Residential Treatment #bipolar #residential treatment

Other than parent five children, two with mental illness, I also work part-time and go to school. I volunteer and spend time with friends. All of this is to say I got busy last year and didn’t blog much, but I’m back. Still a mom of five kids, including two with mental illness, still dealing with their mental illnesses.

T entered residential treatment earlier this week. People have been asking me, Did something specific happen? No. Nothing specific. But over the last few months T has been getting increasingly unpredictable, angry, volatile, and violent. Several months ago his psychiatrist suggested residential treatment, as he felt there was not much more he could do medically for T. We weren’t ready then, but I eventually got T on a waiting list for an excellent facility in Texas. It is over 3 hours away. He will be there for at least 2 months.

T has “failed” acute treatment centers twice, meaning he went in for a week or two until he was no longer an imminent danger, and then came home, only to need acute treatment again within a few months. He has also “failed” day treatment. Insurance is paying for some of his residential treatment. The cost for treatment is $500 per day.

I do not know exactly how residential treatment works, except T is living among other boys approximately his age, going to school there, eating all his meals there, and doing cognitive-behavioral therapy several times a day. He is with the other boys and staff 24/7. Upon intake, he stated he didn’t have any problems, but that he was there for being “crazy.” All of the other patients there have similar mental illnesses. He has a therapist and a psychiatrist, and there is an interdisciplinary team meeting about him each week.

We can talk to him twice a week — however R wanted to check on his welfare, so we call the staff every day just to hear that T is okay. R is a little sad without T, but on the whole our family is much more peaceful without T. There is more harmony, more time together, more cooperation, less fighting.

I have been very open on Facebook and in person with my friends and coworkers about T’s situation (he gave me permission to post about it, and even share his address so people can send him get well cards or letters!) I miss him, but it’s mostly a huge relief that I do not have to worry about him harming the other kids, or students at his school. He was suspended just before Christmas break for punching another student.

I’m feel really hopeful that T learns how to manage his intense emotions, mitigate his propensity toward violence, and learns how to cooperate with others while he is there.

Dear School

I have gotten your messages. Twice. The first time, I thought there must have been an error.

This is Mrs. XYZ from the 504 department at your son T’s school…

I called back and left my number. I kind of forgot about it. I am busy — in addition to parenting two kids with mental illness, I have three neuro-typical kids; I work on Saturdays and Sundays; I take a college class on M/W/F. I’m considering being a co-leader for my daughter S’s Girl Scout troop (I emailed them, as long as you don’t mind that I’m not crafty and I hate camping, I’m in!) Everyone is busy.

Today, a few weeks later, I got the same message. It didn’t sound malevolent — but they said it again. 504.

No, no, no, no, no. God no. No. I’m not playing that game. An IEP is special education for children; it’s a LEGAL DOCUMENT that the school has to follow. A 504 is simply some accommodations; a 504 does not include special education and they do not need to be written out.

A school is legally required to provide an IEP to any student who needs one but “needs one” is a grey area when you’re dealing with T’s issues. However, back in June I took both T and R for psychological AND academic testing, and they both came back with learning disorders. R’s are more severe — especially in areas of reading and writing. He does not understand phonics at all.

T’s learning disorders are less severe than R — he can read and write with more fluency. However, his results showed a serious Auditory Processing Disorder, and he’s bipolar. That falls under the emotional impairment category for an IEP.

Like an insurance company’s job is to say no to everything your doctor says you need (in my experience), a school’s job is to deny extra services unless they absolutely have to. In R’s case, it was obvious he needed them. T’s case is less clear-cut, but I think he’s in need of more support than a 504 will give him.

Just like I do with the insurance company, I’m going to fight the school to get T what he needs.

Threat assessment level: LOW

Last week R’s school counselor called to talk to me because R has been telling her he wants to hurt people. More specifically he’s been saying he has the desire to hurt people but doesn’t actually *want* to — but if he gets angry enough, he will.

The counselor told me that he told her he’s stressed about all kinds of things; some legitimate (T hurting people), some not (R has too many chores, according to him). We had a meeting at the school. I brought my friend AT who has children with special needs and has been through the school district with them. She knows a lot about dealing with teachers and schools and IEPs. The school brought the counselor who called me, the special ed coordinator, and the principal.

On the whole the meeting went well. Thanks to years of therapy, R is very self-aware. He genuinely doesn’t want to hurt people. The school officials said they could see he has a heart. (Aside: some days I’m not sure T has a heart.) He’s outspoken about his difficulties, and thanks to some degree of autism (which I’ll write about another time), he talks to people incessantly. So what I’m saying is that R has strong feelings and likes to talk about them. The school isn’t worried that he’s plotting world domination, because he’d undoubtedly tell someone about it first.

However, because he did threaten to hurt people, I had to get a “threat assessment” done on him.

When I brought it to R’s psychiatrist, he kind of laughed and said, “What am I, a mind reader?” No, you’re just the guy my insurance pays $150/30 minutes for who gives us Risperdal and Focalin. But he wrote the school a threat assessment. It said something like “He does not express active intent to harm people, and knows it would be wrong to harm people.” The note also mentioned that R’s IEP should accommodate his over-reaction to loud noises/being overly-stimulated.

To that end, the school suggested R stop taking PE. It is a requirement for our state — unless the IEP precludes it. R’s IEP is being changed to preclude it. PE is just too loud and over-stimulating for R; he over-reacts to the noise and stimulation by getting angry and feeling the urge to hurt people.

So no more PE for R. I don’t care; it’s a fine solution given the situation. R is fine with it too, but he worries a little that people will notice he’s not in PE and will make fun of him for being different. One day I’ll write about how both R and T are reading Wonder by RJ Palacio for school, and what an amazing book it is.

NAMI

I get a lot of support from NAMI, the National Alliance on Mental Illness. http://www.nami.org

I learned about NAMI from a therapist when we lived in another state, then when we moved here I actually found a local group that supports parents/caregivers of children/adolescents with mental illness. The group meets once a month and we talk confidentially about the challenges/successes we’ve had over the last month. I am outgoing and I want to share my experiences (duh) and I want to hear how others have dealt with children with mental illness, and I want to hear IT WILL GET BETTER.

I’ve learned what local hospitals are better than others; I’ve shared about the hospitals R and T have been at; I’ve learned how to talk to schools and teachers about mental illness. Probably the most important thing I’ve learned is how to talk to the police about mental illness.

If you have to call the  police re: a mental-ness based incident, you can ask for a police officer who has been trained to deal with psychiatric emergencies, often called a Crisis Intervention Team program.

I hope I never have to call the police, but I know it’s a possibility. Just recently, T’s psychiatrist, Dr. J, reminded me to call the police if T threatens violence with any objects in his hands.

How did I know?

Bipolar is a big word to throw around, especially on young kids. My kids who are bipolar are 12. I wasn’t sure what the word was when my kids were younger. R started showing signs first. He was ANGRY. He would RAGE. He was suspended from preschool at age 4 for throwing a chair at a teacher; he was suspended from Cub Scouts a few years later for the same thing.

R was not happy

I took him to a psychiatrist and he was initially labeled DMDD, which is Disruptive Mood Regulation Disorder. I also refer to it as “baby bipolar,” because it describes kids who are too young to be called bipolar.

We went gluten-free. He saw a therapist weekly for years. He was on medication for ADHD (I’ll write about that another time). He was still angry. Eventually he got so angry he tried to hurt himself; I took him to the local emergency department, and they admitted him to a psychiatric hospital. That’s where he got the diagnosis of bipolar disorder.

I’m not tired. Well maybe a little.

In the waiting room

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Whenever I go to my son, T’s psychiatrist — once a month or so — he tells me I look tired. My reply is always the same: Well, I’m with my 12-year-old son, reporting to his psychiatrist about his violent impulses. You would be tired too.

His psychiatriast, Dr. J, is Canadian, but I guess he missed the memo about Canadians being overly polite.