My daughter and her RTC

  1. 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
    Last edit by gwenith on Feb 24, '05
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  2. 15 Comments

  3. by   DDRN4me
    Though i cant answer for the facility, please know that i care what happens to your daughter,. I work with an adolescent psych program in a school setting. we have one particular girl who is a "cutter" , and very good at it. she can and will hide objects and use them to cut herself. she has even used paper when she cant find anything else. often, she will not tell anyone she feels unsafe until she has already cut. she is also very manipulative, and will get friends or family memebers to buy objects she knows she shouldnt have.
    All of that said, i ahve never heard of making someone, even on so, stay in a room with only a paper gown. what is t hat supposed to prove ??
    also, the facility is setting themselves up for a huge liablility by having male staff supervise females in that state. Our male staff will not be in a room alone with our female students, and vic versa. I wll not even do a body check without a witness.
    Perhaps a call to the state dept of mental health is in order. I know i dont have answers for your daughter, but you could "pave the road" to make things better for someone else. Best of luck. prayers for your family.
  4. by   j-mac
    Quote from mgallant
    Though i cant answer for the facility, please know that i care what happens to your daughter,. I work with an adolescent psych program in a school setting. we have one particular girl who is a "cutter" , and very good at it. she can and will hide objects and use them to cut herself. she has even used paper when she cant find anything else. often, she will not tell anyone she feels unsafe until she has already cut. she is also very manipulative, and will get friends or family memebers to buy objects she knows she shouldnt have.

    Yes, except for the having us buy her things that she shouldn't have part, this sounds exactly like Meg. I am concerned with the ability to pruchasee razors as well and not having them dectected when on the floor.



    All of that said, i ahve never heard of making someone, even on so, stay in a room with only a paper gown. what is t hat supposed to prove ??

    I believe that this was undertaken as a procedure for her when she was able to concele a shard of broken CD and harm herself in the quiet room the first week. And I can see that as well. But my concern is that she was closely monitered and still couldnt have a blanket, and was clearly shaking during our visit at that time. I gave her my coat to cover with during that visit. Also the staff seemingly listening in on our conversation.


    Our male staff will not be in a room alone with our female students, and vic versa. I wll not even do a body check without a witness.
    Perhaps a call to the state dept of mental health is in order. I know i dont have answers for your daughter, but you could "pave the road" to make things better for someone else. Best of luck. prayers for your family.

    I should clairify, the male staff member was present on the floor along with another female staff member. Meg was allowed during the day to be on the floor, out of the room, under the females supervision. But the male staff member was there as well. I was concerned with the humilliation factor.

    Thanks for your prayers. I also have a wife that suffers from schizo-affected disorder but is under controll and functional. So you can see I do appreciate and need every prayer and edge I can get.....


    j-mac
  5. by   canoehead
    It sounds like the paper gown was a bit much, and some iffy issues with a staff member screaming, or telling the pt she didn't know what to do. But it also sounds like a bit of manipulation on your daughter's part too and in your sympathy you are giving her the benefit of the doubt.

    She was able to cut herself when on SO...unfortunately it happens with very determined patients. I know of a woman on 1-1 who sat crosslegged with her back to the nurse and bit through her femoral artery- nothing could be done in time to save her. Your daughter successfully cut while on SO, so they upped the precautions.

    They stripped her completely and put her in hospital clothes the next time. Unfortunately paper(?) but if thats what they use there probably wasn't a choice for the nurses on duty. I'm sure it was uncomfortable, and I wasn't there, but do you think your daughter might have milked the situation for effect? Were you cold without your coat? If they had given her a blanket it would have defeated the whole purpose of taking her clothes as there are lots of folds and ways to sneak and arm out and grab a sharp object if you are wrapped in a blanket.

    Male staff- not so cool- but with only one man and one woman scheduled they may not have had a choice, again, we would need to have more information.

    If a nurse was required to stay within arms reach I'm sure she was uncomfortably close, but it's her butt if something happens. Especially if she didn't know you as trustworthy from previous experiences. Could your daughter have asked you for a pen, or some gum in those little pop out packages, or could she have reached in your purse to get them? Both can and have been used to produce life threatening wounds in my experience.

    Did you think to empty the pockets of your coat before you wrapped it around her? As a nurse I would have been very nervous about that one, and they were bending the rules by allowing you to do that.

    Obviously I don't know you or your daughter, and I don't know what you've been through, but these are some possible reasons.

    PS No hospital I know of will hand out copies of their policies on demand for liability reasons.

    Good luck
    Last edit by canoehead on Feb 25, '05
  6. by   Bjo
    i worked in an adolescent psychiatric hospital for 10 years. i know how much you love your daughter and you are justified in being concerned for her. however, i would have to question if they have explained her diagnosis thoroughly. bi-polar is an "axis i" diagnosis. there are actually four other axis's that could have a diagnosis associated with them. on axis ii, you probably need to find out if she has anything related to personality disorders. this could be borderline traits (usually given to teens) or something else. if you find out that she does have borderline traits, i would recommend that you read all you can about borderline personality disorder. it is one of the hardest diagnosis's to deal with. it is very sad that she ended up with stitches. many times, (and this is all in general and not directed personally at your daughter :-) "cutters" don't really want to commit suicide. they want the pain to stop. more often than not, when they cut deeply enough for it to be life threatening, they didn't mean to do it.
    as for the staff, "cutters" can wear them down very quickly. throughout all the best efforts to stop them, if a cutter wants to cut, they are going to find a way to do it. they will even use their fingernails if they have nothing else. they can be very manupulative and it is very hard to try to help them find better ways to cope with their pain. try the following links below and see if you can find out anything that will help you and your family. my heart goes out to you because your pain and frustration shows in your post.

    www.selfinjury.net
    http://www.palace.net/~llama/psych/injury.html
    Last edit by Bjo on Feb 25, '05
  7. by   j-mac
    Quote from canoehead
    It sounds like the paper gown was a bit much, and some iffy issues with a staff member screaming, or telling the pt she didn't know what to do. But it also sounds like a bit of manipulation on your daughter's part too and in your sympathy you are giving her the benefit of the doubt.
    It is the "iffy" situations that concern us most...We are aware of the manipulation factor in anyone that suffers this type of behaviour, and although I'm sure there was a bit of that intwined in these incidents, we have repeatedly given the RTC the benefit of the doubt by allowing them to continue with our daughter for 4 1/2 months now. The screming incident is a perfect example of this.



    She was able to cut herself when on SO...unfortunately it happens with very determined patients. I know of a woman on 1-1 who sat crosslegged with her back to the nurse and bit through her femoral artery- nothing could be done in time to save her. Your daughter successfully cut while on SO, so they upped the precautions.

    The fact that they were caught off gaurd and had to up the precautions is not disputed at all by us. In fact I applaud it. But supposedly a search was done before her entering this room which lends creedence to meg's view of events. That she was allowed to enter her residential room after the search and without supervision.


    They stripped her completely and put her in hospital clothes the next time. Unfortunately paper(?) but if thats what they use there probably wasn't a choice for the nurses on duty. I'm sure it was uncomfortable, and I wasn't there, but do you think your daughter might have milked the situation for effect? Were you cold without your coat? If they had given her a blanket it would have defeated the whole purpose of taking her clothes as there are lots of folds and ways to sneak and arm out and grab a sharp object if you are wrapped in a blanket.

    They have the choice of the regular cotton gowns as well, because she has been in them before. I'm sure it was uncomfortable as well, I don't like those gowns when I see my doctor much less having to wear them in front of everyone including male staff. She didn't milk that situation, she seemed fine with it, it was myself who had the problem with it. And it was cold enough that she was shivering, and when I gave her my coat I was chilly, and I was in street clothes. I'm alittle confused by your last sentence. In the previous paragraph you told an unfortunate story of a woman who was successful at suicide using nothing but her teeth. Giving the all to common therory that we have heard of " well, if she really wants to harm herself, we can't stop her." Then here you take precaution of a basic such as a blanket to keep warm, while direct monitoring?

    Male staff- not so cool- but with only one man and one woman scheduled they may not have had a choice, again, we would need to have more information.

    Forgive me. Sometimes I assume that floor plans are simular for other RTC's as they are here. There are two sides with a staff station seperating the two wards C3 and C4. Meg was on C4 at the time and C3 had two female staff.


    If a nurse was required to stay within arms reach I'm sure she was uncomfortably close, but it's her butt if something happens. Especially if she didn't know you as trustworthy from previous experiences. Could your daughter have asked you for a pen, or some gum in those little pop out packages, or could she have reached in your purse to get them? Both can and have been used to produce life threatening wounds in my experience.

    Actually I was informed that eyesight was to be maintained. Not "arms length." We visit our daughter every other day like clock work along with her brother. Some of the other girls on the floor have kind of adopted us because of the fact that most parents don't visit as often if at all. It's sad. We are accute to anything that would produce injury and to notice signs in Meg's behaviour that signals this type of action. And I am her father, but nothing was in my coat but dryer lint.

    Did you think to empty the pockets of your coat before you wrapped it around her? As a nurse I would have been very nervous about that one, and they were bending the rules by allowing you to do that.

    There was nothing in the pockets. As for bending the rules, how would I know because as I have stated we have repeatedly asked for protocol and proceedures so that we may be familiar and have never been given anything but the papers that we signed to admit her.


    Obviously I don't know you or your daughter, and I don't know what you've been through, but these are some possible reasons.

    Thank you for the input here. I really appreciate it. It does help to kind of get an insight to all of this from the professonals point of view....


    PS No hospital I know of will hand out copies of their policies on demand for liability reasons.

    Good luck

    Why not? whos liability are they protecting? Mine or theirs? Liability should not be a concern unless they are not following their own policy and something happens, right? ie: allowing a cutter to purchase razors......etc.


    But thanks again....


    j-mac
  8. by   j-mac
    Quote from Bjo
    I worked in an adolescent psychiatric hospital for 10 years. I know how much you love your daughter and you are justified in being concerned for her. However, I would have to question if they have explained her diagnosis thoroughly. Bi-polar is an "Axis I" diagnosis. There are actually four other Axis's that could have a diagnosis associated with them. On Axis II, you probably need to find out if she has anything related to personality disorders. This could be borderline traits (usually given to teens) or something else. If you find out that she does have borderline traits, I would recommend that you read all you can about borderline personality disorder. It is one of the hardest diagnosis's to deal with. It is very sad that she ended up with stitches. Many times, (and this is all in general and not directed personally at your daughter :-) "cutters" don't really want to commit suicide. They want the pain to stop. More often than not, when they cut deeply enough for it to be life threatening, they didn't mean to do it.
    Her Axis II, is indeed borderline. This was diagnosed about 6 mos. to a year into her treatment. She also hears "whispers" before she was prescribed Effexor, I believe. So schscophrenia (sp?) may be of concern as well. I have readd the sites you provide, however it's been awhile, maybe this weekend I do a refresher...thanks.

    The last couple of sentences here are very true, unless ofcourse, she informed staff of sucidial thoughts and was rebuffed.





    As for the staff, "cutters" can wear them down very quickly. Throughout all the best efforts to stop them, if a cutter wants to cut, they are going to find a way to do it. They will even use their fingernails if they have nothing else. They can be very manupulative and it is very hard to try to help them find better ways to cope with their pain. Try the following links below and see if you can find out anything that will help you and your family. My heart goes out to you because your pain and frustration shows in your post.

    I apoligize if this comes off as rude but, I feel that this statement is little more than an excuse designed to absolve staff for incompetence. The girl was allowed to purchase razors and bring them to her room on the floor undected. That in no way is akin to using her fingernails, teeth, or paper. Again I am not trying to be rude here but when something happens that is the very first thing we hear. And thanks for you genuine concern for me and my family.


    j-mac
  9. by   hypnotic_nurse
    Obviously you feel your daughter is not safe at this facility, and it sounds as though you are making arrangements to move her as soon as possible.

    Some patients who cut are very manipulative; this is very difficult for family and staff, as the patient works pretty hard to stir everyone up...and often is able to effectively divide the people who should be working together for the patient's best interests. This doesn't mean that every incident is due to your daughter, but it does mean that some incidents might be.

    Before your daughter goes back to that facility (if she has to), it might be a good idea to set up a meeting with whoever is the person ultimately in charge. Write out your concerns in advance, and then ask for each point to be addressed at your meeting. As each point is addressed, let the person finish talking, and then ask questions.

    I am somewhat surprised that you were not given a list of patient's rights and unit rules when your daughter was admitted. It's unlikely you could get a copy of the protocols for the unit as these are long and involved and there's usually only one set...those are for the staff and the hospital oversight committee.
  10. by   Bjo
    I don't take it as being rude at all. You are the only one who can fathom the whole situation and I'm sure you've heard all the excuses from staff. I sincerely do wish you the best of luck in this.



    I apoligize if this comes off as rude but, I feel that this statement is little more than an excuse designed to absolve staff for incompetence. The girl was allowed to purchase razors and bring them to her room on the floor undected. That in no way is akin to using her fingernails, teeth, or paper. Again I am not trying to be rude here but when something happens that is the very first thing we hear. And thanks for you genuine concern for me and my family.


    j-mac[/QUOTE]
  11. by   Psi
    Quote from Bjo
    I don't take it as being rude at all. You are the only one who can fathom the whole situation and I'm sure you've heard all the excuses from staff. I sincerely do wish you the best of luck in this.



    I apoligize if this comes off as rude but, I feel that this statement is little more than an excuse designed to absolve staff for incompetence. The girl was allowed to purchase razors and bring them to her room on the floor undected. That in no way is akin to using her fingernails, teeth, or paper. Again I am not trying to be rude here but when something happens that is the very first thing we hear. And thanks for you genuine concern for me and my family.


    j-mac
    [/QUOTE]


    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.
  12. by   CharlieRN
    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.
    Sounds like a more aggressive treatment plan then is possible in the the litigious USof A. Here the responsible physician would be afraid to be sued if, as can happen, such a kid does kill or maim herself by accident. I agree that the minimization of secondary gain is a necessary part of the treatment. But so is the avoidence of "splitting". The patient has successfully generated a "split" between her treatment staff and her parents.

    J-mac, what you need to do is find a facility you are comfortable with. Get all the information they can give you about how they will treat your daughter. Discuss all of your questions and concerns with them. Then you MUST put complete trust in them! You and the staff must form an unbreakable bond. What they say, is true. Period. Especially when they wrong!

    It is essential for yor daughter's mental health that she not be allowed to split the staff/family unit. This is not without pain and risk. You will have to change the way you have been interacting with treatment staff. that will be painful. There is a risk that she could actually be mistreated. That is why you do your research first and assure yourself you can trust the professionalism of the staff.
  13. by   Bjo

    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.[/QUOTE]

    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 !
  14. by   Psi
    Quote from Bjo
    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 ![/QUOTE]

    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.

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