Hello Mom to My Girl,
You have my empathy, right now will be the hardest time for you and your daughter, with your daughter in a facility 8 states away. When my daughter was 11 yo, she was also in a facility, but in the same state, so, we could visit frequently. Our daughter begged us to get her out of the facility, and it really pulled on our heart strings with her impassioned pleas to get her out, which included not getting along with the other patients/clients; however, it was for her own good to keep her in the facility, as she had not recovered enough at that point.
Our personal observation (we were there with her when visiting), and staff observations indicated she was getting along with each other as well as others in this situation were.
We had to trust in the process, and if you pull out too soon, it will be worse than if no treatment had ever been done, and they will be cycling in and out of treatment for years to come if not the rest of their lives when we talked to parents who had previously done that.
With your D being 20, she is old enough to sign herself out (don't communicate this to her, or acknowledge/validate this if she says something - however, do have a plan for this outcome). Please be mindful, that her mind will continue to develop until she is +/- 26 yo, where she can potentially have life long changes still instilled into her. Our daughter pretended not to pay attention to the staff; however, from observation, she soaked in a lot of benefit from what they were teaching her there.
If my wife and I didn't put her in a facility, she would likely be dead or be in a much worse place than she is now mentally - I was forced to take the lesser of two non-desirable paths, which resulted in having a daughter around who hated me, or have no daughter at all.
Since then, our daughter has warmed up to me and my wife and realizes that we are not the bad parents she has split us as.
Our daughter is diagnosed with anorexia nervosa (AN), and was at the upper end of lethality for her BMI when she was admitted to the hospital. She is now, and has been at 80% on the weight/growth charts for the past couple of years.
Thankfully our daughter is in full remission (rare, as AN has lower success rates than residential BPD treatments which is highly comorbid with BPD), even though her mental health condition is on her mind a lot. Our daughter is now 17, and has somewhat come around to us; however, she still keeps me, her father, at a healthy distance, as she perceives me as her 'jailer' as I put her in the hospital against her will. My daughter has shared with me that she thinks she has BPD (self-diagnosed), even though I do not see much impulsivity in her ( much less than her peer group ).
My recommendation is to talk to her case worker(s), as they have resources to help support you emotionally (even if it doesn't feel like it), in our case we had one that was assigned to us, and we had regular and consistent updates with the case worker and the team that was treating her, have a list of questions for the team, and make this team answer your questions and concerns to your satisfaction, that is what they are there for. Do not let them give you a half-@$$ answer, but one that you can be satisfied with. Also, do your homework, know what to expect, as this will be a team effort with you and her providers, and you will be taking over your daughter's care once PHP (partial hospitalization protocol) and/or IOP (intensive outpatient protocol) happen.
Since our daughter was so young, she was segregated from the adult population in the hospital, to which I was thankful for; however, at 20 years old, your daughter is likely with an adult population, which can be very rough and be exposed to a lot of things she hasn't been exposed to before, and that can be very impactful to her, especially if the other clients have been there many times before (for not finishing their course of the treatment in prior visits and/or relapses).
Hospital stays are extremely costly in both financial terms as well as emotional terms; however, I was of the mindset of only doing this once, and not have a life-long repeating pattern that other parents/patients had experienced that would ultimate destroy not only her (and our) mind, but our finances too.
Right now it probably feels like you are stuck between a rock and a hard-place. If I were in your shoes, I would buckle-up buttercup, and see this thing through, no matter how tough it would seem now, as it will only get worse if you don't see it through. This takes great emotional strength that I did not realize both myself and my wife have. At that time I was very leery of mental health professionals; however, it took me years to eventually trust in the process, as if you take the time and effort to learn the process, it can and will work, as our daughter's story is a resounding success story surpassing seemingly insurmountable odds, as our daughter made sure that she would never be subjected to being hospitalized again against her will - it was our daughter's change of her mindset, once she knew that mom, dad, and grandparents had a united front in keeping her in there until she was fully treated - she took it upon her self to fix herself - and for our daughter it was the perceived abandonment by her entire support system to keep her in hospital that did this for her - she hated us for keeping her there; however, the end result was so worth it. It was tough love, we hated every minute of doing this to her, but it had to be done for her 'own good' - the alternative was death or a life of moving in and out of mental hospitals with a less than desirable population with more severe issues as she would age through this ordeal.
AN has a death rate of 11% (from starvation and/or suicide), whereas BPD is 8-10% (from suicide).
One of the best pieces of advice I can give, right now, that your daughter is several states away is to self-care, whatever that looks like for you, so you can have the energy and stamina to get through this dark time in not only your life, and to be emotionally supportive of your daughter's life too.
limit your calls with her, and when you do call her, or she you, validate the way she is feeling (scared, lonely, abandoned by you, etc). Affirm gently that you are there for her, and available at a certain time each day for a limited amount of minutes, so she doesn't totally feel abandoned by you. I would suggest limiting it to a number suggested by her team, or no more than 45 minutes per day, otherwise it will become counter-productive with excessive begging and marathon sessions of circular arguments by your daughter on why she needs to get out. Only validate the valid (the way she feels). Do not validate the invalid (her desire to stop the program).
My heart goes out to you, as I've 'been there, done that'. Don't hesitate to ask question, we are here to listen to you, and offer emotional support.
Take care.
Salty Dawg
