I belong to a support group for moms who parent children with mental health risk. With the exception of just a few, all of us have had the experience of driving our child to a psychiatric hospital, filling out mounds of admission paperwork, saying a painful goodbye to our child, and driving away. Whether it be for a 72 hour psychiatric hold and evaluation, residential placement or 3-5 months of rehabilitation, as a parent this can be the lowest moment of our parenting journey.
In my own parenting story I have had to leave my son too many times in the hands of someone else. Our son has been placed 25 minutes from our home, and has also been placed 1,500 miles from our home. Each time was for his best – to keep him safe, to give him all the professional help and care – intensively and quickly – that he needed, and to give us, his parents and family, rest.
Rest. And relief. These two words are something that we long for when we parent special needs children, explosive children, and/or children with mental health risk. Our daily job to keep them safe, to keep our home and the siblings safe, and to pave some sort of way for their future is exhausting. Our bodies can only expend so much energy advocating, refereeing, walking on eggshells in order to keep the peace and avoid a colossal meltdown. (Click HERE to read more about how to know WHEN to take your child to a psychiatric hospital.)
And so when that day comes when it is time to admit your child to a psychiatric type of treatment facility here are 10 things to know:
1. You are doing the right thing. There has been a journey your child and your family have traveled to get to this critical point. And now there is HELP. It is not failure that leads you to admitting your child into a treatment program. It is love and wisdom. And it is foresight. You want your child to have a future. This may be the only way to get to that future.
2. Clothing and items to bring: Depending on the level of care and intensity of programming, there will be some rules and restrictions. There will be a list of items patients are allowed to bring in. Most facilities want clothing and shoes to have no ties, laces or drawstrings. Sometimes they provide scrubs and socks, and sometimes they allow the patient to bring in clothes from home. These will be searched to make sure everything is safe and meets their rules. Flip flops and Vans slip-ons are the easiest for facilities to accommodate. We have gone to Walmart and found super cheap knock off slip-ons and sandals. Facilities usually provide all toiletry items. Long term residential care will allow patients to bring in their choice of toiletries, and are also more lenient on clothing.
3. There is a mound of paperwork to fill out at admission. Followed by a barrage of phone calls the first two days. The psychiatrist, nurses, social workers, individual therapists etc. will all be calling you for info…and be prepared to repeat the SAME details over and over again. Prepare a list of medical history, therapeutic history, medication etc. to share. You have the right as the parent of a child under the age of 18 to be involved in their therapy and medical goals. Do not hesitate to call the facility and talk with the team of professionals so that you are included in all decisions and know what therapy goals are being made.
4. Psychiatric hospitals and residential programs have a daily schedule and what they call “programming.” Patients learn the routine fairly quickly. This routine includes hygiene (for some parents, this is the highlight. My own son finally learned proper hygiene in this type of setting, which I am very grateful for!), meeting with a nurse to go over meds, (doctors only pop in once a week typically), meal times, outside recreation, phone call time, and family meetings. “Programming” includes group therapy, individual therapy, personal reflection and journaling on their bed. Therapeutic work usually includes reflecting on what led the patient to the facility, thinking about how their behaviors affect their family and friends, and identifying their emotions (this is probably the hardest). Each patient is asked to come up with goals to work on in therapy and will eventually make a safety plan for returning home.
5. You may not be able to talk with your child for the first 24-48 hours. One of my friends was not allowed to talk to her daughter for the first week of residential placement due to the nature of the situation. Pre-COVID families are allowed to visit during visitation hours-usually in the evening. This can be emotionally exhausting. I’m not going to lie – phone calls and visits will be really, really hard. Children will be scared, hurt, and might feel abandoned. These emotions may come out as tears, avoidance by silence, yelling, cursing, blaming, and even begging. And then after they express all of this, you have to leave and walk back out the door. Or hang up the phone, not knowing what will happen next.
6. Your house may feel very, very quiet after the drop-off. Our son is an exponential person – it is like having ten of him in the room at one time. So when he left our home for a residential program, we experienced silence for the first time in years and years. We found that our bodies needed the rest and relief that the quiet brought. And we chose to lean into it as a gift. A time to reflect and refuel. Because as we know as parents, the journey continues the next day. One of my favorite sayings while our son was outside our home was “today is a good day.” Yesterday may have been a tornado. Tomorrow might find rocks falling from the sky. But today my child is safe and I have rest from the storm.
7. Find a few trusted friends and/or family members to share with. Find a support group to join. NAMI (National Alliance on Mental Illness) has a list of local groups in your area on their website. You will gain much wisdom and resources from others who have walked in your shoes ahead of you. Shared suffering can bring much strength. Accept meals, child care for siblings, gift cards, house cleaning etc. And know that sometimes people want to help but they do not know how. So be bold and ask for specific things you need. Accept the love and care that people want to shower on you.
8. Siblings will need time to process. Possibly they have tried to stay out of the way for years, hiding in the shadows so as not to rock the boat. Or they have been scared – scared for their sister or brother, scared for themselves. It might take days, weeks, months for the siblings to share their thoughts and feelings. Just continue to be present and open, asking them each day how they are doing and if they have any questions, ideas or concerns.
9. Insurance and Discharge: For an insurance company to cover any Inpatient stay, the patient has to meet the insurance company’s “medical criteria.” Depending on the situation, a daily, weekly or monthly review will occur. This review involves the social workers and therapists submitting reports to the insurance company about the patient’s progress, a risk assessment, and therapy goals. If the insurance company deems that the patient does NOT meet medical criteria you will have to make a choice: pay out of pocket expenses to keep your child at the facility if you do not feel they should come home yet, OR get in the car and pick up your child.
***IF you feel very strongly that your child is not safe to come back home, insurance is refusing to pay, and you do not have the funds to pay, there is a last resort option. You can call your county’s Department of Human Services and ask to speak to a social worker. Ask for the social worker to do an assessment on your child and risk assessment for the child returning to your home. They might have some public assistance funds available for a longer placement. OR you can sign a Voluntary Custody Agreement, where they can take over custody and can place your child, on THEIR dime (i.e. tax payer’s money), in a longer care treatment setting. I know this, because I have had to do this. The implication is that you will have a lot of people managing your child and making decisions for them and for your family. But in this last resort situation your child and your family can remain safe and will receive essential therapy and treatment that is needed for a successful transition back home.
10. Discharge Plan: You will receive many phone calls leading up to discharge. For the therapists and social workers to feel safe sending your child home, your child will need to show progress on the goals they set. You will be asked if you feel safe and comfortable having your child return home. If you feel good about your child coming back home, therapists will then go over the Discharge Plan. This will have a list of therapy goals, a safety plan, a list of next step professionals to reach out to for ongoing help. The facility might offer a Day Treatment Program. The child attends the program 8 a.m.- 4 p.m. and continues to work on therapy goals by participating in group and individual therapy. This will mean that school is put on hold. But again, each of these therapy steps and interventions is meant to make school and future plans a possibility. Day Treatment programming also gives the family more time to adjust, make plans, and ease into the new normal.
Once a patient is fully discharged, the facility will not contact you to follow up. It is up to YOU to put in place the next steps of therapy. This, honestly, is the hardest part for many parents. And why children go through the revolving doors of inpatient settings. It takes a ton of time, energy and tenacity to find the right fit of psychiatrists and therapists for the long term journey. This is where a support group can be a life-saver and life-giving. You might actually find more resources and trusted referrals from parents in your similar situation than from the professionals.
If you find yourself in the situation I have described in this article please know that you are not alone. And I am so sorry that you are going through this. Right now might be the darkest time of your parenting life, but know this is just temporary. There is a light at the end of the tunnel. The tunnel might be very long, but there is a way through. Keep breathing, praying, researching and asking questions. No one loves your child like you do. Let that love carry you through.
For those of you reading this article and have not experienced this situation yourself, but know of someone who has, and you are wondering how you can help – I will be writing my next article addressing some practical ways you can offer help. So please stay tuned.
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Prayers and Warm Regards,