Category Archives: psychiatry

What to know about psychiatric residential treatment

What to know about psychiatric residential treatment
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residential centerHave you been searching for psychiatric residential treatment for your child?  Do all the programs sound wonderful?  Ads include quotes from happy parents, and lovely photos and fabulous-sounding activities.  But what’s behind the ads?  Residential treatment programs are diverse, but there are important elements they should all have.  Here’s how to avoid low quality residential treatment.

Psychiatric residential treatment is serious stuff–it’s difficult to do–especially when troubled children and teens are put together in one facility.

Should you ask other parents for their opinion of a program?  In my experience with a child in psychiatric residential care, and as a former employee of one, word-of-mouth is not the best way to assess quality or success rate.  There are too many variables: children’s disorders are different; acuity is different; parents’ attitudes and expectations are different; length of time in the facility is different; what happens once a child returns home is different…  It’s most helpful to ask questions of intake staff and doctors or psychologists on staff.  Quality psychiatric residential care facilities have important things in common.

What to ask about the staff:

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  • What is the training and licensure of staff?  Are there therapists with MSW degrees, registered nurses, psychiatrists and psychiatric nurse practitioners, and is a medical professional available on site 24/7?
  • There should be a high staff to patient ratio, and a physically comfortable environment with lots of emotional support.
  • Do the staff seem mature to you?  Do they support each other, are they a team?  There is often heavy staff turnover at residential treatment centers because the work is emotionally draining, so staff cohesion is as important as the qualities of each individual.
  • Safety is paramount.  Staff must be able to safely manage the things that can go wrong with troubled kids.  They should be trained in NCI (Nonviolent Crisis Intervention), “training that focuses on prevention and offers proven strategies for safely defusing anxious, hostile, or violent behavior at the earliest possible stage.”

What to ask about programs:

  • Does the program specifically identify parent/family involvement as part of treatment?  Does it emphasize parent partnership with staff?  Ask.  Whether you live close or far from the center, even out-of-state, you should be regularly included in conversations with staff about your child’s treatment.  You should also be included in a therapy session with your child periodically; some facilities can connect with you over Skype.  Your child’s success in psychiatric care depends on their family’s direct involvement.
  • The program should coach you in specific parenting approaches that work for child’s behavioral needs.  While your child is learning new things and working on their own changes, you must also.
  • You should be informed why your child is getting the treatment or behavioral modifications he/she is receiving.

Body health is mind health, and vice versa.

  • residential programsMental health treatment will include medication and therapy, but must also include positive activities and an educational program.  The whole body needs care:  exercise, social activities, therapeutic activities (art, music, gardening), healthy food, restful sleep, etc.

Is your child emotionally safe as well as physically safe?

  • You should be able to visit the unit or cottage where your child will live, see their bedroom, and see how the other children interact with staff and how staff interact with each other.

What to ask about the business itself:

  • Can you take a tour ahead of time?  Can your child or teen visit too if appropriate?
  • Are emergency services nearby (hospital, law enforcement) that can arrive quickly?
  • Does the facility have a business license in their state?  Do they have grievance procedures?  Is the center accredited as a treatment facility, and by whom?  In the U.S., the main accreditation authority is called JCAHO (Joint Commission on Accreditation of Healthcare Organizations).

Psychiatric residential treatment works miracles, but it doesn’t work for all children.  Some need to go into treatment more than once to benefit. Some fall apart a few weeks or months after discharge.  These are common.  What’s important is that you and your child are taught skills for managing his or her unique symptoms, communicating well, and committing to staying well together.

Good luck.

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On psychiatry and stigma

On psychiatry and stigma
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When parents complain about psychiatrists, it’s often due to them judging the parent as being the reason for child’s problems; one might call this a bad “bedside manner,” but with huge consequences for the family.  If parents aren’t listened to, or are talked down to, they can’t help, nor live with, their incredibly stressful child.  Yet poor customer service is not unique to psychiatry; the medical field has lots of practitioners who aren’t helpful or people-friendly.  What’s different about psychiatry is that The Rest Of The World often thinks it is sinister and evil.

Our Own Worst Enemies
Nada Logan Stotland, MD, MPH

“Oncology manages to cloak the most primitive possible treatments—poison and burning—with elaborate protocols. Yet the mention of psychiatry conjures ECT, and ECT conjures images of the snake pit.  …We are the only specialty with our own dedicated hate group. We shouldn’t be our own worst enemies.”  May 18, 2010, Blog @ www.psychiatrictimes.com

o        Dr. Stotland, above, mentions ECT  (electroconvulsive therapy), or “shock therapy.”  It reboots the brain and is the only thing that keeps some people alive and eases their suffering.  So how is ECT worse than shocking a stopped heart with a defibillator–two paddles on the chest and BOOM!  Which is more barbaric?

o        In the TV medical dramas, there’s this common scene:  a patient is in a hospital bed surrounded by doctors, and the patient is bleeding, or screaming in pain, or convulsing.  Somehow this is acceptable in prime time.  What if the scene was different.  Instead, an agitated, hallucinating patient is being restrained, and injected with a drug that immediately calms and relaxes them.  My guess is the public would find it sickening and unethical.

o        When a sweet-looking child loses all of his or her hair after being poisoned by chemotherapy, it evokes sympathy and compassion.  But if this same  child’s hair was lost while taking a psychiatric medication, then it would be seen as a barbaric side-effect of forcing drugs on children to send them to zombie-land.  Cancer treatment is forgivable,  treatment for brain diseases is not.

This public attitude must change.   It victimizes the victims who live with mental disorders, and their providers and families.   Mental health treatments are no more barbaric than those of other medical illnesses, but the stigma manifest in blame, prejudice, and ignorance of brain function are cruel–can’t people see we are doing the best we can to get help for sick people?  Let the dialogue be about improving lives instead of finding fault with doctors, sufferers, and families.

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My son has the problem, yet the therapist focuses on me, huh?

My son has the problem, yet the therapist focuses on me, huh?
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Question:   My son’s therapist keeps telling me what to do, or that I’m not doing the right things at home.  But my son is the one with the problem, why all this focus on me?

 

 

Answer:   You are working hard to manage a difficult situation, and you clearly care about your son because you are bringing him to therapy, but your own stress and exhaustion may cause you to aggravate his behavior even though you don’t intend to.  My guess is that the therapist is trying to tell you how to change your parenting or communication style so that your son’s stress is reduced.  This can be a hard message to take when you know you’re doing everything you can, plus you can’t be sure your son is honest in session.

 

The problem I’ve seen with therapists is that they often don’t know how to talk to parents about parenting issues without sounding like they are making presumptions and blaming the parent for the child’s problems.  A good therapist or doctor will show compassion for a stressed parent, and listen to their side of the story.  Then take the time to explain exactly what the parent might do differently, and why.

 

Try giving this therapist a chance first, and ask him or her if you can meet without your son present, and request that they fully explain the reasoning behind their advice.  Let them know that this has been hard for you and you’ve felt blamed, and that you need their support.  Then listen carefully.  If you’re still not convinced of their point, ask them for the title of a book that you can read in privacy and decide for yourself if it applies to you.  Another way to check is to find a parents’ group if one is available, and hear how other parents deal with a challenging child.  If none of your efforts clarify things for you, and if you feel that you can’t work with this therapist, you might consider finding someone who has a better approach to your situation.

 

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Your troubled child’s “recovery”–how you help them achieve it

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What recovery looks like – A person with a mental or emotional disorder who is in “recovery” can look and act like anyone else.  At the least, they have stable relationships, a steady job, a place to live, a regular diet, cleanliness, and regular mental health check-ins.  Recovery is maintained when the person pays attention to themselves to notice if the symptoms are starting, and then takes action to stop the symptoms.

What your child will need to sustain recovery as an adult:

INSIGHT  +  STABILITY  +  RESILIENCE

INSIGHT– self awareness

Insight allows a child to recognize they have a problem, and choose to act to avoid the problem.  If insight is not possible, they need a toolbox of options that help them to respond appropriately, instead of reacting to chaotic messages in their brain. Knowing and admitting they have a problem, or knowing techniques for avoiding problems, are very powerful skills they need as adults.

STABILITY – fewer falls or softer falls

Your child is like a boat that’s easier to tip over than most other boats; any little wave will capsize them, and everyday life is full of waves, big and small.  Your job is to notice when the troubled child is starting to capsize and show them how to right the boat, or if that doesn’t work, how to use the lifesaver.  Eventually, your child will learn how to sense when trouble is coming on, avoid the thing that causes problems, and ask others for help.  Sense it.  Avoid it.  Ask for Help.

RESILIENCE – bounce back when they fall

Troubled children have a much harder time bouncing back from problems.  They have extreme responses to simple disappointments like breaking a toy, or poor grades, or something as serious as the parents’ divorce.  Some even fall apart in joyous times because the emotional energy is too much!  You must be acutely aware of this–they will not get back on track by themselves.  Don’t worry that helping them will spoil them or “enable” them.  Eventually they will learn from you how you do it.

“…We are all born with an innate capacity for resilience, by which we are able to develop social competence, problem-solving skills, a critical consciousness, autonomy, and a sense of purpose.”

     “Several research studies followed individuals over the course of a lifespan and consistently documented that between half and two-thirds of children growing up in families with mentally ill, alcoholic, abusive, or criminally involved parents, or in poverty-stricken or war-torn communities, do overcome the odds and turn a life trajectory of risk into one that manifests “resilience,” the term used to describe a set of qualities that foster a process of successful adaptation and transformation despite risk and adversity…”   http://www.athealth.com

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Mental illness more deadly than cancer for teens, young adults

Mental illness more deadly than cancer for teens, young adults
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Why isn’t everyone more upset?  A disease is killing our children and it’s worse than cancer and leukemia.  Why is pychiatric research 30-40 years behind cancer, as well as the development of pharmaceuticals and other treatment modalities?

We don’t get casseroles when our child is hospitalized for a mental health crisis

Out of curiosity, I did some research on child mortality rates from various causes, because I wanted to know how death from mental illnesses compared with other fatal illnesses of childhood and adolescence. The results were astonishing, unexpected, and disturbing.

Childhood Illness Age Range Annual Deaths per 100,000 Children
Cancers, leukemia: 5-14 yrs 2.6
Cancers, leukemia: 15-19 yrs 3.6
Childhood diabetes: Avg. 15 yrs 2.2
Anorexia: 15 – 24 years 6
Suicide ** 10 – 14 years 1.6
Suicide ** 15 – 19 years 9.5
Suicide ** 20 – 24 years 13.6

(The chart columns are in the order listed in the box, somehow I couldn’t get the right grays!)

* The starting point for the data on the medical illnesses was the website for the Center for Disease Control and Prevention www.cdcp.gov  in Atlanta; the starting point for the mental illnesses was the website for the National Institute for Mental Health, www.nimh.gov.

** The suicide data was from those with depression, bipolar disorder, schizophrenia, and psychotic disorders-unspecified.  (Suicide from other mental health causes, such as borderline personality disorder and co-morbid substance abuse, is also prevalent but I could not find data for young adults.)

This screams out for a changes in attitude, policy, and investment in children’s mental health treatment!  I had no idea that death rates from mental illness were 3 to 4 times higher than the feared cancers and leukemias.  It is imperative that young people with mental health issues receive aggressive and sensitive treatment as would be expected and demanded of medical doctors treating cancer.

The data was difficult to find, requiring searches in many different medical journals and numerous articles, as nothing like it was compiled in one place.  I chose to use the cancer, leukemia, and diabetes data because deaths from all other causes were insignificant by comparison.  The death rates for cancer and leukemia are averages for the different forms of each, and in the journals they were presented together.

I welcome additions or corrections of this data from any other sources, and encourage readers to investigate this for themselves.

 

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