Category Archives: parent rights

Helping your troubled teen after they turn 18

Helping your troubled teen after they turn 18
3 votes

Most young people aren’t ready for adulthood by 18 years of age, but your troubled teen is especially unprepared. By 18, their legal status instantly changes to “adult” and they are free to fail at life’s countless tests. Your hands are tied and you can’t keep your son or daughter safe from themselves any more.

Pace yourself for a marathon

Your job as parent is far from over.  Not surprisingly, parenting an 18+ year old will feel the same as when they were 17 years 11 months old.  They’ve been behind their peers for a long time–emotionally or socially or academically. You’ve done everything possible to get them ready for adulthood, but they simply aren’t!  For troubled teens, the teen years last into the mid-20’s or longer. And this is really scary; suicide rates across all age groups are highest for people aged 16-24.  It’s the period of greatest stress, whether the person is suicidal or not.

Many people with disorders aren’t able to take full responsibility for themselves until their early 30’s.

Over the past 16 years, I’ve asked this question of people with mental health disorders, their parents and siblings and children, and their friends:  “At what age did (you, your loved one) make the conscious choice to take responsibility for themselves: treatment, income or job, living on their own, choosing to associate with healthy people. I asked dozens and dozens of people. Their answer? Every single one told me they or their loved one didn’t turn things around until they were between the ages of 29 – 34.

True story: a co-worker once shared about his bipolar disorder and his years of substance abuse and hardships. I would never had guessed this grounded stable person had a troubled past. I asked when he turned his life around; it was 30. I asked what motivated him.  His answer? “I couldn’t avoid it anymore. I ran out of excuses. I hit rock bottom too many times.”

The questions to ponder are how much to sacrifice and how much to let go.  There needs to be a balance.

Parents have a tendency to rescue their adult son or daughter when a crisis befalls because  it’s so hard for the child to recover from set-backs.  But rescuing too much makes them more dependent on the parents (or adult siblings).  Pressuring a troubled teen to be an “adult” when they are not ready may lead to their dependence on others who might make their lives worse.  Or they’ll cope with drugs or alcohol, or risky choices, or give up.

I know of a couple in their 70’s who’d rescued their troubled 34-year-old daughter her entire life, and faced cutting her off because they couldn’t manage anymore.  They were heartbroken to let her go, painfully afraid she would become homeless or suicidal, and deeply regretful they unwittingly undermined her capacity for independence.  Don’t let this happen to you.

The first challenge is deciding where they’ll live.

As with any troubled teen, they must become independent eventually.  It may be a tough call for you:  bear the stress if they live with you? or worry when they leave your protection, possibly forever?  Ironically, your adult child must be better than ‘normal’ young people at managing life because they have so much more to worry about.  Besides the usual adult responsibilities, add self-monitoring for mental and emotional stability, taking meds or obtaining therapy, and disciplining themselves to stick with dozens of choices that support their well-being (diet, exercise, healthy friendships, education or work, financial stability…).

If your troubled teen of 18 must live at home full or part-time, change your rules and expectations. Rules can include a requirement for ongoing mental health care. Your troubled teen must transition to becoming your guest who stays at your invitation and a renter who contributes to the household and follows the landlord’s rules.  You’ll need discipline to step back and respect their privacy and (reasonable) choices and activities.  This may not be easy to achieve–you’ll make many compromises.

In the eyes of the law, you are not responsible for them anymore.

You really aren’t.  In fact, you have the right to banish your 18-year-old from your home and change the locks on the doors.  The parents who do this are usually in fear for their physical and emotional safety–not because they don’t care.  If this describes you, it’s understandable and forgivable if you feel forced into this step.  But know this, things change.  Your adult child will change; banishment is not forever.

There’s good news. Adults have more options for support.

Ironically, your troubled teen, by 18, will have more access to services than ever, and you’ll both get the support you’ve desperately needed.

  • In the U.S., people with mental health problems are protected from job/housing/educational discrimination by laws that protect the disabled.
  • insurers are required to provide mental health care on par with all other treatments and services.
  • Mental health advocacy groups support adults by offering support groups, referrals to safe housing or appropriate job opportunities, social connections with safe accepting peers, and legal and legislative advocacy.
  • Educational institutions have special departments solely for supporting students with disabilities, and that includes troubled young adults.

This is what your troubled teen needs to function after 18, listed in order of value:

  1. A constant, supportive family (that sets boundaries and asserts high-as-possible expectations)
  2. Support from peers and mentors or counselors
  3. A job or continuing education
  4. Ongoing mental health care
  5. A safe living situation

Adjust your expectations for how quickly they’ll progress.

Parents with ‘normal’ 18 year olds gradually revise their relationship with them, becoming a mentor and peer rather than a parent.  You can’t do that yet; your challenge is to flow between the role of parent, disciplinarian, social worker, and therapist until they are ready.

You can do this.  Stay patient.  Keep a bridge built.  They’ll eventually grow up.

–Margaret

 

Please rate this post and comment.  Your thoughts and experiences will help others who read this article.

2 Comments

Filed under adult, mental illness, parent rights, parenting, suicide, teenagers, teens, troubled children

Your rights as the parent of a teen with a mental disorder

Your rights as the parent of a teen with a mental disorder
7 votes

You really do have more rights than you think.

Some background: In a previous blog article on the subject of rights, I described how parents and caregivers can be shocked to learn that their troubled teenager has the right to refuse treatment, Teen rights versus parent rights when the teen has a mental disorder.

What if your teen refuses treatment?  They usually get worse, sometimes much worse. Tragically, if your teen experiences psychosis for a long period, such as in schizophrenia or bipolar disorder, their brain degenerates just as in Alzheimer’s disease.

If a teenager had any other illness besides a behavioral disorder, withholding treatment would be considered child abuse and grounds for removing the child from the home.

Laws in many countries err on the side of protecting a person’s civil rights, but a teenager is likely not ready to take the responsibility that goes along with these rights. An excellent site covering laws pertaining to Special Education Law is Wrightslaw. Click on “Topics from A to Z.”

  • For safety and health reasons, you can search your teen’s room and remove or lock-up risky items like drugs, weapons, razors, pornography, or anything affecting health (rotten food, unclean garments, chemicals). Caution: this can destroy trust if done inappropriately! Inform your teen only if you find and remove unsafe items but otherwise leave everything else alone! If you call the police regarding illegal items, and if your child is charged, their criminal record can be expunged by age 18.
  • You can set any curfew time you think appropriate, and you do not have to adhere to curfew times used by law enforcement. Suggestion: compare with other parents’ curfews. Your teen will more likely follow rules that his or her peers follow.
  • You can monitor everything in your home, and on your computer and phone. You can limit cell phone services, and get GPS tracking on the phone and in the car. Prevention is more effective if your teen is informed about this, and it prevents others from taking advantage of your child, too.
  • You can report your concerns to anyone: teachers, other parents, and the local police precinct.
  • You can search for your child by calling other parents or businesses, or visiting their friends’ homes, or searching public places where your child might be.
  • You can and should call the police if your child runs away, or if your child is being harbored by someone who wants to ‘protect’ them. It is illegal to harbor runaways and subject to criminal charges.
  • You can notify anyone who encourages your teen to run away or stay away from home, or who takes your teen with them without your permission, that this is custodial interference and also subject to criminal charges.

You have the right to be involved in treatment

“Communication between providers and family members needs to be recognized as a clinical best practice.”*

  • You have the right to contact any mental health professional directly, and provide information relevant to your child, your family (e.g. marital conflict), and your family’s needs (e.g. bullied siblings). The professional can legally receive and document this information, but may not be able to discuss it with you.
  • You have the right to communicate freely and openly with a practitioner or teacher about anything you both already know—no confidentiality exists.
  • You have the right to schedule your own appointment with a professional without your teenager, and ask for information about how to get help for yourself and your family, and what kinds of help you may need.
  • You have the right to information about your child’s diagnosis and behavioral expectations, the course of your child’s treatment, and how you should interact with your child at home.
  • You have the right to a second opinion. And you have the right to change treatment or refuse treatment based on that second opinion.
  • You have to right to participate fully in medical decisions about your child. For example, you have the right to ask a doctor to stop or change medication or treatment that is creating behavior problems or side effects, which harm your ability to manage your teen.
  • You have the right to “information about the treatment plan, the safety plan, and progress toward goals of treatment.” *

“While confidentiality is a fundamental component of a therapeutic relationship, it is not an absolute.”*

“Medical professionals can talk freely to family and friends, unless the patient objects after being notified of the intended communication. No signed authorization is necessary.”

–Susan McAndrew, Deputy Director of Health Information Privacy, U.S. Department of Health and Human Services

Teachers and mental health professionals have leeway with confidentiality Providers often misunderstand the Health Information Privacy and Accountability Act (HIPAA), which defines what must be kept confidential. Many also misunderstand the Family Educational Rights and Privacy Act (FERPA) and state laws that govern confidentiality, so they tend to err on the side of confidentiality. However, the American Psychiatric Association states:

“Disclosures can sometimes be justified on the grounds that they are necessary to protect the patient. For instance, it is generally acceptable for a psychiatrist to warn a patient’s family or roommate when the patient is very depressed and has voiced suicidal thoughts”* or plans to harm others.

Professionals should provide explicit information about safety concerns: such as the warning signs of suicide; the need to adhere to medication and other treatment; an explanation of how your teen’s disorder can impair judgment; an explanation of reasons the teen must avoid substances like alcohol and drugs (including some over-the-counter drugs); and the need to remove the means for suicide, especially firearms, sharp objects, matches, chemicals, etc.

How doctors and therapists manage confidentiality

Their basic philosophy is to do what is in the best interest of their patient. For example, if the teen is in an abusive family situation or seeking care only on the condition of confidentiality, their privacy will be protected. “The default position is to maintain confidentiality unless the patient gives consent… However, [family members or friends] may need to be contacted to furnish historical information…” If the practitioner determines that the teen is (or is likely to become) harmful to him- or herself or to others, and will not consent, then they are… “justified in breaking confidentiality to the extent needed to address the safety of the patient and others.”  –The American Medical Association, 2001, “The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.”

A good professional will be honest with your teen, and tell them that they will communicate with you based on what you already know. They will also tell your child that suicide or violence risk will always be communicated to you and/0r an emergency medical service. From everyone’s perspective “It is always better to defend an inappropriate disclosure than to defend a failure to disclose with bad outcome (e.g. injury or death).”

Giving a teenager with behavioral problems the sole right to make critical medical decisions is crazy!

I hope that families and mental health advocates can someday agree on how to maintain civil rights without letting a person control their future when they are not in their right mind. Until then, work with the system as best you can. I find that teachers and practitioners do their best to help families despite the restrictive civil rights and confidentiality mandates. Good luck.

How am I doing? Please rate this article, thanks. Margaret

* Reference“The Clinician Should Maintain a Confidential Relationship With the Child or Adolescent While Developing Collaborative Relationships With Parents, Medical Providers, Other Mental Health Professionals, and Appropriate School Personnel,” developed by Jerry Gabay JD and Stewart S. Newman MD. The authors would like to acknowledge the support of the Oregon Council of Child and Adolescent Psychiatry for their support of this effort.

4 Comments

Filed under confidentiality, discipline, parent rights, teenagers