Hospitalization for mental illness

[Anonymous]

Call your psychiatrist first, OP. Don't just go to the ER. He will direct you to a hospital.

[Anonymous]

Anonymous wrote:OP here. Does anyone know whether Shepherd Pratt takes patients from outside MD? It might be a good choice. (That said, we may be doing an emergency hospitalization tonight.)

Sending good thoughts, OP. I'm sorry you are going through this. We are not far behind you, I think. I agree about the ER not being a great solution if you can avoid it. However, if he's a danger to himself or others, that is your best bet. We have gone past the point of 18 with my DC (stabilized for a while but now, not so much) and your options are greatly limited once your child is over 18, so do everything you can now.

[Anonymous]

Silver Hill in CT has a longer term residential program for teens. The minimum amount of time patients spend in the program is 4-6 weeks; it is not uncommon for kids to stay longer. They also have an inpatient acute care house/unit for adolescents & most kids spend some time there for stabilisation.

Silver Hill is, unfortunately, very expensive (insurance may or may not pay for some of it). It is supposed to be a top notch program, though, & may be well worth the high price tag if you can afford it.

[Anonymous]

Anonymous wrote:OP here. Does anyone know whether Shepherd Pratt takes patients from outside MD? It might be a good choice. (That said, we may be doing an emergency hospitalization tonight.)

Sending you hugs and good wishes.

[Anonymous]

This may be beside the point now but SP definitely takes patients from outside Maryland.

[Anonymous]

OP here--not beside the point yet. We are still in crisis but trying to contain it until we can get a game plan together. Not sure we can afford some places mentioned here, but we're willing to look at it. Does anyone have a ballpark dollar figure? I'm also really worried about having him so far from home. He will not go willingly so getting him there seems awful, and then I imagine he will feel like we have abandoned him. Worse because it'/ around the holidays.
Thanks to you all. We keep thinking it can't get worse, but we're learning that it can.

[Anonymous]

Anonymous wrote:FWIW, I will pass along what my DD's psychiatrist told us: that hospital admits are geared toward crisis stabilization, and the whole decision hinges on what insurance companies want: evidence that the patient is a clear danger to herself or to others.

Anecdotally, he reports that PIW is often a pretty dysregulated and chaotic environment. Children's is often recommended as the quieter/less emergent caseload option, but I didn't find that to be the case when my DD was admitted. Of the local hospitals, our psychiatrist recommends Inova Fairfax/Kellar.

OP here--Kellar's website doesn't indicate an in patient option. Is there one?

[Anonymous]

For the kind of inpatient program you would want him in, it's $46K for 20 days. I wish I were kidding.

https://retreat.sheppardpratt.org/program-overview/pricing/

Hang in there, OP. I know you said he's not been diagnosed with schizophrenia or bipolar yet, but it's relatively unusual to carry that diagnosis at 17. The next few years are the most common for them to emerge, particularly in men (a little later in women). Early and continued treatment with antipsychotics is indicated and can help. I know they have significant side effects, but the alternative is really often worse.

I'll be thinking of you and your family and sending all my best.

[Anonymous]

OP - So sorry your son and your famly are going through this. I can only relate that our oldest daughter was a very, very hard case to identify in terms of medications and she was not identified as having a mental health issue until she went away to college and it reached the point that she hospitalized herself. It was a very, very hard time for all as on paper she was just what every parent would want in a daughter, student, community member etc. She had to withdraw from a top tier college, came home and fortunately found a good psychiatrist here to work with though as you have seen there were ups and downs over her college and grad school years. Since you seem so at the end of your rope, I will share some of the things that may be considered:

- She was very hard to diagnose, beyond the anxiety - but probably was a derivative of the bi-polar family. But with not classic it was hard to say if meds dealing with that would help. Ativan was med given to her to help keep mood stabilized, but more to take when in a panic or escalating situation. As an adult she still uses it today when she knows she will be in overtly stressful environment.

- She could get started on something and have her anxiety and her "acting out" escalate which for her was calling others on the phone or when home being in your face and unable to sleep. And I mean she could go without sleep or much for days even taking meds. I would definitely say this is not the med to start with if it can be avoided at all, but she was put on Klonopin at least for a time. It was the severe lack of sleep, fueled by anxiety that could escalate though not in dangerous behavior, but still very debilitating such as no concentration etc.

- Inability to sleep runs in the family and when my husband had an adjustment to retirement a few years ago, the same psychiatrist helped him to get his system righted, BUT the key was finding a sleep medicine. What finally worked was an older medication called Doxepin. For him the fact that it also seems to deal with allergies was also very helpful as that had been the start of a physical downturn at the same time.

- For her anxiety/depression she, too, went through several medications while in college and then grad school, and it was very frustrating because one would work for even a couple of years and then seem not to. And you probably due know that to really try a new one or mix means coming off for a period of time. I know at one time she was on Lithium, which while scary to think of, really did work in bringing her system into balance. Eventually she found Lexapro to work.

- In terms of treatment she always had a team of a psychiatrist and a psychologist, who worked together though not in the same practice group. While in graduate school after two years of great stability, things came apart again and at that time, it was recommended she go to a day treatment program so she could also pick up her school program as soon as possible because it was important that she reestablish a routine.

- The impact on the siblings as well as parents is real, and you can't isolate one from the other. About the best you can do is to try and spend special time with the other siblings and let them know they are loved and that the one in turmoil is due to an illness.

- Are there no options in the DC area for a hospital based day program with an educational component once the teen is stabilized? Or it would seem if you get your son into a hospital for stabilization that he would need to be released to a therapeutic day treatment program to start with.

Not sure any of this will apply, but thought I would share.

[Anonymous]

Anonymous wrote:For the kind of inpatient program you would want him in, it's $46K for 20 days. I wish I were kidding.

https://retreat.sheppardpratt.org/program-overview/pricing/

Hang in there, OP. I know you said he's not been diagnosed with schizophrenia or bipolar yet, but it's relatively unusual to carry that diagnosis at 17. The next few years are the most common for them to emerge, particularly in men (a little later in women). Early and continued treatment with antipsychotics is indicated and can help. I know they have significant side effects, but the alternative is really often worse.

I'll be thinking of you and your family and sending all my best.

The Retreat is a great program, and it might take someone as young as 17. But it is a private pay program and the facility is unlocked, which may not work for where you are now. PP is right about the cost--you can probably submit to your insurance company, but percent of payment may not be high.

At the Retreat emphasis is on thorough evaluation and diagnosis and then getting someone on a good treatment plan. There is a lot of therapy and ancillary programs like physical movement classes etc. and lots of availability of psychiatrists, including many residents.

Patients have to go voluntarily, which they establish through a phone call. The threshold is pretty low for voluntary--an acceptable reason for admittance could be just to get their parents off their back. They cannot handle someone in an acute episode. But someone in that state can be admitted to the regular SP system and then move to the Retreat when stabilized. (All information based on my experience trying to get an older teen there.)

SP other than the Retreat program takes many kinds of insurance. There is an adolescent crisis stabilization unit at their Ellicott City campus. This would appear to be where you would need to start given where you are. I would phone the admissions number to see what information they can give you.

https://www.sheppardpratt.org/patient-care-and-services/child-adolescent-services/inpatient-services/adolescent-unit-ellicott-city/

My older teen ended up through a series of mishaps (long story) in the adult wing of the Ellicott City campus four years ago. This is a complete lock down facility. The building at the time was slated for demolition--I don't know if this occurred. If it hasn't been demolished it no doubt has crumbled even more since I was there--the best thing I can say about the building's physical state is that it was well heated.

The adult wing patient population consisted almost entirely of homeless or very impoverished people who had been referred from the ER. It was pretty nightmarish and it took three days to get my child out. At visiting hours I did see younger kids there from the adolescent program. But they may have changed everything since then; just want you to be aware that there are things to look for, and you may want to see if there are better options at the Towson campus.

[Anonymous]

Anonymous wrote:So far docs have been unanimous that he is not schizophrenic or bipolar--so not sure abilify is the right thing yet. Too soon to tell yet if last night changes that view.
I think perhaps based on what I'm hearing here is that what he needs is a residential program, rather than crisis hospitalization. Any suggestions as to how to begin that process? I do not want to warehouse him--I contine to have hope that he can get through this. But he will fight it every step of the way.

Our kid is on abilify with no bipolor or schizo dx either. It is purely for anxiety related aggression. It has been a MIRACLE drug. And she has been hospitalized several times.

Have you looked into something like St. Vincents north of Baltimore? They do residential diagnostic work. It's 30 days, I think, to truly get an idea of what's going on. Then they have residential if needed.

http://www.catholiccharities-md.org/st-vincents-villa/?referrer=https://www.google.com/

[Anonymous]

To begin this process there are two possibilities - either your insurance or the school district, through an IEP. Start both processes and see which goes faster! Different states do this different ways, also. I know Pennsylvania is much different than either MD or VA, for instance.

[Anonymous]

Anonymous wrote:To begin this process there are two possibilities - either your insurance or the school district, through an IEP. Start both processes and see which goes faster! Different states do this different ways, also. I know Pennsylvania is much different than either MD or VA, for instance.

Are you saying you can use an IEP to get long term inpatient hospitalization or residential treatment? If so, can you explai more how that works?

I always thought just that the IEP could be changed to support continued education during treatment.

[Anonymous]

For adolescent crisis stabilization, here are the available options I know of:

Nearer--Dominion, Children's, and PIW (Psychiatric Institute of Washington)

Farther but still driveable--SP, Johns Hopkins, and Snowden at Mary Washington (Fredericksburg)

I no little about the last. Every place otherwise has very mixed reviews. The fact is if you are in crisis, you may just have to take whatever place has an empty bed. None of the options are that great, but stabilization should be done in under a week so it's pretty temporary.

[Anonymous]

Anonymous wrote:

OP - So sorry your son and your famly are going through this. I can only relate that our oldest daughter was a very, very hard case to identify in terms of medications and she was not identified as having a mental health issue until she went away to college and it reached the point that she hospitalized herself. It was a very, very hard time for all as on paper she was just what every parent would want in a daughter, student, community member etc. She had to withdraw from a top tier college, came home and fortunately found a good psychiatrist here to work with though as you have seen there were ups and downs over her college and grad school years. Since you seem so at the end of your rope, I will share some of the things that may be considered:

- She was very hard to diagnose, beyond the anxiety - but probably was a derivative of the bi-polar family. But with not classic it was hard to say if meds dealing with that would help. Ativan was med given to her to help keep mood stabilized, but more to take when in a panic or escalating situation. As an adult she still uses it today when she knows she will be in overtly stressful environment.

- She could get started on something and have her anxiety and her "acting out" escalate which for her was calling others on the phone or when home being in your face and unable to sleep. And I mean she could go without sleep or much for days even taking meds. I would definitely say this is not the med to start with if it can be avoided at all, but she was put on Klonopin at least for a time. It was the severe lack of sleep, fueled by anxiety that could escalate though not in dangerous behavior, but still very debilitating such as no concentration etc.

- Inability to sleep runs in the family and when my husband had an adjustment to retirement a few years ago, the same psychiatrist helped him to get his system righted, BUT the key was finding a sleep medicine. What finally worked was an older medication called Doxepin. For him the fact that it also seems to deal with allergies was also very helpful as that had been the start of a physical downturn at the same time.

- For her anxiety/depression she, too, went through several medications while in college and then grad school, and it was very frustrating because one would work for even a couple of years and then seem not to. And you probably due know that to really try a new one or mix means coming off for a period of time. I know at one time she was on Lithium, which while scary to think of, really did work in bringing her system into balance. Eventually she found Lexapro to work.

- In terms of treatment she always had a team of a psychiatrist and a psychologist, who worked together though not in the same practice group. While in graduate school after two years of great stability, things came apart again and at that time, it was recommended she go to a day treatment program so she could also pick up her school program as soon as possible because it was important that she reestablish a routine.

- The impact on the siblings as well as parents is real, and you can't isolate one from the other. About the best you can do is to try and spend special time with the other siblings and let them know they are loved and that the one in turmoil is due to an illness.

- Are there no options in the DC area for a hospital based day program with an educational component once the teen is stabilized? Or it would seem if you get your son into a hospital for stabilization that he would need to be released to a therapeutic day treatment program to start with.

Not sure any of this will apply, but thought I would share.

I am very sympathetic to how hard it is to diagnose kids and adolescents with mental illness. No one wants to mistakenly label a child. Behaviors which in other populations would be considered diagnostic symptoms are often problematic, but dismissed as "within the range of normal" for an adolescent (i.e. because parents and doctors refer to adolescent hormone swings, risk-taking behavior, and moodiness as normal).

BUT, I just want to point out that there are a few key clues that seem to have been overlooked in your situation, which, when properly considered, point convincingly to a bipolar spectrum diagnosis. Your description of talking on the phone a lot, being in your face and being unable to sleep are pretty much hallmarks of hypomania. There are 2 variations on mania -- the one most people recognize is "frank" mania which is pretty much so manic so as to be disconnected from reality w/ paranoia, delusions of grandeur or extreme hyperactivity. But, hypomania, is a sort of "lower degree" of mania, and it is often misattributed by doctors and family members as behavior that is normal or the result of choice.

Also, the problems with sleep that run int he family is a clue that points heavily to bipolar. Sleep disturbance is a prime component of bipolar and people often mis-attribute the cause of sleep disturbance to anxiety, when both the anxiety and lack of sleep are caused by the underlying bipolar.

Cyclicity is hinted at when you mention that medication that coincided with a regular downturn that occurs with seasonal allergies is also common with bipolar.

Finally, the fact that Lithium worked so well, is a fact weighing in favor of bipolar diagnosis.

A lot of times, bipolar goes undiagnosed while doctors try anti-anxiety meds, sleep medications and/or depressants, either alone or in combination. When one of these medications is tried, they will often seem to work for awhile until the patient cycles either up or down. The doctor and patient think the medication has "stopped working" when really the problem is the wrong diagnosis and wrong class of medications.

All of this is why it's really, really critical to be working with a highly experienced psychiatrist who isn't just doing 15 minute medication checks, and who has a lot of experience depressive disorders so that a proper diagnosis can be made.

There are many good books that describe bipolar, but I really like Frances Mondimore's Bipolar Disorder: Guide for Families and Patients (or something like that). It has a really good overview of symptoms, variations, medications, psychotherapy, etc.