My daughter and her RTC

[j-mac]

Hi everyone.

I'll start by letting you know first off that I am not a nurse of anykind but I have a particular problem that a friend on another site told me you all might be able to help with...I'll try and explain as completely as possible.

My daughter is a diagnosed bi-polar that is a "cutter." She has had this problem for over two years (that we know of) and has been hospitalized 13 times on stablization units at (name removed to preserve privacy). Three of her incedents of cutting occured while she was in school and after a difficult process of IEP and recomendations she is catagorized as "level 5" by the state and afforded for RTC.

In October of last year we thought we had been very lucky to find an opening at the RTC right there on (name removed to preserve privacy) own grounds. We admitted her and signed all the neccessary papers, and I asked at that time if they had anything that showed what their rules and protocalls were, and was told that they would check into it and get back with us.

The first incedent was within the first week. My daughter had informed staff on the unit that she did not feel safe and was appropiatly placed on suicide observation (SO). It was unclear weather the staff allowed her into her room or if she had a peice of broken CD hidden in her clothing but she was able to cut herself while in the "quiet room." Ofcourse this was the first bone of contention between myself and the floor staff. Because I wanted to know how she was able to harm herself while under SO.

The next incident was about three weeks or so later. She had cut herself again overnight in her room. She was placed on SO again and put in paper gown with nothing under. A staff member was constantly in earshot and eyesight. Which I had no problem with except the earshot part during our visits. It felt that the staff was listening in on our conversations. I asked if we could have a little privacy, also if she could have at least a blanket to wrap herself, and was denied. I had to give her my coat because she was shivering uncontrollably. I brought this up with the admin. And they said they would look into it. I also asked again for protocalls and proceedures in writing so we could understand the different levels of what actions they were taking. Never recieved them.

The next incident happened during school. She had taken a personal pencil sharpener apart and cut her arm. When we arrived again she was on SO and in paper gown with nothing underneath, and a male staff member was present on the floor. I blew a gasket. I immeadately called the head of the RTC, and demanded that she either be covered up or the male staff be moved to the other side, off the same unit as my daughter. And told him I was disappointed with the decission to put her in that humiliating circumstance. During the visit we were told by my daughter that overnight while she was sleeping in the quiet room she was awakend by an itch on her head and when she wen to scratch it there was a mouse in her hair! I called a meeting between the administrator, floor supervisor, and social worker/theripist. After hearing my greivences about everything from cleanliness of the floor to rodents to the merit of allowing my daughter in nothing but paper in the presence of male staff. Nothing was done but to re-paint the art/visitation room.

The next incedent happened while I was at work. My daughter wanted to get away from the chaos on the floor and go into the quiet room and read and was told by the supervisor that would be fine, she was on safety observation but not SO. So she did. At the change of shift the next staff member told her that she couldn't have anything in the quiet room and had to read at a table in front of the station (commonly done if the kids are "zoning") My daughter got into a little battle about weather or not she was "zoning" or not and called home. I called back and talked with the staff and told them that I understood that different staff had different perceptions and that I would talk to my daughter. That was fine with her. I called back and got ahold of my daughter and started to have her tell me her side of the story when from the backround I heard the same woman I just got off the phone with begin screaming at my daughter accusing her of lying to me. I finally got her back on the phone and told her to put the staff on. When this woman got on the phone she lit into me yelling that my daughter was lying and that she wasn't going to put up with me interfering. I asked for the supervisors number and was refused. I then again called the head of the RTC and arranged a "meadiation hearing." During this hearing this woman lied and said that I cussed at her and was beligerent and that what my wife and I were saying was untrue and no creedence was given to our concerns.

We spent the next week or so going back and forth about weather or not to transfer her to another RTC. During a team meeting we had decided to leave her in place, with the understanding that communication would be more free and we could just start over. We were willing to over look the neglegence to that point because my daughter really likes her theripist and we are very happy with the family sessions. We were told by the team that they didn't want to continue this, in so many words. I couldn't believe it!

Which brings me finally to the latest incident. Two weeks ago while on an "outing" (on the weekends one of the staff will take a few of the girls to say, a Target or Wal Mart, or a movie) my daughter got away with purchasing a pack of disposable razors, she got them up on the floor and hid them. 3 nights ago she told a staff member that she was unsafe, and felt like killing herself. And was ment with the staff member telling her that she didn't know how to handle it. Nothing was reported. And the next morning my daughter cutherself deep enough to require 13 stitches, and was moved to the main hospital under the adolesent unit care.

My question is what the heck is up here? What can I do? When she is released she will be sent back to that unit and we are frightened of that. We have another RTC process started but that is not completed yet....Help, suggestions?

j-mac

[Psi]

It doesn't sound like your daugher has a mental illness. I agree that it does look like Borderline Personality Disorder. The best thing the staff can do is to lift all the restrictions and play each event of self harm down. In reality the fact that she is getting such intense input is probably making the situation worse. In the UK she would probably not be admitted to hospital, she would be patched up with a minimum fuss in A&E and given an opportunity to talk with someone briefly.

I disagree. Borderline Personality Disorder has specific criteria in the DSM- IV and this is absolutely a mental illness/ psychiatric disorder, or whatever name it can be given. Either way, the issue is that this family is in distress and is asking for help.

That's my !

The priority of the healthcare staff involved should be to do no harm to the situation. There is no evidence that mental health services can do anything to alleviate personality disorder. There is plenty of evidence that providing support can be a damaging process. It doesn't matter that BPD is mentioned in the DSM or the ICD-10, it is still just a description of a list of personality problems. It doesn't have the characteristics or more importantly the treatablity of serious mental illness. The fewer therapuetic interventions this girl is subjected to the better.

[Bjo]

I disagree. Borderline Personality Disorder has specific criteria in the DSM- IV and this is absolutely a mental illness/ psychiatric disorder, or whatever name it can be given. Either way, the issue is that this family is in distress and is asking for help.

That's my !

The priority of the healthcare staff involved should be to do no harm to the situation. There is no evidence that mental health services can do anything to alleviate personality disorder. There is plenty of evidence that providing support can be a damaging process. It doesn't matter that BPD is mentioned in the DSM or the ICD-10, it is still just a description of a list of personality problems. It doesn't have the characteristics or more importantly the treatablity of serious mental illness. The fewer therapuetic interventions this girl is subjected to the better.

You may be absolutely right. I just don't think that is the issue for this family. Wth all due respect. :-)

[Psi]

The priority of the healthcare staff involved should be to do no harm to the situation. There is no evidence that mental health services can do anything to alleviate personality disorder. There is plenty of evidence that providing support can be a damaging process. It doesn't matter that BPD is mentioned in the DSM or the ICD-10, it is still just a description of a list of personality problems. It doesn't have the characteristics or more importantly the treatablity of serious mental illness. The fewer therapuetic interventions this girl is subjected to the better.

You may be absolutely right. I just don't think that is the issue for this family. Wth all due respect. :-)

It does seem to be the issue. Daughter had a problem, then she went into hospital and the problem got worse. It seems likely that the problem got worse because she went into hospital. It seems basic good nursing practice to question any intervention that makes a patient's presenting problem worse. I think this is the core of the issue.

There may well be issues around splitting. But not buying into splitting does not mean that this girls father has lost the right to question the treatment she is given, particularly when it is causing a deterioration. In my view the nursing approach of constant observation and relieving the patient of all responsibility for her behaviour is bad practice.

[CharlieRN]

Personality disorders can be treated in hospital and need to be if they have gotten so serious as to be life threatening. It is certainly better if they can be nipped in the bud with a strong behavioral program out side the hospital.

Generally speaking pd's are learned behaviors. Children learn most things at home. The family is not going to be able to act as the corrective agent if they are already the causitve one. They will need to be changed as much as the patient does.

It is clear, from what the father has told us, that his daughter has found all the buttons to push to make him jump through hoops. She is sitting back and playing a little game of "let's you and them fight."

I wonder how many of the dreadful things that she said happened to her, he actually saw happen? Which of them were documented by staff? How many could be verified by any, responsible, second person? A staff person was heard to shout that the patient was lying over the phone to her father. We all chime in with "how unprofessional" and sure its unprofessional, but it is also most likely to have been absolutely true. PD's do lie. Seeing 'Truth' as a superior 'good' is the sign of a mature and balenced mind. A superior good would be something more important than getting one's own way or avoiding embarassment.