A Mental Health Tragedy Unfolds and the System Doesn’t Have an Answer

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Most of my clinical time as a psychiatrist is spent helping individuals and families who desperately want my help. There are myriad treatment options to improve the lives of people suffering with mental health symptoms, and they work.

But not everyone with symptoms is willing to receive help. A small percentage of clinic time is spent with a loved one seeking guidance on how to intervene when someone in their family is clearly sick, but refuses help. We talk about how to convince someone they need help, or even how to pressure them in the direction of help when necessary. And yet I know that patients themselves need to be on the team for treatment to succeed. Mental health treatment only works when the patient wants help and participates.

Mental health treatment only works when the patient wants help and participates.

This is on my mind after reading a news story about a person with mental illness who refused help, deteriorated, and eventually (predictably in this case) took his life. The man’s family had been pushing him to get help, which he did not want and rejected.

When we watch news stories about tragic mental outcomes that end in violence or suicide, it is often suggested that more awareness or more dollars will be the solution. But what happens when the sick person truly doesn’t want help, even when he needs it?

Our laws respect each person’s right to choose or refuse treatments, as they should most of the time- until the balance tips (and sometimes it does). Sometimes people really need help and don’t realize it. And while most people who choose sickness over side effects aren’t doing any harm, we don’t have much recourse for the few who trigger serious concerns.

Here in Texas, we can send a person for a few days to a mental health hospital if someone’s safety clearly depends on it, but doing so requires overt threats of harm to self or others, or such severe psychosis that a person cannot remain safe. Hospitalizations are short, and there is rarely time to implement any real solutions. Lasting care is still only available to those who agree to receive it, or those in forced care because they have broken the law.

When I encounter a situation where there exists a chronic safety concern (anything that won’t resolve in a few days), there is rarely a pathway to truly solve the problem without voluntary participation on the part of the sick person.

I tell families that people have a right to live with their symptoms and refuse treatment, if they aren’t hurting anyone. When the signs are apparent that something bad is bound to happen, but things unfold gradually, then the system doesn’t have an answer. The gap here affects only a small number of people, but it’s a big gap when safety is at stake.

Posted on May 14, 2018 by Melissa Deuter.

College Parenting on Summer Break

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Final exams are coming, and shortly afterward, college kids will be coming back home for the summer break.

Students come home soon for summer break, and if it’s your first summer after your student left the nest, you may be wondering what to expect.

1.     Exhaustion is normal for a few days after final exams. Many students have been studying day and night for weeks. It’s not unusual to crash out for a few days.

2.     Don’t expect the teenager who left in the fall to come home a full-fledged adult by the first summer. Kids will revert to their default settings in their parents home. Realistically, your child is probably going to lie around and watch TV or play video games.

3.     If you’re expecting productive behavior over the summer, make it clear from the beginning. Do you want your student to get a job, or help out around the house? Don’t think he’ll do those things automatically. Make it clear what you expect from the get go.

4.     You’ll be annoyed. You’ve been missing your kid all year, and looking forward to having him home for the summer. But it won’t be all sunshine and roses. Expect to feel ignored, disrespected, and even used. Let go of your perfect images, and expect misunderstandings and growth opportunities as you cross this new threshold.

5.     You’re on the road to separation, but you aren’t there yet. If your student is still spending summers at home, she’s not grown and gone from the nest yet. She is still a kid in many ways. You have more ground to cover before she’s actually on her own.

Posted on April 30, 2018 by Melissa Deuter.

Is It Useful To Ground A Twenty-Year-Old?

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“Is it useful to ground a twenty-year-old?”

This is the question that came up while talking with a Dad this week. He has a now twenty-year-old daughter living in his house, and she doesn’t do anything he asks of her.

We’re not talking about your average defiant kid, though. In fact, she is respectful and sweet. She just doesn’t get things done. The problem is chronic overwhelm, not laziness or disregard for the rules. Whether it’s filling out paperwork, or washing laundry, tasks aren’t completed when they need to be.

She stopped functioning due to legitimate symptoms of depression and anxiety that hit during formative years. But there’s no getting up and getting moving now that symptoms have leveled off. She doesn’t even know how to get moving. She never learned the basics of how to make herself take care of daily responsibilities when she was unmotivated or uninterested. Being sick got in the way of important life lessons. For a while, it was a true crisis and everything was on hold.

“Now that she’s an adult, I’m not sure what to do,” he said. “I was thinking I should take her phone and teach her a lesson about acting like a grown up.”

I asked him if he heard the incongruence between his intent (to have her behave like an adult) and his planned intervention (to punish her like a child).

“Well what else can I do?” he asked.

Suddenly he finds himself trying to “ground” his adult daughter, and it is immediately clear that this isn’t going to work.

The problem with grounding a twenty-year-old is that it communicates that the parent is the adult, and the twenty is expected to be a good child. Grounding fails because being a submissive child isn’t working anymore. She needs to own up to her responsibilities like an adult.

So what’s the answer if grounding isn’t going to work?

The world around won’t her ground her and won’t try to teach her a lesson, but the lessons will come. Those who don’t follow the rules face the consequences.

“Can you imagine this situation with someone other than your daughter? A family friend moves in, and he’s lying in bed in a dirty bedroom, not doing his laundry. What do you do then?” I ask.

He says, “I send him back to his parents, because I’m not going to put up with that. But it’s different. This is my kid. I’m stuck with her.”

“Are you stuck with her?” I ask. “Maybe she needs to be the one who is left holding the responsibility for herself. Maybe it shouldn’t be you who is stuck with the responsibility, but her.”

He has a long way to go still, but this got him thinking. I don’t think he’ll ground her after all.

Posted on April 23, 2018 by Melissa Deuter.