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[quote=Anonymous]I have BTDT with my ex-spouse multiple times.  He is bipolar.  The first time my therapist recommended that I call his therapist to share some worrisome signs.  I did so and asked that he keep my sharing confidential.  He called me back and advised me that he could not acknowledge that my then husband was a patient and that in any case he would never agree to keep anything private as it would destroy his therapeutic relationship.  He advised me if I had a problem to ask my spouse to come in with him on his next visit.  We did so, but to be honest, the psychiatrist's unwillingness to include family in treatment was a red flag that he wasn't very good.

The second psychiatrist was very clever and at our first early joint visit essentially said to my spouse in front of me -- "well, you would want her to be able to call me if she was worried about something wouldn't you?"  Of course, my spouse could hardly say no, and thus the psychiatrist had put my spouse in a position to have waived any HIPAA privacy rights.  I called him from time to time if I saw anything that indicated a change in moods.  Over time, the psychiatrist came to see that I was often right and he came to trust me.  This was the time that my exDH experienced the longest stability.

Another time I had to call a physician (not a psychiatrist) to follow up on something.  That time, I basically told the office staff that I respected HIPAA, but that I was providing information to them and they were not revealing anything private and that the doctor should call me if the information I provided indicated there was an emergency.  (It did and the doctor called me back almost immediately, as an emergency entitles him to waive HIPAA. )  In that instance, I was able to track my exDH down and get him to go to the emergency room, which he had been advised but failed to do.

Unfortunately, exDH's psychiatrist retired.  My DH is now my exDH, and I have no connection to the new psychiatrist, so I do not call.  I suppose I might if I saw something really dangerous, but the honest truth is I am tired of this role.  However, if it were my child instead of my exDH, I would not stop contacting the doc.

I would do it by email or fax.  It creates a written record.  You can choose your words carefully.  And, you can submit your entire information before someone cuts you off and says they can't listen due to HIPAA.  I think you have to offer to have the psychologist share your observations with your child.  Asking for it to be kept secret is probably a non-starter.

What's your relationship like with your child?  Can you ask to meet the therapist, suggesting that you want to learn how to best support your adult child?

Do you have a  therapist for yourself?  I found it very helpful to have a therapist to help me deal with my spouse's mental illness.  A therapist is also the best place to get guidance on specific steps to take regarding suicidal threats or talk.

Have you ever taken NAMI's Family to Family course or participated in support groups?  These can also be helpful.  I also love a book by David Karp called The Burden of Sympathy.  It discusses the dilemmas of having a mentally ill relative. It's always so hard to know where to draw boundaries.  Also good is "I'm not sick, I don't Need help" by Xavier Amador; it addresses how to talk with an MI loved one in oder to encourage them to stay in treatment. 
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