This week I spent several hours on the phone with two mothers whose daughters need inpatient placement and care. Both young women are dealing with substance abuse issues, anxiety, depression and possible bipolar disorder. Both are beautiful, vibrant, intelligent and vital, and will serve the world in amazing ways when they are well.

But right now, they are not well.

And so the questions arise:

When is hospitalization the right move?

When is long term inpatient treatment the best approach?

The answer:

When safety, recovery and prolonged wellness cannot be achieved with a less restrictive approach.

Both of my children diagnosed with bipolar disorder experienced numerous hospital stays. Michael, my son, also spent what amounts to nearly two years, cumulatively, in long term residential treatment programs. Because of these extreme interventions, both Chloe and Michael are alive and well today. Time spent in safe, medically supervised environments kept them from self-harm and, in Michael’s case, substance abuse. It also allowed their medical teams near-constant access to monitor and adjust their protocol for quality care. In the end, time in treatment reduced their recovery times significantly and imbued them with tools and skills they would not have learned in a less-restrictive environment.

Of course, I vividly recall and viscerally remember each time the decision for inpatient treatment was made. Each was literally gut-wrenching, heart-breaking, and required serious soul-searching. But each time my children were better off in the end, and I’m grateful for the medical personnel who encouraged and supported us when the moves were necessary.

A hospital stay might be necessary if someone is:

* Seeing or hearing things (hallucinations)
* Thinks people or entities are out to get them (paranoia)
* Having bizarre or paranoid ideas (delusions)
* Is thinking or talking too fast, uncontrollably jumping from topic to topic and not making sense
* Is too exhausted or depressed to get out of bed or manage basic hygiene or self-care
* Is continually abusing drugs and/or alcohol
* Has not eaten or slept in several days
* Has tried outpatient treatment (therapy, medication management, support groups, etc.) and still has symptoms
* Requires a major change in treatment plan or medication under close medical supervision
* Talks about death or suicide
* Causes harm to self or others
* Attempts suicide

If you need help finding an appropriate facility, contact your medical insurance provider or employee benefits personnel for guidelines. If these are not available, call your local DBSA, Mental Health America, or NAMI offices for options in your area.

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Tags: abuse, diagnosis, dual, health, mental, parents, substance, teens

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Comment by Deanna on August 7, 2008 at 8:18pm
No problem, I had a teenage son that I had problems with. I put him in jail to keep him safe and away from the harmful things that he was doing to himself. He hated me at the time but now he Thanks me all time.
Comment by Kate McLaughlin on August 7, 2008 at 5:10pm
So true, Deanna.
Pete Earley's book "Crazy" articulately illustrates this challenge.
Thanks for your comment!
Kate
Comment by Deanna on August 7, 2008 at 5:06pm
I like this but here in Florida unless your picked up by the police, a threat to yourself or others they will not baker act you. Many times, people that are in this situation don't want help unless they hit rock bottom.
We, as the family, can beg and plead but until the pt wants help there is nothing we can do.

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