Could use some advice - ex hasn't been taking his meds

[momtara]

Our parenting coordinator said that my exH's own doctor said that my exH hasn't been taking his meds and is being irrational.  PC thinks I have to do -something-.  I have to make a decision quickly.  Seems that I have two options.  One is to have our lawyers talk and tell him he needs to get back on his meds and provide monthly reports from now on, or he can't see the kids.  Once he's on meds and seeing docs regularly, he can see kids unsupervised.

Second option is to go to court and ask to suspend unsupervised time until we can do a psych eval.  Which would take longer and give me peace of mind for longer.

The psych eval ultimately may just say whatever his doctors can already say, but it will take longer and thus the children are protected a little longer.

A third option is to do nothing.  The this is, my exH hasn't actually DONE anything other than try to stop me from taking the kids to doctors etc... .but he does get very irrational and send wacky emails.  His own shrink and the PC think he should'nt have the kids until he's back on the meds.

Do I:

1.  Go for the option of having lawyers discuss, and in a few months he can see the kids again unsupervised once he's getting the proper help again?

2.  Go for the option that will provide more safety, but ultimately lands us in court, which could open a can of worms?

He has only a little parenting time now, a few nights a month, and his family is there.  Still, I do worry about the kids; they are very young and can't protect themselves.

Basically I can keep doing this thing halfway, or go the full monty.  He has never had a court ordered psych eval, something I regret.  But there was a time to do it, and doing it now is more combattive.  Antyhing that goes to court can be iffy.  If it takes 2 years and all our money, he may end up with the same parenting time, but the kids will be a wee bit older.

Another concern for me is that doing anything will exacerbate his abandonment issues and then he is perhaps more likely to cause problems for the kids once he gets them back, whenever that is.  If he has them back for a while and is doing fine, then something triggers him again, he will now realize he could lose them, and then he may be even more likely to do something irrational.

His docs think he's delusional etc. but they don't understand that he has a PD.  They only see him a little bit and don't realize what really triggers him.  Honestly, I think the meds calm him down but they don't stop all of his delusional thinking.  He still wants me back, and things related to that are what can trigger him.  If he thought I was dating, I think he'd get triggered a lot worse, even on the meds.  (I know you may think the docs can't know more than I do, but I lived with him.  THe meds calm him down, but ultimately, they don't stop his wacky thoughts.)

I know you can't know the whole story, but what do you think?  I was hoping not to have to do anything, but if two doctors are concerned, I have to do SOMETHING.  But on the other hand are the courts, which ultimately will compare him to so many worse dads - drunk drivers, druggies, etc., and he has a steady job and looks good.  He's pretty clean living and hasn't had a problem in a long time, he's just mentally illl and delusional.  And tends to find ways to block me and control me and get revenge.  I worry that he will do that using the kids more and more.

[momtara]

Also, he has used the kids to get revenge - when we were married, he wouldn't let me, or them, sleep one night and kept blocking me from going into their room, etc.  I have a bruise to show for it.  No physical stuff lately though.

Really could use any thoughts you guys have!

[livednlearned]

The first option is probably how my L would approach things, knowing full well that pwBPD don't tend to do too well with compliance. So if you do option 1, it's best to view that as one part of a longer-term strategy. One challenge with this option is figuring out what exactly supervised visitation will look like, who will be the supervisors. You've probably given that some thought? You also need to prepare yourself for the emotions heading your way -- yours and his. You can't agree to supervised visitation and then play around with it otherwise you'll weaken your stance in any future hearings.

A more aggressive option is to file an ex parte emergency suspension of visitation based on what your two third-party professionals are advising. Ex parte just means that you do something before a judge rules on it, but do it in a way to let the courts know that you're acting in the best interests of the kids because it wouldn't be wise to wait until the court date. It's an offensive move that allows you to end visitation instantly, and it's a stronger hand to play in court.

If it works the same there as where I live, your lawyers will probably go to court for a brief hearing to enter the ex parte motion, and give enough details to assure the judge that there is substance to this motion (two third-party professionals will count as substance, plus your ex's prior history of being under a psychiatrist's care).  Then the judge sets a hearing date that is probably months away -- if you ex's L is genuinely concerned, he will probably agree to move it back as far as possible in hte hopes he can get his client to demonstrate responsible behavior (like taking medication) in the interim. In the meantime, your ex probably won't see the kids. Or, maybe you compromise and say after a month of taking meds and checking in with the doctor, supervised visitation can resume.

The third option --- doing nothing -- sounds like a rationalization. You've been around a lot of mental illness your whole life -- your mother, if I remember correctly, and now your ex. Your tolerance for mentally ill behavior is probably higher than most people. That can be a liability when you're dealing with courts because your job is to protect your kids, not your ex husband. Court doesn't care about your ex's abandonment issues, and they don't care if he doesn't take his medication -- the only reason they pay attention to any of this is because of the potential adverse impact on the kids. If he has abandonment issues, that's on him. He's a grown up, and plenty of adults with mental illness take care of themselves and follow their doctor's orders.

If your PC and his shrink -- both highly trained therapeutic professionals -- are advising you to do something, that's probably the perspective you need to pay attention to. If you have the PC's professional opinion, and the doctor's concerns, you don't need to wait until your ex does something. The fact that your kids are so young is also going to weigh in your favor.

Prepare for this to go to court, but expect it to also be a very slow chess game with your ex agreeing to do things that he cannot stick to between now and any big hearing. You may or may not end up dealing with this in court, it really depends on how your ex responds. Even with the strong boundaries of court actions in place, you can be compassionate toward your ex by working with his parents to make sure he understands that people are concerned about him. He doesn't seem as narcissistic as other BPD sufferers, and he is already under a psychiatrist's care, so maybe he'll agree to DBT or something that is more likely to help him with his root issues.

Asking for a psych eval is probably a good idea. Keep in mind, though, that the psych eval might be very watered down. There is a tendency to be very cautious about making a diagnosis. And the eval has to be done by someone who is a forensic psychiatrist who is trained to do these tests -- your ex's shrink might not be qualified. So while it might be an important data point in court (just having one ordered might tell the judge that something is up), it won't be a smoking gun. If you do order one, make sure the motion is explicit -- mine was a motion for a medical examination by a forensic psychiatrist. It specifies the MMPI-2 (the first one, ordered by the PC, did not), and gave N/BPDx 30 days to do it (which he hasn't done). You could also talk to your L about putting something in there about DBT, but my guess is that telling your ex to get therapy through a court order will make him less likely to comply. I can't imagine being very proactive if the court ordered me to get therapy, and I don't see why that would be any different for someone suffering from BPD.

[momtara]

"The third option --- doing nothing -- sounds like a rationalization. You've been around a lot of mental illness your whole life -- your mother, if I remember correctly, and now your ex."

I think you hit the nail on the head with a lot of that, and you remember so well.  Thank you so much.  I wish I could get this perspective from my attorney!  I think I have to head into the chess game.

I wish my kids were old enough to be able to fend for themselves a bit.  If we do unsupervised even for a year or two, they'll still be young and vulnerable.  What scares me is that if someone is unstable, they only need a bit of time to do something bad.  But courts don't take parenting time away unless things are really really bad.

[livednlearned]

I wish my kids were old enough to be able to fend for themselves a bit.  If we do unsupervised even for a year or two, they'll still be young and vulnerable.  What scares me is that if someone is unstable, they only need a bit of time to do something bad.  But courts don't take parenting time away unless things are really really bad.

I recognize this kind of thinking -- I do this too, and am trying to recognize it. My T calls it "catastrophizing."

You aren't suggesting taking away parenting time. You're being very reasonable, suggesting that your ex goes back on his medication, sees a doctor, continues to see the kids as long as he is supervised. So you aren't asking the courts for the catastrophic option, you're thinking like a responsible, reasonable, but concerned parent.

You have a lot going for you, and all the arrows are pointing in a favorable direction. Imagine that court is on your side, and wants the same thing you want. 

[momtara]

Other issue is, he is constantly claiming that I withhold the children.  It's nonsense, but he could play the alienation card.  Then we get into my having to show that I invited him to spend two hours on July 4 with us, etc.  (I wonder if I brought these problems on by loosening boundaries.)  

[livednlearned]

Other issue is, he is constantly claiming that I withhold the children.  It's nonsense, but he could play the alienation card.  

That's what all BPD sufferers say when the stable parent sets a boundary. You aren't alienating the kids, and your ex has nothing except distortions of very reasonable behaviors to back him up.

Your L will dismiss his claims, and all the other outrageous claims your ex tries to make, and get the judge to focus on the real issue, which is that two highly trained professionals are concerned that the children's father is not taking his medication, and given the ages of the children, and the nature of the dad's delusions, they are worried about visitation. Your L recommends that the father have supervised visitation and take his medication regularly. Then you leave things vague. Let it be up to your ex to show that he can do this, and then he can file to have things adjusted.

You and I are in a different position than a lot of the dads here on the site (and some moms). The court believes us. Doesn't mean we don't go to court and file motions and pay buckets of money and deal with a mentally disordered ex spouse who can really mess up our kids and try to ruin our lives, it just means that if you live up to your duty as a stable mother, the burden is on your ex to prove he isn't the problem.

My ex has accused me of parental alienation, child abduction, infidelity, and stealing money from him. He repeatedly tells the court I am mentally ill, narcissistic, a gold digger, that I have an eating disorder and anger issues, that I tried to abort my son, refused marriage counseling, that I stalk him online, that I'm dating a pedophile. I'm sure I'm forgetting a bunch.  

None of it is true, and the court dismisses everything he says because he has no documentation, no testimony from anyone, and a bad track record of complying with court orders. Meanwhile, I show up, make reasonable requests, protect my son when it's warranted, and behave like a grown up.

You're credible. He's not. And you aren't dealing with prejudice about dads being the more capable parent.

[allibaba]

Momtara,

Just wanted to throw in my own two cents... .the third option... .it really isn't an option.  No matter how much we rationalize that our ex wouldn't do this... .or wouldn't do that... .the number 1 priority is to protect our little ones.  My professionals (the police DV folks and the shelter folks) told me NOT TO MINIMIZE THE BEHAVIORS... .  That sort of attitude is the kind of attitude which has caused harm (psychological or physical) to many, many other families of people with mental illness.  If you are being warned - the only real options are 1 & 2

[momtara]

Thanks.  That kind of validation really helps.  I wasn't leaning toward doing nothing.  I tried to set up an appt with my atty but she is busy until next Wed, so I will just call her on the phone tomorrow.  I'd rather hash this out in person.  She gets impatient on the phone.  Oh well.  Hard to find a perfect attorney.

So what it comes down to is, we will write to his attorney and say he has to get on the meds, submit reports, and he has supervised visitation for a while.  But what I am going back and forth on is the psych eval.  It's rare to get a reason to have one.  Now I have a reason.  It may be useful later, but definitely will be expensive.  I don't think it will change parenting time, since he only has a little.  It just may be something to help me figure things out.

[livednlearned]

What is your attorney saying about the psych eval?

[momtara]

That's what I'll have to find out when I talk to her on the phone today.  It would largely be a tool to give me more information and possibly keep him under supervised visitation for longer.  However, from what I've heard, it doesn't necessarily change anything.  It probably won't say he's psychotic and a potential killer.  But what *do* they say?  I don't know.  If it said he had a PD would he get better treatment? Maybe.

What I'd love is for my ex's parents to have to supervise until the kids are older.  I don't know if that's realistic.

My attorney is going to tell me she doesn't have a crystal ball.

[livednlearned]

However, from what I've heard, it doesn't necessarily change anything.  It probably won't say he's psychotic and a potential killer.  But what *do* they say?  I don't know.  If it said he had a PD would he get better treatment? Maybe.

It might make sense to pace this. So first step 1) suspend visitation or ask for supervised visitation and your ex must adhere to doctor's orders about taking his medication. Don't give him a time period to prove he's stabilized, just leave it open-ended. Let him file to change.

Second step 2) Your ex fails to take his medication or his delusions/behavior worsens. You file a motion for a psych eval whenever it makes sense, or, if he files to reinstate unsupervised visitation, you file the motion for a psych eval.

When you have as much custody as you have, and you have a bunch of people who see what's going on with your ex, the psych eval is a little less important than it might be if you were walking in cold to a custody battle and had to overcome a gender bias and no history of psychiatric care. That's just looking at the psych eval if custody is your goal.

If your goal is to manage your ex and try to get him into DBT treatment or something else, than the psych eval might matter more. The downside is that they are expensive, they don't always result in a diagnosis, and even if a judge agrees to court-ordered therapy, your ex can choose to not comply, or he can comply and not do the work.

It helps to be clear about your goals, otherwise you go around in circles trying to second-guess a bunch of strategies and decisions.

Also, I think you biggest decision is whether to suspend visitation until a hearing takes place, or wait until a hearing. This is the kind of thing an L can help with. Is it important to act urgently or not. Or, phrased another way, if you don't act urgently, does that undermine your case. And do you have enough to go on to act urgently.

[momtara]

We are going to act urgently.  However, I think the thinking is that we first tell his attorney what we want, saying he has to go to his doctors, we suspend visitation, he starts taking his medicine again, he submits reports.  If they don't voluntarily agree to all this, then we go for an emergency hearing next Friday before he takes the kids again.  I am definitely doing that.

What I do wonder is the psych eval.  Yes, it's expensive, may not make a difference.  If it does result in a diagnosis, yay!  We do already have two shrinks evaluating him, but they don't see BPD.  They also think his medicine helps a lot and dont' realize that some of his behavior is tied to how I react to him.  When he thinks we are getting back together, he's doing fine and they think the medicine is working.  It certainly helps him be less depressed, but it doesn't change his feeling or some of his reactions.  It is still better than nothing.

Ultimate goal?  What I'd love is if his parents have to supervise him until the kids are old enough to fend for themselves  a bit, like 4 years from now.  They are very young.  I just don't know if I could get that.  I do think that even if they have to supervise for a few months now, it will open their eyes to the situation at hand a little more.

I don't know.

[momtara]

":)on't give him a time period to prove he's stabilized, just leave it open-ended. Let him file to change."

This I like.  However, don't know if his attys will go for it, which would mean it has to go to court.  But it is the kind of thinking I need more of, to really know my options.  You are great.

[ForeverDad]

What exactly is your psych eval?  I've noticed over my years here that it generally means psych tests (MMPI2 is said to be the best but just one of several to use) and an overall assessment.  But it doesn't address the parenting and custodial aspects.  That would be under $1000.  Less often I notice some talk about their psych eval including how the parenting aspects are affected, in other words, a custody evaluation.  Custody evaluations should include psych evals but are not limited to them, they include interviews with each parent and children and others who can provide information as well.

That's why I ask what a psych eval would be in your area.  Would it take the results of tests and interviews and make recommendations concerning how parenting and custody are affected?

In any case, the fact that the professionals are concerned is a good indicator that they're alert and won't pooh-pooh his issues and behaviors.  As they emphasized though, it's your place to be the one to stand up and get things done, it's not their place (or designated turf) to do it for you.  This is not a time to be timid, silent or hiding the problem person's issues and behaviors.  If you did that then you'd be sabotaging yourself, your parenting and your child's future.

[momtara]

Yes, I guess a custody eval would be more involved. 

So I talked to the PC again.  She said she talked to my exH's shrink, who feels he should be on his meds or it's a real problem.  He is going to try to get my H to take them again. 

PC says she thinks if he gets back on meds, it's ok for him to have the kids unsupervised.  They both just want him taking his meds and stable.

PC also says we should compel monthly reports and also have a PC to act as an intermediary.  Unfortuantely, I stupidly only retained the pc for x months and her time is comign to an end.  H probably won't agree to continue with her.

The PC said that a psych eval "probably won't help because it mostly tests for personality disoders, and Xh would do fine on an MMPI."  She says the court just won't care that much about the results of it. 

She and the other doc never believe it's BPD.  They use terms like schizophrenia, bipolar, the usual.  I don't buy that, but I guess he could have both.

She also said she thinks the custody we should have had is he sees the kids one day a week until they are much older, not one overnight every 2 wks.  In my mind, it's not much different either way.  If someone is unstable, they're unstable.  But custody is somethign not being changed right now, except that it'll be supervised until he gets stable.  (Theoretically).

Anyway, maybe the psych eval would be a waste.  I could ask for supervised visits until we do a custody eval.  The custody, in teh end, might not change much, but it would take longer and provide longer peace of mind.  So who knows.

But yeah, we are going to do something.  I really appreciate everyone's perspective.  Hard to get it from my lawyer sometimes.

[livednlearned]

What I do wonder is the psych eval.  Yes, it's expensive, may not make a difference.  If it does result in a diagnosis, yay!  We do already have two shrinks evaluating him, but they don't see BPD.  They also think his medicine helps a lot and dont' realize that some of his behavior is tied to how I react to him.  When he thinks we are getting back together, he's doing fine and they think the medicine is working.  It certainly helps him be less depressed, but it doesn't change his feeling or some of his reactions.  It is still better than nothing.

The psych eval is leverage. It's a card you play. So if the opposing lawyer says, "No way to supervised visitation, and if my client doesn't want to take meds, then he doesn't have to." Then your L says, "Ok, then I'm filing for suspension of visitation and a psych eval. Oh and by the way, I have two expert witnesses willing to testify that this guy needs to be supervised."

Then your ex confers with his lawyer, and they try to figure out their next move. If the L worries about the psychiatric stuff, he might counsel your ex to agree to supervised visitation and sticking with the medicine until xyz date. Your ex and his L might pretend to each other that your ex is a really reasonable, stable guy who can do this.

You'll go back and forth until there's an impasse. If it's an impasse people can live with, then no court. If you can't live with it, then the psych eval happens.

One wild card in all of this is that you might not be allowed to read the psych eval. That happened in my case. Except n/BPDx is such a narcissist he gave me permission to read it. Another wild card is that even if there isn't a diagnosis, there will be a big fat document that describes your ex's delusions and other behavior. The judge will read that.

My ex's first psych eval was not the MMPI-2. It was based on interviews between a psychiatrist and N/BPDx. The "diagnosis" is very lame -- it doesn't come outright and say it. But it says that a Cluster B personality disorder cannot be ruled out, and that the pattern of instability in N/BPDx's relationships, plus xyz suggests blah blah blah.

Even though there is no diagnosis per se, the judge can read that this guy is one angry, unstable dude with a lot of problems in his personal life.

I got full custody after that hearing. My PC testified, I testified, and the judge read the report.  

[livednlearned]

Another Q for your L is to ask her what will cost less. Because any strategy is going to be a gamble. So what's the more expensive option? How much extra does it cost to ask for custody now, but maybe not go all in. How much will it cost if you wait a year and then go all in. How much if you go all in now, and lose, and then go at this again in a year?

You probably already have a sense of this, but it's good to get your L to be upfront about this. My L ballparks it now automatically because she knows I'm going to ask.

[momtara]

Interesting!  That is very good to know.

Other things I am worrying about:

With someone who has abandonment issues and catastrophizes, he will now know that if he wants off his meds, he may lose unsupervised time with the kids.  So doesn't that set up a worse situation?  The PC told me not to extrapolate like that, but... .

I had another thought.  If he knows we are threatening court, he may go back to his shrink now and get back on his meds quickly.  Then his L can say, we took care of the problem.  Do we lose our teeth that way?  We need regular reports saying he's still on the meds, and a PC to intervene.

PC says asking for a long supervised sentence could make me look like mean mom.  If she believes he's fine having unsupervised while he's on his meds, then I'd guess a court may think that way too. 

It is very hard for me to figure out whether I'm just being the typical scared mom, or have reason to believe he could snap and do something awful.  I just live in a normal world and don't understand guys who could use kids for revenge. Even if they "only" do it once, it shows how they may think.

I talk to my lawyer this afternoon.  I need to be clear.  I think I am getting there.

[livednlearned]

A couple other things to make sure of: that the PC is willing to testify on your behalf. Either repeating what your ex's Dr. said -- if that is something she can do. Or having the Dr. testify directly. Or maybe both of them sign sworn affadavits or something.

I think what your PC is saying -- about the mean mom thing -- is true if you were to ask for supervised visitation forever. You aren't doing that. You're saying here's the situation right now: he's not taking meds. Your solution is: supervised visitation. Then the judge will cook up something reasonable out of that. He might suggest a timeline, or he might suggest regular reports, or he might just say supervised visits, or he might say let the doctor call the shots, or the PC call the shots or whatever.

I had another thought.  If he knows we are threatening court, he may go back to his shrink now and get back on his meds quickly.  Then his L can say, we took care of the problem.  Do we lose our teeth that way?  We need regular reports saying he's still on the meds, and a PC to intervene.

Maybe this is a reason to consider asking for a psych eval. Because that puts the bar higher, it's something you want, it's a useful data point. Also, it might take your ex some time to find a forensic psych qualified to do one, and then pick one he's comfortable with.

[ForeverDad]

Around here we generally comment that medications can moderate the extent and intensity of Borderline behaviors but meds alone are not the answer, long term therapy is key to eventual recovery.  So we often view meds as a stop-gap measure, not the answer.

If your husband has other or additional issues such as schizophrenia, that's a different category of mental illness, and also has somewhat different ways of being unpredictable and extreme.  For that reason our typical advice, insight and suggestions we may not always apply as you seek strategies and courses of action.  Pay special attention to the professionals.  When they say meds are needed, take it seriously.  (Of course, I'm sure you do.)

[momtara]

I do.  I appreciate that! 

I just don't think the meds are *enough*.  I don't think they realize how much worse his behavior gets when something triggers him, particularly abandonment.  Or that even on the meds, he was still imagining certain things.

Moderating the behavior is a start, but overall, I don't know that meds would stop him from acting rash.  I could hire more professionals to get a different diagnosis, I imagine.  It's certainly done (especially by the rich!)

Here's something, I've been pondering.  He has gone all his life without the meds and survived somehow (maybe with a lot of internal pain).  He had a job that he functions well at.  Now he has to be on serious meds.  Only since I divorced him.  It makes me wonder how bad he could be if he went all his life without meds and survived.  Then again, my mother didn't really show symptoms of her mental illness until my dad left... . 

[momtara]

So this morning I am thinking back on what the PC said and thinking that when she said a psych eval wouldn't help, she meant a court ordered one.  If I can get an order for him to be evaluated by a forensic psychologist, it could take a while and then be much more thorough, and I could hire the person.  The PC seems to think that it could reduce his parenting time to day visits.  Buuuut I don't see really a big difference between day visits and overnights - if someone is dysregulated, having a little time is as bad as a lot of time with the kids, in my opinion.  It seems to only make sense to do it if it will mean he gets supervised until the kids are much older.  This is my chance to ask for it and I still don't know if I should do it.

[ForeverDad]

I recall when we separated and went to family court, after the first couple appearances we both were ordered to get psych evals and the reports were to be made available to the court and both lawyers.  I did mine at a county agency as specified, completed a questionnaire and session with a graduate student from the local university.  Maybe two hours in all?  I got the report, just over one page long.  Yes, it listed 'anxiety'.  No kidding.   The cost was sliding scale and so I paid full price.  I never learned whether ex did her testing.  The magistrate never brought it up afterward.  So much for court ordered simple testing.

[momtara]

I guess what I'd have to ask for is a custody eval by a forensic psychiatrist.  Still don't know if unsupervised day visits are really better for the kids than what he has now, one overnight every two weeks.  I am trying to figure out from the tea leaves if it would be worth it to put us through the evals.  It would give me some peace of mind for a while, but cost a lot and if it just meant weekly day visits, I don't know that it's an improvement.  Of course, I really don't have a way of knowing how it would work out.