care of psychiatric patients. There are none.
Same for education. There are none.

Has your kid ever been hospitalized? They absolutely do medical evaluations. And it sounds like the author's kid was at Shepherd Pratt, where my kid has also spent quite a lot of time. They 100% do medical evals.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The standout, to me, is the lack of national or state standards for psychiatric care----- which should BEGIN _ not end_ with medical evaluation. Medical evaluation isn't mentioned once in the article and I bet not one of the many "professionals " she and her daughter have seen, including the inpatient hospitals, did any medical evaluation. She should be tested for the known biological causes of anxiety and depression, first.
But no one in the psychiatric community has any long term benefit from doing so.

After, and ruling out biology, there needs to basic standards of care of psychiatric patients. There are none.
Same for education. There are none.

Has your kid ever been hospitalized? They absolutely do medical evaluations. And it sounds like the author's kid was at Shepherd Pratt, where my kid has also spent quite a lot of time. They 100% do medical evals.

Please tell us what medical evaluations at SP entail?

[Anonymous]

Anonymous wrote:

Anonymous wrote:PP, I had the same reaction, but if the program was an hour away, she would be gone from 3:30 to 8:30. That’s a really difficult time to find child care for other children as a single parent household. If they are younger, that might be most of their waking, non-school hours. I could see decisions about trade offs going either way.

Mom of a seriously mentally I have a child with multiple hospitalizations, multiple (unsuccessful) suicide attempts, many different IOPs and PHPs, many different medications, two residential treatment stays and was in a public non mainstream in MCPS. I also have two other kids. So I know the challenges.

I found a few things that bothered me. The declination of PHP due to inconvenient hours, declining what had to have been RICA due to it not being at pretty enough, and not wanting to spent money on care - no sympathies for a neuro and a lawyer.

I get that it’s really hard. I remember crying the first time I had to leave my kid in the hospital. I couldn’t make it to work that day, I was such a mess. I remember playing the game with MC Crisis and almost losing because right after they cleared my kid, another suicide attempt. And I get that it’s extra tough because her kid is only 10. But some of their choices don’t make sense.

Agreed. Also the "fancier neighborhoods than ours" -- a doctor and a lawyer?? GMAFB. It's a terrible, terrible road, that's for sure. But why haven't they done residential? They could send their kid to St Vincent's in Timonium, for instance, using insurance. They don't have to go out of state or go through schools. There are other options.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I read the story. I've had some experience with my kid at an inpatient facility, and also lots of therapy and medication over the years.

I realize one of the challenges of an article like this is trying to condense a very long, complicated story into a single written piece. I also appreciate the need to leave out some details due to privacy issues.
That said... there was one part of the story that stuck out for me, and when I discussed the article with my DH, he related that he had the same reaction when he read it.

There is a point in the process where the care team is recommending an outpatient program. (This is after the second, more successful inpatient program.) The author says it sounds great, but then when the time of the program is changed to 4:30-7:30, the author makes a flat statement that is is "impossible with two other kids at home." The recommendation for this program even comes up again in the article, and author states they instead went with a virtual option. One they were doubtful would be helpful, and sure enough wasn't.

I fully appreciate that for a person with this severe level of mental health needs there will never be "one thing" can magically fixes everything. I also understand (as I said above) that I don't have all of the details.
However, while my reaction throughout reading this article had been nothing but sympathy, this part brought me up short. I just couldn't understand why this particular treatment was deemed impossible. At this point, the kid hasn't been in school, the author is taking family leave and ultimately quitting her job. There is already tremendous upheaval in their family life. I can only imagine the amount of upheaval that the siblings of this child are already experiencing. Needing to get a sitter, or arrange transport, or... something? That feels do-able based on all of the other things this family has done, and the crisis level of the suffering child. It left me scratching my head. Did anyone else have the same reaction? Am I missing something obvious?

The program is an hour away three days a week. 4:30-7:30 means she doesn't see her other kids three days a week. The parents are also divorced, so that means her kids sit by themselves three afternoons a week if those are her days

Sorry but thats exactly why it doesn't make sense. They're divorced. He should have taken the daughter 3 days a week.
Men can't fucgging pull up.

Dad is a physician. Mom is an attorney. Which one do you think has more bandwidth to be away from the office?

Dad.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The standout, to me, is the lack of national or state standards for psychiatric care----- which should BEGIN _ not end_ with medical evaluation. Medical evaluation isn't mentioned once in the article and I bet not one of the many "professionals " she and her daughter have seen, including the inpatient hospitals, did any medical evaluation. She should be tested for the known biological causes of anxiety and depression, first.
But no one in the psychiatric community has any long term benefit from doing so.

After, and ruling out biology, there needs to basic standards of care of psychiatric patients. There are none.
Same for education. There are none.

Has your kid ever been hospitalized? They absolutely do medical evaluations. And it sounds like the author's kid was at Shepherd Pratt, where my kid has also spent quite a lot of time. They 100% do medical evals.

Please tell us what medical evaluations at SP entail?

Oh lord, let me try to remember the specifics: they tested blood sugar levels to make spikes/changers weren't causing symptoms, checked for signs of infection that could cause psych symptoms, including "sneaky" things like lyme, liver function tests (which I think was just blood testing).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I read the story. I've had some experience with my kid at an inpatient facility, and also lots of therapy and medication over the years.

I realize one of the challenges of an article like this is trying to condense a very long, complicated story into a single written piece. I also appreciate the need to leave out some details due to privacy issues.
That said... there was one part of the story that stuck out for me, and when I discussed the article with my DH, he related that he had the same reaction when he read it.

There is a point in the process where the care team is recommending an outpatient program. (This is after the second, more successful inpatient program.) The author says it sounds great, but then when the time of the program is changed to 4:30-7:30, the author makes a flat statement that is is "impossible with two other kids at home." The recommendation for this program even comes up again in the article, and author states they instead went with a virtual option. One they were doubtful would be helpful, and sure enough wasn't.

I fully appreciate that for a person with this severe level of mental health needs there will never be "one thing" can magically fixes everything. I also understand (as I said above) that I don't have all of the details.
However, while my reaction throughout reading this article had been nothing but sympathy, this part brought me up short. I just couldn't understand why this particular treatment was deemed impossible. At this point, the kid hasn't been in school, the author is taking family leave and ultimately quitting her job. There is already tremendous upheaval in their family life. I can only imagine the amount of upheaval that the siblings of this child are already experiencing. Needing to get a sitter, or arrange transport, or... something? That feels do-able based on all of the other things this family has done, and the crisis level of the suffering child. It left me scratching my head. Did anyone else have the same reaction? Am I missing something obvious?

The program is an hour away three days a week. 4:30-7:30 means she doesn't see her other kids three days a week. The parents are also divorced, so that means her kids sit by themselves three afternoons a week if those are her days

Sorry but thats exactly why it doesn't make sense. They're divorced. He should have taken the daughter 3 days a week.
Men can't fucgging pull up.

Dad is a physician. Mom is an attorney. Which one do you think has more bandwidth to be away from the office?

I think if my kid was *suicidal* I would team up with my co parent to get my kid some treatment.

[Anonymous]

Anonymous wrote:I really don't understand turning down the 8 week intensive program in the afternoon. If your child is in crisis and that is the only option, you make it work especially with a doctor and an attorney as parents. If the child had to take her to cancer treatments or for dialysis at that time the parents would make it there.

I also don't understand the threats by the DBT program to hospitalize. Go ahead and call to report the family. There aren't many in patient treatment centers so most ER's aren't going to move forward with admitting a nine or ten year old no matter what the treating psychologist says.

The difference is dialysis and cancer treatments are almost 100% likely to work.
The IOP program is like 5% likely to help. Everyone is just guessing.

[Anonymous]

Anonymous wrote:I really don't understand turning down the 8 week intensive program in the afternoon. If your child is in crisis and that is the only option, you make it work especially with a doctor and an attorney as parents. If the child had to take her to cancer treatments or for dialysis at that time the parents would make it there.

I also don't understand the threats by the DBT program to hospitalize. Go ahead and call to report the family. There aren't many in patient treatment centers so most ER's aren't going to move forward with admitting a nine or ten year old no matter what the treating psychologist says.

You didn't understand what they were doing there? They wanted to dump her as a patient. Hence the demand for a treatment contract that was totally unreasonable. Child's issues were too difficult. Private practices like EASY patients.

[Anonymous]

Anonymous wrote:I also have three kids and one who did multiple ER visits and an in patient hospitalization in 6th grade, plus multiple threats to call police or CPS on us, plus one forced trip to ER in a police car.

But my sympathy for the writer really wanted over the article. Yes the system sucks and there are insufficient resources and parents have puzzling few rights here. But the writer complains about even people that are trying to help you. DBT is all about keeping people out of the in patient hospitalization so if they all recommended hospitalization, that really says something. I was really irked at her saying “oh the evening programs don’t work for me” — clearly it’s not ideal but how do you turn that down? I was also somewhat surprised at how little discussion there was of medication she is probably under medicated for the anxiety and maybe OCD as well (I think fixation on mental health can be a form of OCD perseveration).

I also agree with PP that for some of these kids they are less suicidal and more attention seeking. I think it’s particularly true for high IQ girls who can construct very detailed narratives almost like they are writing a version of the bell jar in which they are the starring character. The DBT programs are more successful in treating that than some other modalities but it is really challenging. As our DBT therapist pointed out, if she doesn’t get the attention she is seeking from the words she is expressing, she may move on to actions. It’s a really hard line to draw. For my kid, the hospitalization was soooo boring and unpleasant that it at least convinced her that she needed to stop saying things that were going to get her out in the hospital. Then she was able to switch her focus to other things once she wasn’t caught up in that narrative. The writer’s daughter is clearly very intelligent with that poetry, so part of the issue may be that she is wildly bored in school and has constructed this alternate high drama life for herself that she is now trapped in without a clear way to break that cycle. The mental health stuff has become her whole life and as a high IQ kid, she’s knocking it out ofvtje park

I would also love to see more research on how puberty hormones affect anxiety in young teen or teen girls. I’ve seen so many that are sudden fly struck by crushing anxiety within a year or so of getting their period and who are then significantly better by 8th grade or so. Now living through perimenopause i think there is insufficient understanding of how female hormones contribute to anxiety.

I think you read this situation correctly. I have a friend whose daughter is behaving in very similar ways, so much that I had to check the author's name to see if it was my friend.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m totally out of my depth here because my kid is an externalizer, not an internalizer. But - isn’t it possible that ignoring children’s statements about death/suicide might be better than the intense reactions described here? Making suicidal statements and gestures is a good way to get a big adult reaction, which in turn can reinforce the behaviors. And then simultaneously makes it difficult to discern if the child is actually at risk because there’s no way to discern if they have a plan and ability to carry it out if all statements result in going to the ER. I don’t know, it just seems like statements made by children this young should be handled differently from
statements made by adults and teens.

NP here. There's actually something to this.

My teen DD experienced a lot of what's in this article. Not as extreme, but much of what's written is very familiar to me.

But let me tell you that as a parent, it's very hard to gauge what is attention-seeking behavior and what is a real threat. At least in the beginning, and even then for a LONG time. The reality is, a lot of it IS attention-seeking behavior, but you still have to take it seriously, because 1) What if it's not; and 2) What if a half-hearted attempt goes sideways? I promise you every parent with a child like this has had that thought of "Oh, she just wants attention" but it is still frightening because of 1) and 2). And so, you learn to err on the side of caution.

I will say that over time, we came to recognize certain patterns and behaviors. And what we saw was a lack of commitment to getting better. DD wasn't taking medicine she was prescribed. She was approaching therapy more as an attempt to win over the therapist to validate her long list of grievances about what a terrible life she had had (which was a fiction -- she had a fine childhood). The only thing she really seemed to relish was group -- and even then she seemed to get some kind of sick satisfaction out of watching all the other screw-ups and feel superior to them. It was REALLY strange and unsettling, and we're still dealing with that superiority complex now that she's into her 20s.

But what changed is eventually we said "enough." And stopped the intensive interventions. We pulled her out of the PHPs. We got her a personal therapist and offered group therapy so she could get that fix, but she decided not to go. But basically, we decided to stop coddling her. It was scary as hell. But the intensive therapy wasn't changing anything -- it was just bankrupting us and perpetuating the drama.

You know what happened? She stabilized. She matured. She graduated high school and went to college. And while there are still troubling mental health behaviors now and again, but they're fewer and far between. She's an adult now so I can't make her see a psychiatrist, although I've urged her to.

So, for us, at least, dropping the rope had a better outcome than continuing down the road. I'm not saying this would work for every family that finds themselves in this nightmare. But, it's worth a conversation. Sometimes if you stop coddling, it can work.

Out of curiosity, was your child also school-avoidant? What were you doing for school and how was that affected when you dropped the intensive interventions?

There were avoidant behaviors — leaving class and hiding in the band room closet, for example. She never came out of school — the PHP was done over summer, purely by coincidence. There was more outright school refusal in middle school but that was only a couple of times.

[Anonymous]

Anonymous wrote:Divorce has consequences on children well being they should have thought that through first

This is not a spillover effect or consequence of divorce. That is so incredibly ignorant and you should be slapped hard for saying it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I read the story. I've had some experience with my kid at an inpatient facility, and also lots of therapy and medication over the years.

I realize one of the challenges of an article like this is trying to condense a very long, complicated story into a single written piece. I also appreciate the need to leave out some details due to privacy issues.
That said... there was one part of the story that stuck out for me, and when I discussed the article with my DH, he related that he had the same reaction when he read it.

There is a point in the process where the care team is recommending an outpatient program. (This is after the second, more successful inpatient program.) The author says it sounds great, but then when the time of the program is changed to 4:30-7:30, the author makes a flat statement that is is "impossible with two other kids at home." The recommendation for this program even comes up again in the article, and author states they instead went with a virtual option. One they were doubtful would be helpful, and sure enough wasn't.

I fully appreciate that for a person with this severe level of mental health needs there will never be "one thing" can magically fixes everything. I also understand (as I said above) that I don't have all of the details.
However, while my reaction throughout reading this article had been nothing but sympathy, this part brought me up short. I just couldn't understand why this particular treatment was deemed impossible. At this point, the kid hasn't been in school, the author is taking family leave and ultimately quitting her job. There is already tremendous upheaval in their family life. I can only imagine the amount of upheaval that the siblings of this child are already experiencing. Needing to get a sitter, or arrange transport, or... something? That feels do-able based on all of the other things this family has done, and the crisis level of the suffering child. It left me scratching my head. Did anyone else have the same reaction? Am I missing something obvious?

The program is an hour away three days a week. 4:30-7:30 means she doesn't see her other kids three days a week. The parents are also divorced, so that means her kids sit by themselves three afternoons a week if those are her days

Sorry but thats exactly why it doesn't make sense. They're divorced. He should have taken the daughter 3 days a week.
Men can't fucgging pull up.

Dad is a physician. Mom is an attorney. Which one do you think has more bandwidth to be away from the office?

Dad.

No. A doctor treats patients. People. A lawyer is just a paper pusher.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I read the story. I've had some experience with my kid at an inpatient facility, and also lots of therapy and medication over the years.

I realize one of the challenges of an article like this is trying to condense a very long, complicated story into a single written piece. I also appreciate the need to leave out some details due to privacy issues.
That said... there was one part of the story that stuck out for me, and when I discussed the article with my DH, he related that he had the same reaction when he read it.

There is a point in the process where the care team is recommending an outpatient program. (This is after the second, more successful inpatient program.) The author says it sounds great, but then when the time of the program is changed to 4:30-7:30, the author makes a flat statement that is is "impossible with two other kids at home." The recommendation for this program even comes up again in the article, and author states they instead went with a virtual option. One they were doubtful would be helpful, and sure enough wasn't.

I fully appreciate that for a person with this severe level of mental health needs there will never be "one thing" can magically fixes everything. I also understand (as I said above) that I don't have all of the details.
However, while my reaction throughout reading this article had been nothing but sympathy, this part brought me up short. I just couldn't understand why this particular treatment was deemed impossible. At this point, the kid hasn't been in school, the author is taking family leave and ultimately quitting her job. There is already tremendous upheaval in their family life. I can only imagine the amount of upheaval that the siblings of this child are already experiencing. Needing to get a sitter, or arrange transport, or... something? That feels do-able based on all of the other things this family has done, and the crisis level of the suffering child. It left me scratching my head. Did anyone else have the same reaction? Am I missing something obvious?

The program is an hour away three days a week. 4:30-7:30 means she doesn't see her other kids three days a week. The parents are also divorced, so that means her kids sit by themselves three afternoons a week if those are her days

Sorry but thats exactly why it doesn't make sense. They're divorced. He should have taken the daughter 3 days a week.
Men can't fucgging pull up.

Dad is a physician. Mom is an attorney. Which one do you think has more bandwidth to be away from the office?

Dad.

No. A doctor treats patients. People. A lawyer is just a paper pusher.

Men are so much more important, PPP. Haven't you understood this yet? A man could never have a colleague cover for him while he takes care of his own daughter! What a silly woman headed thing for you to even think!

[Anonymous]

Anonymous wrote:

Anonymous wrote:I really don't understand turning down the 8 week intensive program in the afternoon. If your child is in crisis and that is the only option, you make it work especially with a doctor and an attorney as parents. If the child had to take her to cancer treatments or for dialysis at that time the parents would make it there.

I also don't understand the threats by the DBT program to hospitalize. Go ahead and call to report the family. There aren't many in patient treatment centers so most ER's aren't going to move forward with admitting a nine or ten year old no matter what the treating psychologist says.

You didn't understand what they were doing there? They wanted to dump her as a patient. Hence the demand for a treatment contract that was totally unreasonable. Child's issues were too difficult. Private practices like EASY patients.

As someone whose kid went through DBT, I don't think this is right. The DBT program--by definition--is typically a year long program that involves a weekly group session, a weekly individual session, and, for minors, a parent group. You can't just do a little bit of DBT because it would be like doing a little bit of calculus class -- it's a skills based program and all the skills need to work together. It really demands a fair amount of commitment, and it's definitely a much harder modality for the practicioners beause they are typically available for check-ins with the patients througout the week to help them use the skills. But like all practicioners, they need to do certain things to maintain their liability coverage and comply with mandated reporting laws -- and if a child is repeatedly stating a suicidal ideation that is concrete enough, they really don't have much choice about reporting it. (Reading between the lines, I also really wonder if the DBT professionals thought the parents were not being realistic, and that requiring the in-person consultant was a way to get them more educated about options.) If they wanted to dump her as a patient, they could have just said "We can't meet her needs."

On the reporting, this is where the system is totally f-ed up. The mandated reporters have to report. If you refuse to take them to an ER for assessment, they may have to call CPS and report you for medical neglect. Regardless of the fact that there aren't available beds and the treatment doesn't actually cure anything (but will keep the child safe for a brief moment while they are inside). So if the school counsel or the therapist or whoever tells you they are going to call, you have to go to the ER and hope you can talk the ER person out of commiting the child. IME, the ERs that actually have a juvenile unit are more likely to send you home -- they know they need to save those beds for the really serious cases and are better able to suss out the kids that are just attention seeking. The ERs that do NOT have a juvenile unit are worried about their liability, aren't skilled in interviewing kids/teens so won't ask the right questions, and will keep you sitting in a random ER bed indefinitely while they wait for a bed to open up God-knows-where. So the worse case scenario is some therapist or counselor who doesn't know much forces you to take the kid to an ER where they don't know much, and then you end up stuck going to the worst option for in-patient, just because that's where there's an open bed.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I really don't understand turning down the 8 week intensive program in the afternoon. If your child is in crisis and that is the only option, you make it work especially with a doctor and an attorney as parents. If the child had to take her to cancer treatments or for dialysis at that time the parents would make it there.

I also don't understand the threats by the DBT program to hospitalize. Go ahead and call to report the family. There aren't many in patient treatment centers so most ER's aren't going to move forward with admitting a nine or ten year old no matter what the treating psychologist says.

You didn't understand what they were doing there? They wanted to dump her as a patient. Hence the demand for a treatment contract that was totally unreasonable. Child's issues were too difficult. Private practices like EASY patients.

As someone whose kid went through DBT, I don't think this is right. The DBT program--by definition--is typically a year long program that involves a weekly group session, a weekly individual session, and, for minors, a parent group. You can't just do a little bit of DBT because it would be like doing a little bit of calculus class -- it's a skills based program and all the skills need to work together. It really demands a fair amount of commitment, and it's definitely a much harder modality for the practicioners beause they are typically available for check-ins with the patients througout the week to help them use the skills. But like all practicioners, they need to do certain things to maintain their liability coverage and comply with mandated reporting laws -- and if a child is repeatedly stating a suicidal ideation that is concrete enough, they really don't have much choice about reporting it. (Reading between the lines, I also really wonder if the DBT professionals thought the parents were not being realistic, and that requiring the in-person consultant was a way to get them more educated about options.) If they wanted to dump her as a patient, they could have just said "We can't meet her needs."

On the reporting, this is where the system is totally f-ed up. The mandated reporters have to report. If you refuse to take them to an ER for assessment, they may have to call CPS and report you for medical neglect. Regardless of the fact that there aren't available beds and the treatment doesn't actually cure anything (but will keep the child safe for a brief moment while they are inside). So if the school counsel or the therapist or whoever tells you they are going to call, you have to go to the ER and hope you can talk the ER person out of commiting the child. IME, the ERs that actually have a juvenile unit are more likely to send you home -- they know they need to save those beds for the really serious cases and are better able to suss out the kids that are just attention seeking. The ERs that do NOT have a juvenile unit are worried about their liability, aren't skilled in interviewing kids/teens so won't ask the right questions, and will keep you sitting in a random ER bed indefinitely while they wait for a bed to open up God-knows-where. So the worse case scenario is some therapist or counselor who doesn't know much forces you to take the kid to an ER where they don't know much, and then you end up stuck going to the worst option for in-patient, just because that's where there's an open bed.

yikes. I’m going to put that one in my back pocket in case I ever need it (hope not).