Here is a letter I am working on to send to the director of the facility. This provides an explanation of what happened this past Monday.
"Another massive fail in the treatment of dual diagnosis: The 'Catch' 5250"
On Aug. 19, 2013, precisely 2 months from the day my severely compromised son reached out for help with his illness, (dual diagnosis of Bipolar disorder and substance abuse), he was hopeful and anxiously anticipating his admittance into the XXX Department of XXX Rehabilitation's substance abuse facility in XYZ, USA.
But, alas, the help he wanted, the help he needed, the help his friends and family hoped and prayed he would receive, would not come to fruition.
Those of us that work closely with, and care for an individual with a severe and persistent mental illness know the soul crushing blow of another missed opportunity to find help for those who suffer with the ravages of their illness.
Why 'soul crushing' you ask? Because we know that if our loved one suffered with any illness other than mental illness, they would receive prompt, compassionate care. But sadly, often due to the 'unpleasant' or downright scary symptoms and behaviors of some individuals suffering with brain disorders and co-occurring addictions, proper care is very difficult to find.
You see, 3 yrs ago, my then severely depressed 20 year old bipolar son called one afternoon to ask me if I could 'feel the pain of every individual in the entire world'. Several hours later he threw himself in front of a car in an attempt to end his life. Thankfully he survived the attempt, but was left with a traumatic brain injury, and an even more virulent form of bipolar disorder. His neurologist told me that the blow to his head inflicted by a car traveling 45 miles per hour was equivalent to what a prize fighter might receive in an entire lifetime.
I could write a tome about our experiences, but the greatly edited concise version of my son's struggles for the last 3 years, is a nightmare of multiple psychiatric hospitalizations, arrests, jails, substance abuse, rehab, addiction, homelessness, compliance with meds, non-compliance with meds, and prostitution, with brief periods of wellness lasting no more than a few months at a time.
For those of us lucky enough to have loved ones that have not yet succumbed to the 'Great Escape', we know the devastation of a missed opportunity for treatment. For my son, this past Monday, Aug 19, was another missed opportunity; those of us fighting this battle with our loved ones know how few and far between these opportunities arise, how fleeting they are, and if not acted upon immediately, are gone like a puff of smoke.
My son, homeless for the last 2 months, wanted that help. Asked for that help. Showed up for every appointment with his Voc rehab counselor, cooperated with all preliminary requirements, and patiently awaited admittance into rehab for TWO MONTHS. For my son to wait that long and not give up, while waiting TWO MONTHS, in and of itself, was nothing short of a miracle.
So, on this past Monday morning, after entering the facility, my son followed the admitting nurse into a room to go over his meds, and, according to what she later told me, (I was not in the room with them), when she told him that there was some sort of a problem with the date on one of his RX bottles, he reached over, took the pill bottle, tore off the date, and said, "there, now it's fixed".
Next thing I know, the nurse, my son, and a med tech come into the lobby where I was waiting, and the admitting nurse told me that because of what he did, he would not be allowed admittance into the facility, that she was not going to 'put up with' that kind of behavior. She said she had a call in to his doctor, and felt sure that the RX 'date' problem could have been easily resolved when the doc returned the call, but because my son tore the date off the bottle, she was not going to allow him admittance.
Well, I was stunned, and as I struggled to digest this information, I could see my son becoming angrier and angrier. And within seconds, he began to rage, and began screaming obscenities at her and threatened to punch her in the face.
Oh boy. Not good. Not good at all.
I was able to talk him into going outside the building, and I proceeded to sincerely and profusely apologize for his appalling behavior, then I looked her straight in the eyes and said, "this is what bipolar is, this is why he is here, he needs help". She did not respond. But the med tech piped up and said "because he's not taking his meds"! And I looked her straight in the eyes and said, "that is what bipolar is".
My sons behavior was appalling, horrific, scary, and completely unacceptable. I will be the first one to admit that. But I need to share an observation. An observation I have made several times while on this journey with my son. The situation could have been completely avoided. It did not have to happen. But because this intake nurse chose to lord her perceived position of authority over my son and refuse him admittance because he tore a scrap of paper off a pill bottle, is the match that lit the fuse on this entire chain of events. Had she laughed off his antic with the pill bottle, had she attempted to calm his frustration and anxiety over the issue with the 'date' on the bottle, this very unpleasant scenario would have never played out. Instead, she chose to escalate and fan the flames of a brain damaged, drug addicted, mentally ill patient.
This employee clearly lacked crisis intervention training, for if she had, she would have known to be calm, reassuring, helpful and supportive of my son as he began to exhibit signs of frustration and anxiety. Frankly, I have seen police officers with far less formal education respond to crisis situations far more effectively than this mental health professional did.
Do I 'blame' this nurse and her med tech for my son's terrible behavior? Absolutely not. She responded in the manner probably 99.9% of people would have responded. However, had she responded differently, chances are my son would presently be getting the help he so desperately wanted and needs, and our state could possibly save thousands and thousands of dollars on avoiding future hospitalizations, incarcerations, and interventions for my son, and hundreds of others caught in this 'Catch 5250' of our mental health system.
And what is this 'Catch 5250' phrase I have coined? It is the 'catch 22' of our mental health system. Even a willing patient (and most are not willing) can not get the help they need when they need it because they must conform to certain standards to be able to access that help, but they can not conform to those standards because of the nature of their illness.
A year ago, during another small window of opportunity that opened because my son was so so ill with bipolar and drug addiction that he was prostituting himself; so broken he was willing to get help with his illness, he reached out to a county mental health agency. They treated him for a while, but then refused treatment because he would not stop doing drugs. So what happened? He could no longer get his bipolar meds. And then what happens? He sinks further and further into addiction and mental illness without his meds. So a man arrives at the emergency room bleeding uncontrollably, but is refused admittance because they don't allow blood on their floor. The man begs for the medicine that will stop the bleeding, but they refuse to give it to him because he was operating the chainsaw that cut him after having a few beers, and drinking and cutting wood is not a safe combination.
Sound ridiculous? It is. But it is exactly what happened to my son on Aug. 19th.
My son is not a bad person. Yes, at times his behaviors are atrocious, and he knows it, and he hates his lack of control, impulsivity, and lack of a filter. He needs help. He wants help.
The very next day after this incident, he called me crying, asking me what can he do? Why does he do these things? Why does he fuck everything up?
All I could say was, "don't give up, please don't give up, we will keep trying".
My heart breaks for my son. My heart breaks for all our sick and disenfranchised. How many more times will opportunities arise in which they are willing to reach out for help and are refused before they decide to make the 'Great Escape': http://youtu.be/uSyf8fWqSPs
Provider Education, National Alliance on Mental Illness
Family to Family facilitator, National Alliance on Mental Illness