I don't think we should wait for "next time"

[Elbry]

When my 14DD's therapist quit she told me next time we have an incident of serious self injury or a suicide attempt, she needs to go to a RTC.  She just got out of the hospital and that was the Psychiatrist at the the hospitals recommendation as well.  Then we saw her med manager yesterday and she said the same thing.  So they all agree.  Ever since this whole thing started I have followed every recommendation to try and help my DD.  But this time, I don't think I can.  How can I just sit back and wait?  I am so sick and tired of this I want to scream, but if I started screaming I wouldn't be able to stop! :'(

She has had 3 suicide attempts in the past year and each time she has one she ups the ante.  They get more and more serious and last time she very nearly succeeded.  She changed her mind and 3.5 hours post overdose she came and told me what she had done.  I live like 3 minutes from the hospital.  They rushed her right in, no waiting.  They were able to get a 4 hour Tylenol level and it was through the roof and they started the antidote right away.  She was admitted to the ICU and was pretty much unconscious, she would just grunt at the doctors, wouldn't really wake up. Except for the dry heaves she was having every 10-15 minutes all night long.  They transferred her to a pediatric ICU 3 hours away because she looked so bad and her Tylenol levels were so high.  But through it all, she lived.  And so far her liver looks ok, she has to have it checked again though because damage can show up later.

So if her last attempt was that serious, what on earth is she going to do next time?  I am so scared, and I don't like the idea of waiting until the next time.  I don't want to put her in a RTC, it breaks my heart, I will miss her so much, and she won't understand.  But I don't know what else to do.  I feel like I really need to stand up to her providers and tell them she needs to go now.  She has insurance that will pay for but it needs referrals and prior approval and it's quite a process from what her therapists have told me in the past.  So it isn't something I can just do.  I need them on board.  How do you know you are doing the right thing?

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

[jellibeans]

Elbry

In the meantime is your home safe? I have all meds locked up in my home and if my dd16 is unstable then I lock up the knifes too and anything else that isn't nailed down. Have a safe home is key even though I know it is not completely safe. If my dd is unstable then she is grounded... . she doesn't go to others homes where she can get drugs etc... .

I am not sure why they just didn't send her directly from the H to RTC... . I am not sure of your insurance but they don't always make it easy to just check them in.

My dd16 tried to overdose 7 times within an 8 month period... . not that I am competing but you need to show a pattern to most insurance companies. There has to be a history beofre being admitted.

What else have you tried to help her in the meantime? What kind of therapy is she receiving?

It sounds like a pretty serious attempt and I would be concerned too for her safety. Do you know what is causing these SI? Is there a pattern?

I know this is a difficult time for you but hang in there. Things do get better in time but sometimes they get a lot worse. Have you read the book "Overcoming BPD by Valerie Porr"? It really helped me so much and I go back and reread it often.

[peaceplease]

Elbry,

I am sorry that you are going through all of this.  I can imagine how scared you must be  with these suicide attempts.  Have you told med manager, her therapist and psychiatrist how you feel?  Did you ask why they want to wait while you worry for her life?  Or, were you unsure about RTC?  It is a tough decision for a parent. 

jellibeans is right about the insurance.  I worked as utilization nurse during off hours for a rehab, once, and there was a criteria that needed to be met before they would agree to admission.  With that being said there, I would hope that three suicide attempts would meet the criteria for admission to RTC.

Have you asked for referrals, and they denied?

[Elbry]

I try to keep my home as safe as possible.  Meds and sharps are locked up.  But Tylenol is over the counter and easy to get.  When I started locking up the razors, her sharp of choice, she started breaking pencil sharpeners and taking the blade out of them and that is what she used for her second attempt.  Now she actually prefers pencil sharpener blades for cutting, which I can't keep her from, she sneaks and hides them, she can get them at the dollar store.  We took her bedroom door off the hinges so that I could check on her more often and more easily, and because she would barricade herself in her room.  We search her room for sharps but somehow she hides them.

This all started 9/12 when at a routine Dr. visit for a yearly physical.  They saw she had been cutting.  I was floored, I had no idea anything was wrong.  I had never had any problems with her in her whole life.  We immediately got her a counselor and med management but she wouldn't talk.  Things quickly got worse, so much worse.  12/12 she was admitted to a crisis unit for SI.  2/13 was a suicide attempt by overdose.  By now we realized individual was not working, because she basically sat there for the whole hour saying "I don't know".  SO we started Home Centered Therapy.  A team started coming to the house twice a week and we ended up increasing to a team of 3 people 3 times a week.  We did that for a year.  It just closed out 2/16/14.  7/13 was a suicide attempt by cutting followed by her first hospital stay.  9/13 she was back in the crisis unit for SI, and then in 10/13 had a bad cutting episode and was back in the hospital for a second time.  From that time until February she did very well, no cutting, very few meltdowns and outbursts.  Was doing so well HCT was closed out. Also going on through this is a LOT of truancy, so much that I had to start home schooling her.  We started DBT in Feb this year also.  So she was doing really good then BAM out of the blue comes the Tylenol OD.  She had also started cutting again that week.

Which is probably one of the things that makes this SO scary.  She is such a good actress, it is so hard to tell with her, you don't see it coming.  She was in the living room playing with the little boys, laughing having fun at 7:30 and at 8:30 she swallowed 100 pills. She also doesn't have the rage I have read so much about on here, at least not directed at others, hers is all inward, directed at herself.  She has never threatened to hurt anyone but herself.  She refuses to talk to anyone about what is going on with her so we have no idea what is causing all these attempts.  She insists she doesn't know she just gets the thought and can't get it out of her head.

I called her case manager this morning and left a message that I want to talk about RTC's.  I didn't ask for a referral yet because I was still struggling with the decision.  I keep thinking, how will I feel next time if I don't try to get her into a RTC?  As much as it sux to do it she is really leaving me very little choice.

[raytamtay3]

Elbry - I am so sorry you and your DD are going through this. I have my issues with my DD14, but thankfully she hasn't gotten to this point yet with suicide attempts aside from taking a handful of advil in my presence once.

I think you need to act NOW. You are your DD's advocate. As hard as it is, and I know because I just put my DD in an RTC, you have to do everything you can to protect your DD from herself at this point. She needs help.  

It was probably one of the hardest decisions I ever had to make sending my DD to an RTC. But at least I can say I tried everything to protect her. In your situation, I think it's inpervative you get her in ASAP.

If it weren't for this forum, I don't think I would have had the stregnth to carry through with my decision. I'm so thankful I found this place. And we will all be here standing beside you through this difficult process. 

[jellibeans]

Dear Elbry

There is certainly a history of SI and I think it is good you are going to talk to her case manager about RTC. It is better to plan and be prepared than make the decision when in crisis. I have a bag packed for my dd16 just in case. I don't beleive that she is in any danger right now but there have been too many times that I am at walmart in the middle of the night looking for the proper clothes that she can wear in P hospital.

When my dd16 started BDT therapy she actually got worse for a time... . I am not sure that has anything to do with it but she did struggle more. I also think we were adjusting meds too and that is never a pleasant time. Can you remember if there were any med changes during these SI events?

I know of other pwBPD that don't rage so I won't get caught up in that... . The one thing that is really good about RTC is that they have a chance to observe your DD 24/7 and even if she is a really good actress she will eventually show herself. They also have a chance to change meds under  supervised care and that can be really tricky. Not that meds are the answer but they can help get them through the hard times.

I am not sure what kind of insurance you have but you need to really look at your policy and understand your rights. I have not heard of a story where the insurance company didn't put up some kind of fight or at least limit where your dd can go and those places are not always the best. Time to do some research and get prepared for the worse. I really think that can help when or if a crisis hits. You won't overwhelmed by what is going on at the time and can make clear decisions.

Along with taking her door off you can always strip down her room. She doesn't need all the things in her room... . a bed is really all she needs if that makes it easier to keep an eye on her. Giving her freedom to go out to stores when things are unsettled is not good. Until she shows improvements I would ground her so she can't purchase meds or razors.

I know this is a tough time Elbry... . I really was right where you were one year ago. My dd was in RTC and had really gotten bad so have hope. My dd is doing better. She still struggles but has more good days than bad. She is not cutting or had any suicide attempts since mid December and before that she had gone 6 months with an attempt... . I see that as improvement... . so stay positive and hopeful

[Elbry]

I talked with her CM today and she is going to start the processof getting my DD into a RTC.  She agrees with me that my daughter needs to be in a RTC.  She also mentioned she was very displeased by this last hospitalization.  They basically held her for 10 days and said "keep doing what you are doing".  Well, if what we were doing was working she wouldn't have been in the hospital would she?

Anyway, we have a meeting Wednesday morning with my DD, her CM, and her Med manager to talk about the RTC referral.  Meanwhile, things at home are peaceful and calm.  She is doing fine. She has actually been doing some of her own research into BPD and has been talking to me a lot about it and asking a lot of questions.  It makes me question my decision, but then I remind myself things were peaceful and calm before the last overdose too.  Calm before the storm perhaps?  I don't know, I just don't trust it.

Thank-you for your responses.  I am glad I found this place.   

[raytamtay3]

Hi Elbry. I'm happy to hear that you are moving forward with trying to get your DD in an RTC. And again, I know how difficult it is! I almost "rescued" my DD from being there again! But my DD desperately needs this. And for your DD's safety, she does too. We will be here for you through this. Everyone here has really really helped me stay the course. It's so nice to finally find a place where others can relate, offer so much postive support, etc.  We can do this!