[pink&grey]

Hi All, I just visited with my long time therapist. She's also my son't therapist and has known him for about 4 years. After explaining how he's doing she suggested I consider putting him in an inpatient program. It scares the living crud out of me and I don't know what to do. I'd love some advice from those who have been inpatient and from mothers/fathers who've had to make the decision.

The big issue is that lately he is terribly depressed. The voices are still mostly contained with the risperdone, but his phobia/delusion that someone is going to kill us at night has gotten worse. He's spending a lot of time in bed, and saying things like I hate myself, I want to die, I wish I could kill myself, I'm hopeless, etc. Over and over. Last night the phobia took him to a new level where he was pacing rapidly around in circles screaming these things while he slapped himself over and over. I got him into my bed and got him calmed down somewhat and he decided to go sleep in his bed. When I woke up I couldn't find him and I started to panic. I did eventually find him sleeping between my bed and the wall, but the point is that I'm starting to get very scared that he will kill himself. I've called the pDoc, but they can't get him in until next Monday, and, as my t pointed out, even then it will be just another experimentation with more meds to see what will work over time.

It's so hard for me to put him in the hospital because what if something happens or someone hurts him there? What if he then doesn't trust me and won't tell me in the future if he's in danger? But he's suffering, I'm suffering and my 7 y/o daughter is scared and sad for him.

For those who don't know, I'm a single mom so no one to make these decisions with. Also, my son is 12.

[Sometimes psychotic]

The other patients are not a concern---generally the sickest ones have been heavily drugged and are incapable of interaction at all. Now here is what I want you to think about----if he's hitting himself that qualifies as danger to self---they are not just going to have a lovely chat with him if he doesn't stop immediately upon being asked---he will either be drugged or forcibly restrained----now if you were sick would you want those things to happen? The nurses get paid to stop bad things from happening and they don't know your son and will err on the side of caution. I've never met anyone who has been thankful for either restraints or forced drugging. As far as depression I can't imagine a more depressing environment than the mental hospital----I went to a "good one" at an academic hospital and my pdoc was actually the head of inpatient care so I was given full privileges. Visitors at any hour I wanted but still no more than 2 at a time---they could not visit my room but had to go to the day room with me for some reason ---got to wear my own clothes but no belt shoes or drawstrings on pj's. I got to have food from the outside whenever I wanted. But there are a ton of restrictions on a psych ward---rules vary but on mine you could not have flowers, you could not have anything electronic---mp3, tablet, laptop, phone etc so your entertainment choices are down. The bulk of your life is the day room which has a big TV with daytime TV game shows and the like---you aren't getting therapy its just a warehouse which provides meds---if you need a change in meds its a good place to go because they can figure out how you'll react without 10 different prescriptions. Its expensive as heck $2,000 a day so check your insurance. even if 80 or 90% is paid after a week or so to stabilize you can have a $2,000 bill and it could take much longer than a week. There is literally nothing to do but become a vegetable in there---sure there are books and games but can you focus enough to read while psychotic? I could not. Games require interaction with other patients most of which are barely functional. Puzzles were missing pieces. As such it is an environment of constant failure...you cannot win..you will only be spoken to if you are doing something wrong or its time for meds. For me it actually made hallucinations and delusions worse because there were no distractions. Also for some the hospital is a training ground like a prison is. You might learn how to cut or even better techniques for suicide. For example---I wasn't allowed near the window---clearly that's a method and it was due to nurse restrictions that I though about it and not my own volition.
Now that being said you also need to think of yourself---if you really can't handle him I can see how it would be easy to put him in the hospital for a couple of days/weeks---however I would try to find some source of help in the home. Not necessarily in terms of monitoring but even if you could pay someone to clean the house or watch your daughter its would be a lot easier for you. I guarantee it will be a whole lot cheaper than the hospital bill even after insurance. So personally I would say no hospital but you need to make changes to make life easier for you and everybody else in the home.

[pink&grey]

Thank you as always! This gives me a lot to think about and a better understanding of what I'm really considering. I think I can handle him, but it's so hard to see him suffer. I looked up the hospital that my t recommended and found horrible reviews and news coverage of one lady who was given a bunch of different drugs in a 3 day period and then died there, yet no one knows why...supposedly.

I don't think I can do it. I have to come up with a new plan. I like the idea of getting help around here so that some of the stress and exhaustion is taken off my back. I may consider asking my parents if we can all just move over to their house for a few days too. He's happier there and doesn't get the paranoia as much when there.

[Sometimes psychotic]

Originally Posted by pink&grey

Thank you as always! This gives me a lot to think about and a better understanding of what I'm really considering. I think I can handle him, but it's so hard to see him suffer. I looked up the hospital that my t recommended and found horrible reviews and news coverage of one lady who was given a bunch of different drugs in a 3 day period and then died there, yet no one knows why...supposedly.

I don't think I can do it. I have to come up with a new plan. I like the idea of getting help around here so that some of the stress and exhaustion is taken off my back. I may consider asking my parents if we can all just move over to their house for a few days too. He's happier there and doesn't get the paranoia as much when there.

I think that sounds like a good plan------hope things get better and you should talk to the pdoc about a med adjustment on an outpatient basis...

[Victoria'smom]

Does your area have a partial hospitalization program for kids instead of public school usually they are 7:30-6 pm with a full staff or is it possible to have an evening nurse come in at night.

[Nobodyandnothing]

Hi Pink,
I was in a similar situation when my son was 15. His behavior was similar to what you have described. We took him to the ER on a night that was particularly bad, and he was approved for admission to the closest inpatient unit that accepted children. It was 1 1/2 hours from our home and they would not let me take him there, so at nearly midnight, I followed the ambulance to the hospital.

He was admitted, they checked all his belongings, removed things that could be a danger to him, and showed him his small private room. They explained the rules and I signed a gazillion forms. Then they told me to leave. I said goodbye and the door was locked behind me. It was the hardest thing I have ever done.

Dealing with insurance was terrible. He needed to be reviewed every day and insurance would only approve one day at a time. He could only talk on the phone at a predetermined time for about 5 minutes. Visiting was allowed twice a week. There were children screaming in the halls. They checked on him constantly. Most of his care was from aides trained to deal with kids but he also saw a resident and a social worker every day. We also had family counseling.

He was only there for seven long days BUT this event put a whole series of events in motion:
He was evaluated at school and given special services with an IEP.
We found a new T with whom he has an excellent relationship.
His pdoc continues to see him about every 6 weeks to two months.
And, he has turned himself around about 170 degrees. His behavioral referrals at school went from more than 50 (including several out of school suspensions) in two years to none. He is getting good grades (as opposed to getting a close to failing a full year), his relationships have improved.

I am not trying to say everything is perfect. He has done some really stupid thingd, but there are people he can rely on and dkills he has developed to cope. The biggest change has been at school. Having an IEP is a godsend. He has a caseworker teacher to help him and hold him accountable, he gets several accomodations like being allowed to leave a classtoom and go to a resource room to compose himself when he is angry or frustrated, and he is allowed to take tests and quizzes in the resource room.

What I am trying to say is that committing your child is heck on earth but some good may come of it. It is a decision that you have to make. You didn't say if he sees a T or pdoc. I would certainly go that route first, but don't completely write off the possibility for a short inpatient stay for your son.

Good luck to you and your family.

[Nobodyandnothing]

Sorry Pink. I got carried away and after posting saw that he does see a T. Does he have a pdoc and does he take meds? My son takes strattera, concerta and ritilin. Concerta and strattera are a fairly high doses and are continually being adjusted.

[blackwhitered]

I feel like I should give some input as I was in your son's situation pretty much all last year, but I still have mixed feelings about the experience.

I know there were times when I really wanted to die and would have done (and did do) whatever it took to get there.

But sometimes even though I felt suicidal, somewhere I knew that it was only temporary. It was like my thoughts were "I want to do it, I need to do it, I'm going to do it," but my actions ended up being... basically procrastinating until it passed. And that was the majority of times.

But if your son is really miserable and there is nothing you can do to aid that, you should ask him if he is willing to get some help, even if it means going to inpatient.

I don't know him personally, but I got really upset if someone basically sprung it on me and told me I had to stop everything and go to the ER under threat of calling the police. The times when I knew in advance where I was going and where I had time to discuss with my docs and therapists whether I needed to go were the least harmful. Because a lot of times when you're feeling suicidal, you feel out of control. And they gave me some of that back.

For the moment, it may be enough to keep him in your sight (or have someone watch him) and try to keep him calm and distracted. Hide dangerous objects and tell him he needs to check in with you regularly. If it gets worse in the next few days or he actively does something dangerous, take him to the ER.

Also, I know this varies from state to state, but in the state I used to live (New Jersey), they were starting a new policy with emergency evaluations to avoid an excess of inpatient stays. Basically, you could have an evaluator come to your house or doctor's office, or go over the phone, and have a discussion about where you are in terms of danger level. They also discuss a safety plan with you and your family to make sure you stay safe for the moment in case the urge passes or improves.

Even if you can't do an evaluation with a professional, you could try making a safety plan with your son. Not only addressing what you need to do to keep him from hurting himself, but possibly a plan to address his fears of getting hurt at night. Maybe that will help him feel more secure.

[RunningEagleRuns]

Dont give up hope. Things will get better for you and your son. Good luck.

[pink&grey]

Update from us: we didn't go inpatient, but instead put mattresses in my room for him and my daughter and laid out a spade shovel and pepper spray for protection from the night time paranoia and talked through the auicide stuff. Worked really well for two days. Then my son started saying his chest hurt and throwing up and the fatigue came back... We went to the ER, they said GERD and gave him Pepcid. Yet he's still in bed looking like ****. Idk what is happening. I'll be calling the pDoc every day to try and get him worked in if there is a cancellation. Otherwise we have to deal until next Monday. T is on Wednesday. The good thing is no voices, no suicidal talk and no delusions for 3 days! And no voices that I know of.

On a side note I thought it was very interesting that in the ER the doc, resident, and nurse wanted to know why he was on strattera and for how long, but never asked about the risperdal at all. It was like an elephant in the room. Maybe I'm paranoid, but I could swear it wigged them all out.

[pink&grey]

I said no voices twice. Yep, I'm worn out to the max

[Sometimes psychotic]

Originally Posted by pink&grey

Update from us: we didn't go inpatient, but instead put mattresses in my room for him and my daughter and laid out a spade shovel and pepper spray for protection from the night time paranoia and talked through the auicide stuff. Worked really well for two days. Then my son started saying his chest hurt and throwing up and the fatigue came back... We went to the ER, they said GERD and gave him Pepcid. Yet he's still in bed looking like ****. Idk what is happening. I'll be calling the pDoc every day to try and get him worked in if there is a cancellation. Otherwise we have to deal until next Monday. T is on Wednesday. The good thing is no voices, no suicidal talk and no delusions for 3 days! And no voices that I know of.

On a side note I thought it was very interesting that in the ER the doc, resident, and nurse wanted to know why he was on strattera and for how long, but never asked about the risperdal at all. It was like an elephant in the room. Maybe I'm paranoid, but I could swear it wigged them all out.

Well they probably wanted to know if the straterra was causing his symptoms while risperdal would no doubt be suppressing them because it's anti anxiety and antipsychotic in nature so it wasn't important to potentially stop it because it doesn't cause those symptoms. I'm sorry things are still rough for you but thanks for the update...

[ickydog2006]

I'm too lazy to post my experience with the psych ward, but in short, it's a lot like jail. The biggest benefits are that it can set up a string of event to get help, as someone else stated, and that when testing new medications you are in a relatively safe environment, constantly having medical checks, seeing psych daily, harder to harm oneself if having a bad reaction to meds. However, I did have a bad experience with people not adequately responding to a bad physical reaction. They thought I was exaggerating the extreme muscle pain I was in (that's a whole other tangent though). Overall, it was really hard for me being locked up. I got a max of ten minutes outside a day. Basically no physical contact with anyone, visitors were allowed twice a week, but it was a two hour drive for my husband, little phone time, wasn't allowed to see my son (who was three), locked mainly in living area, and overly medicated. Insurance did cover it for me, and it was voluntary (although it would have been forced/involuntary if I hadn't agreed). Also, as someone else mentioned, hurting oneself, even gently smacking, will not be tolerated and means either forced sedation or restraints, which can often be more traumatizing than helpful. If you do decide later to do inpatient, I really think it should be your son's decision, unless he is in the middle of an episode and you really think he will actively try to kill himself within the immediate future or is going to hurt someone else. That's just my opinion though.