Asking advice on how to handle possible homelessness

[Tightrope walker]

My d24 has been in a downhill ride for since February.  She was living independently with mental health counseling on an outpatient level and receiving support from a mental health agency.  She was even working.  It started with cutting through her muscles several times: ER visits, psychiatric short term hospitalization, back home and then cycle repeated.  She would call me and I would take her to the ER to get treatment.  The third time, the social worker at the hospital worked with the agency and my D was put in a residential house for adult mentally ill individuals which is farther away from our house.  I would bring her to our house about every 3 or 4 weekends.  This summer I was given some wonderful opportunities to travel, stay in a "retreat area", etc.  When I was at the "retreat" my D first cut herself so severely that stitches were required.  She was allowed to return to the residential house. Repeat of the same behavior.  Calls me on a cell phone a couple of days later to tell me that she is going to hang herself.  She did tie her sheets to the bed, but didn't manage to do physical damage.  This resulted in another psychiatric stay.  After 10 days the hospital wants to see her transferred out, since it is a short term facility.  During her stay she attacked people, bit herself, and other serious behaviors.  I did visit her twice and she told me that she would kill herself as soon as she could.  The residential home agrees to take her back with some very defined boundaries: no cutting, must attend a program each week day, etc.

D calls and asks to come home for a visit.  I inform her that she must work out her situation and not try using our house to escape.  I will bring her for a visit when she has made some progress.

She calls me for 5 days in a row, telling me that she is suicidal.  I ask her if she is talking to her counselors and she states yes.  Calls to tell me that she has several belts and is going to hang herself.  I ask her to take the belts to the staff and then I call to alert the staff.  My D does take the belts to the staff and talks to her counselor.  Thirty minutes later she drinks cleanner.

   She has had all the tests and she did not damage her stomach.  I told her that I would not be there while the tests, etc. were being done since this was her decision.  (This was a first for me.) If the residential home does not take her back and there is no opening in the Psych unit, she will have no place to go. I have had her try to kill herself when living with us, so I do not think that our house is a healthy place for her (or me).

    Any advice as to what I should be doing?   I have not made the trip to the hospital yet (it is over 90 minutes away). 

                                            Tightrope Walker                               

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[lovesjazz]

What a horrible situation to go through. So sorry for your pain. It is awful watching our children go downhill.is there any way you can get her committed?

[vivekananda]

Hi tightrope walker,

That is a just terrible situation you are in. Please accept my love to you   , you must be feeling so scared for your dd and angry too perhaps. I hope you are not feeling guilty.   

I feel very inadequate in making suggestions, but I have done some reading to try to help me figure things out. It is a complex area but I would recommend that you also read the suggestions for self harm behaviour. It seems to me that you already understand this, but perhaps it may help clarify your thoughts.

Australian Clinical Practice Guideline for the Management of Borderline Personality Disorder (2012)

Yes, it is an Australian publication written for those working with BPD, but is has good information for you on pp 121 - 132

Now having sent that your way, it seems to me that you need from the hospital to prepare an exit strategy for your dd that takes into account her housing needs. See, it is unlikely that the residence will keep her if she continues to harm - but will they kick her out onto the streets? This is an invidious position for you, they rely on you to step into the breach, to solve their problems for them. This is the problem, she will be discharged to the residence, then the residence will kick her out because she self harms.

The link I sent you has a template for a management plan for professionals (see 137 - 143). Perhaps you could copy it and give it to the hospital, ask for it to be completed... . gee I don't know, but it would cause them to stop and think perhaps. See, what will they put in place for her care after discharge? What treatment is available to her? She is unwell, what are they doing to help her get well? These are the sort of questions I would be asking.

Are you seeing a T? is there any advice from that end?

Do you have any support for yourself in all this?

Cheers,

Vivek      

[Tightrope walker]

Thank-you for your thoughts and replies.

Vivek ananda:

   First of all the Australian Guide is a nice resource.  The hospital has already discharged her and sent her back to the residential facility.  According to my D, she thinks the facility will be telling her to find her own apartment in the next 30 days. 

   Yes, I do have therapist.  My T has been working with me to overcome my Rescuer role that I provide for several family members, including my D.  I am to practice acceptance, validation, etc. but let my D make her own decisions along with accepting the consequences.  It is just that the suicide threats are the hardest to decide how to deal with. 

lovejazz

  She has been is so many hospital situations, including a long term hospitalization as a youth.  The only residential mental health facility in the area, is filled due to state budget cuts.  I suspect that she likes the attention that she receives during her hospitalizations and the safety.  She can act out or feel have severe anxiety, then viola- she receives a medication.  It takes the burden off her having to deal with her feeling.  Currently she is on about 5-7 different meds.

                                                    Tightrope Walker

 

[vivekananda]

The fear of the suicide threats must be terrifying. I hope the 'Guide' helps you put them into some sort of perspective to help you understand what the threat level is likely to be. I know I felt reassured when understood what chronic low level risk meant compared to high risk etc.

A few moths ago I read The Buddha and the Borderline by Keira Van Gelder. It is a beautiful story written by a young woman who recovered from BPD - she self harmed, was heavily medicated, was in and out of hospital etc. I am sending you a link to a 2min video of her speaking on UTube. You wouldn't know it was the same person. I think what we have to hold on to is the idea that there is hope and here is proof of it.

BPD Recovery: Kiera Van Gelder

In her book you can get an idea why her mother was unable to 'rescue' her. It sort of reinforces that in the face of this disorder especially, trying to save our children is not possible. The desire to save them is really our need to do something, we are expressing our emotional needs in an unhealthy way... . rescuing.

I am glad you seem to have a good T. It can make the world of difference I know.

Have you read Valerie Porr's: "Overcoming BPD"? It is a great general BPD book, that is easy to read. If not, I would like to recommend it to you, it may show a different aspect of the subject and help broaden your understanding.

And, to help you with validation, here's a great link to Alan Fruzzetti speaking on the subject as it relates to BPD. It goes for over 50 mins and you may need a pen and paper with you to take notes.

Understanding Validation in Families - Alan E. Fruzzetti, PhD

let me know what you think of them, ok?

Vivek