Hi BMO3;
While I don't have a child with BPD and haven't experienced having a young adult child hospitalized, I'll toss some ideas out there, that maybe can give you a direction forward, for now. I know other parents here have had children hospitalized, so some of them may be able to speak more directly to your situation.
What can I tell to the doctors that helps with BPD diagnosis?
You could consider sharing the "definite" diagnoses that she has received in the past, plus the information that medication generally was not effective for those diagnoses, plus your observations of her behavior (perhaps organized clinically -- the "screening and diagnosis" section of
this article could help). Kind of leading the team towards concluding "sounds like BPD" for themselves.
Another approach could be asking "What can we do to rule out BPD?" Not that you "want it to not be BPD", but I've heard that sometimes asking in the opposite direction can help get results, vs saying "Can you prove it's BPD?" which might be met with a "well, maybe, maybe not". So, you could consider asking "what definitive screening can be done, to rule out BPD?"
- what medication, if any, is most useful for BPD?
What I have heard is that while there is no specific medication that is useful for BPD, medication can help with associated conditions, such as depression and anxiety.
- Who pays for the DBT? It is not covered by Medi-Cal. Are you part of the therapy? Should you insist to be part of it, if you are paying for it?
I'm not sure about payment -- whatever facility your child is at should have transparent and helpful information or live receptionists who can walk you through the financial side. It would seem pretty normal to me for you to call the hospital and say something like "I'm new to all of this, and I need you to walk me step by step through who pays for what, and how."
I suspect that each facility might set its own policies about payer involvement. That would be a fair question to ask them, and you could also frame it as -- "We know that family support can be crucial for mental health recovery... can you tell me more about the parent groups/family groups/family therapy/skills groups you offer for family members here?"
I'd also suspect that clinics know that mid-20s are a tricky age for insurance/finances, as some 20-something year olds are covered by parent insurance and some aren't, and some are just transitioning off of it.
There was another parent
posting here recently, about an experience telling the clinic "look, my child has a history of dropping obligations, and as far as I can tell from your policies, you guys (a) can't tell me whether she's actually participating or not, and (b) I'm on the hook for full payment, even if she doesn't go" -- it was for a 24-year-old, and the clinic was open to talking to the parent about options. So it seems like it couldn't hurt to be straightforward with the clinic -- just be direct and ask direct questions, they're probably used to that.
We have been highly supportive parents during her past psychotic episodes and then helping her getting back to normal routine. This seems like she has started using her illness as crutch. We have spent thousands of $ to give her a new start each time. We are still paying her under-grad parent plus fed loans. We paid for her lease for 6 months last year when she came back home sick, now again 3months of lease to be paid still left & so are her finals for the grad school. This time she made some real bad decisions without much thinking and got herself into trouble again. The worst decision was getting off meds without the supervision of her psychiatrist. Being adult, she can repeat this decision even after she is released from hospital with meds that stabilize her moods. Would it help if we practice tough love this time and let her figure out her life at her own or would it trigger 'abandonment issues'?
That's tricky, and it seems like the answer is always "it depends".
Probably at least part of your path forward depends on how things go at the clinic -- are you guys able to be involved in parent groups/skill groups, are you included in making a discharge plan, are you going to be the official housing for her after discharge, etc. If you can be involved with her team, then it seems like making a "step down" plan could work; "OK, let's all reach agreement together: D26 will live at home for X months after discharge, during which time she will apply for at least 1 job per week until she gets a job. Once she gets a job, she will stick with that job for Y amount of time, and she will pay Mom and Dad Z% of every paycheck for rent. After X months, the team and family and D26 will regroup and make a move-out plan, which will look like D26 applying for one apartment per week until she is approved... [etc etc etc]".
If you guys can't be involved with her treatment, then the plan could look different. Some parents do choose to continue to provide "bed and board" due to their own values and integrity, or if their child is lower functioning. Other parents are able to come up with contracts or agreements, and some parents have to evict their child or get a RO, if the child is dangerous. I wonder if you'll have a better picture of what is the most loving thing to do for her, by observing how she interacts with her hospital stay this time. Like you said, you're wondering if she's just using her MH issues as a crutch, and it's hard to know. But you might get some information about "well, it seems like she is not ready to seriously engage with treatment, so it is OK for us to save our money for later, when she might be more ready, and not pay for XYZ for her now".
Some members have noted that pwBPD are often more resourceful than we give them credit for. While many pwBPD don't solve their problems in a rational way or in a way we'd like, it is more common (at least from what I've heard here) for adult children with BPD to find themselves a place to live, albeit "unconventional", than to be cold on the streets. Your D may choose to live in odd, irrational, bizarre, quirky, or nontraditional places (camper van, tent, with friends, on a couch, etc), but unless she is very low functioning, she can probably figure something out herself. Maybe the hardest part would be coping with the fact that it isn't what you'd want for her.
I'm thinking that if she's been harmful to you, then it might be best for all of you if she lived elsewhere after discharge. Can you get that on the record with the hospital staff, so they don't just assume "hey, we can discharge D26 to Mom and Dad"?
...
This is hard stuff, and I'm sorry I don't have more direct experience with your type of situation. I do hope you can feel empowered to be bold and direct with hospital/clinic staff, asking direct questions and getting helpful, clear answers to your questions. Let us know how things go;
kells76
