Looking for help - 19yo daughter stating intent and facing discharge

[TM3]

TW: self harm, suicide, discharge from hospital, high emotions and fear.
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Hi. I’m in WA. I hope this is ok, and I hope it’s written properly and not in a way that is unnecessarily upsetting, or is offensive. Please be gentle, I am constantly crying or angry and I’m exhausted and scared. I don’t know if I am naive and being used by my daughter (making the psychiatrist right), or if my gut feel is correct and my daughter is in danger.
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My 19yo daughter has recently been diagnosed with BPD. She has previously been diagnosed with ADHD, and is flagged for possible autism. She was in a private clinic for 9 weeks, they wanted to discharge her. Coincidentally on the same day her funding was due to drop and they would have needed to negotiate with her health fund if they kept her. We had a meeting to discuss it and that day before the meeting time the had her transferred to public as an involuntary patient. We spent 3.5 days in ED with her, with either her dad or i alongside her. In the early hours of the morning of the third day, still dark/night time, I walked with her to the bathroom and she made an attempt with something she’d had on her person. The next day they put her in closed ward. She was very up and down, sometimes calm and sometimes self harming and nonverbal. She was there 5 days and had 3 different psychiatrists. The last one met her once, apparently for ‘senior review’. He brought with him a pre-filled treatment plan that is written from her perspective, as if she wrote it. He told her he will discharge her by Tuesday. She told him that was fine as she will do it properly this time. He said he would not allow her to ‘deliberately implicate the mental health system’, which our advocates said later was him denying legal liability. I felt like he was saying that she is intentionally harming to manipulate everyone so she doesn’t have to face the outside world, or things like her lack of housing. He walked out of the meeting when she said that she doesn’t care about housing because she won’t be around to need a house. He sent the doctor back later with the nurse to deliver the paperwork that says she is no longer an involuntary patient. After the meeting I called crisis care because I was too upset to drive. They said that the hospital is right, hospital stays are not helpful for BPD, and that I should learn more about BPD, and stop engaging with her/make better boundaries. They said I should step back and not try help her, or try find her housing.
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I don’t know what is true anymore. I feel like they’re all trying to say I’m just being manipulated and don’t realise it, or that I’m making it worse, and that she won’t really do what she says she will. But both my carer advocate and her mental health advocate don’t feel that is true. And I feel too like every single time someone says ‘well that’s your choice’, or your need to take responsibility for this yourself’, she gets more backed into a corner, more scared or angry and defensive, and then more determined to go through with it. Her mental health advocate managed to convince her to move her stuff to the bed in the voluntary ward, and to try and stay for at least tonight.
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How do I know what I should do. Do I try get housing for her? Do I ask for a public guardian/advocate because she isn’t making ‘rational decisions in her best interests’? Or do I back away and cross my fingers? How do people decide this stuff?

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

[incadove]

Oh wow - TM3 that is terribly scary, and that doctor sounds awful - concerned only for his status and the hospital's. 

BPD patients really do go through with it  and that is what I know Marsha Lineham was concerned with when she started the study.  It struck me that she still recommended 'irreverence' as a treatment modality, and got some patients not to kill themselves by reminding them they had agreed not to quit treatment!

Can you make a simple plan with your daughter to go out for some treat when she is released and let her know you are looking forward to seeing her, ask her to promise that she'll make it, and express how you deeply care and are worried for her?  Perhaps an appointment with an outpatient doctor.  Also have you tried anti-depressants such as Prozac?  Maybe you can ask her to promise to try those first.

I don't really know and I am sorry I am giving quite unprofessional and uneducated advice!  But if it were my daughter I know its such a knotty situation, definitely stay in touch with her closely and I think its fine to put any worries about manipulation to the side until she is stabilized.  She needs to hear there is hope for a better future that it will not always be like this.  When in the dark pit it looks hopeless but logically she might know that there were times she did not feel that way!  I think logic is often a way out.

Anyway I hope she has an upturn and things get better, I would hope for the best but try to take the best actions you can taking this seriously.  When my dd was suicidal I treated it as a dangerous medical condition that required treatment, and asked her not to feel embarassed about it any more than she would if she had heart disease.  It is a real thing and sometimes simple antidepressants actually can help.

[yaneznayu]

Hi, I hope I can offer some useful information.

My first reaction on reading your post was wondering if I had written it.  My wife and I are facing a similar situation with our 21-year-old daughter, currently inpatient, facing potential discharge even though she is still self-harming and not responding to medications.  My comments are based on our experiences with her.

Some thoughts:
* Trust your gut.  Even if your daughter is not intending to hurt or kill herself, the actions that she takes can cause injuries.  Be alert.

* At the same time, take a reality check.  She might be manipulating you.  Both options can be partly true.  Know what you can, and cannot, handle.

* If you can, build up your support system.  NAMI, www.nami.org, offers support groups for families of / parents of people with mental illness.  They might have a support group in your area, in-person or virtual, so you can talk to people going through situations similar to your own.