Vent about psych admit of 12 yo boy

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Specializes in Psychiatrics.

***VENT*** ***Kind of long***

I work in an equivilant to a pysch ER, we do assessments, then reccommend the patient to the correct level of care (therapist, psyciatrist, in-patient, ect...)

Anyways.... I did an assessment on a 12 yr old boy, accompanied by his bio mom and her boyfriend. The boy was making threats to hurt himself, cut his throat, ect. Very defiant, rude, obnoxious, continued to deny that he was ever suicidal, not very cooperative.

After the assessment I called our on call doctor (per protocal) and it was reccommended that this boy go to either day program (if parents felt safe taking him home), or in-patient on our unit.

I go back to the assessment room to inform the boy and his mother of the decision. I basically say "Ok...I talked with our doctor on call, and we have two options. 1. (talking to the boy) You can go to day hospital, or 2, you can go in-patient."

The immediate response from the boy was "My mom has a third option. She can just take me home. I am not ever coming back here. I don't have to!"

I inform mom that yes, that is an option, but we also have a fourth option, mom and mom's bf could file for commitment. The three of them begin to discuss this, and it became heated. I opted to leave the room so that the three of them could discuss the options.

While I was waiting, I noticed the boy attemting to leave the premisis, with mom yelling at him to come back. Luckily he did go back to the room, and our security guard had to stand by to help monitor him. I go back to the room and mom tells me that she wants me to start filing for court committal.

I go back to the nurses station to page our doctor yet again. Not five minutes pass, and I am called back into the room, yet again. Mom has decided that she will take him home, AMA. I let her know that before we can go that route, the doctor must be informed.

Get a hold of the doctor, and the doctor reluctantly agrees to do this. Go back to the room, have them sign AMA. They leave.

NEXT DAY

I get a frantic call from the same mom about the same boy. He went to school and made threats that he wanted to die. She was headed over to the school to pick him up and bring him there. I inform her that if she wants to bring him in, and he was unwilling to come voluentarily, that they (mom and mom's bf) needed to go to the clerk of courts office and have him committed.

Few hours later they stroll in with the court committment papers... and he is promptly admitted (be me).

The entire time the boy is abrasive, rude, and continues to deny any suicidal ideations, he claims that what he said at school was "This (who knows what "this" means) is what makes me feel like killing myself."

Anyways, he is admitted to the unit, and mom still isn't sure that she wants him there. (AFTER obtaning the court order)

Some days I just don't understand people.

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Specializes in LTC.

If he's only 12 why do they need a court order to admit him or bring him in?

SOrry you had a bad night tho *hugs*

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Specializes in Psychiatrics.

Per our policy if the child does not sign in voluntarily, then a court order is required. (Not sure if this is statewide or just our specific hospital.)

It's parents like these that show me how NOT to parent my children (whenver they come along)...

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I think that as parents there is fear and guilt. This 12 yr old with that "third option" comment shows he is probably a little more intelligent and possibly dangerous than you yet know. His parents regardless if they contributed to his being, are most likely fearful of later retaliation, or of acknowledging some kind of real or not real failure.

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Specializes in Psych/Substance Abuse, Ambulatory Care.

I feel you! We have to Section-12 people (that's what we call the psych commitment in MA- not sure if it's the same where you live) all the time from my facility (court mandated drug detox) ...and then once they get to the hospital they become the perfect patient and adamantly deny any SI/HI, which makes us look stupid for sending them out. Then once they're brought back to us and learn that no, we will not be continuing the Ativan they received in the hospital, they start with the threats all over again. It doesn't end, but what can you do :/

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Specializes in Psychiatrics.
I think that as parents there is fear and guilt. This 12 yr old with that "third option" comment shows he is probably a little more intelligent and possibly dangerous than you yet know. His parents regardless if they contributed to his being, are most likely fearful of later retaliation, or of acknowledging some kind of real or not real failure.

I totally agree on believing that he is a little more dangerous than I know...intelligent...probably. And I agree that his mom is fearful of what he may do some sort of retaliation. Lots of psych background with this kid and his mom, if I remember correctly, the father is not in the picture, or if he is, not much.

My issues with the mom is that she is letting her son, a 12 yr old call the shots. Parents should be the ones making the major decisions until it is proven that the child can make competent decisions (and I am probably gonna get reamed for saying/thinking this).

Another issue that I have, is that if you are going to go to a medical professional, and they give you a recommendation that you don't like...that doesn't exactly mean that they are wrong or are stupid. They just may possibly see something that you either can't see or won't see. {end rant}

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Totally agree with you there.

But I'll add that the Mom is not really aware of your presence entirely... do you know what I mean? You were there, speaking with them, and she hears and sees you but there is probably so much acute stress that you weren't really registering so much. You are a peripheral vision sort of status for now. She needs to get some MD support for herself ASAP. She won't be able to see things and make decisions at all without it.

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Specializes in COS-C, Risk Management.
It's parents like these that show me how NOT to parent my children (whenver they come along)...

You'll be amazed how often you end up eating words like these once you become a parent.

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Ahh, the future of America....:down:

Kids who have been parented by doormats.

VERY sad.

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Specializes in PICU.
You'll be amazed how often you end up eating words like these once you become a parent.

It's true, we all say things before we have kids and understand how hard it is. However, you truly can learn. My first job I worked with a lot of kids with cystic fibrosis. Some parents would give them whatever they want because they had a "terminal" illness (at some point, could be decades). I really did learn from that the importance of setting boundaries with the child no matter and treating them like an ordinary child.

Anyway, sorry to deviate. OP,I feel your pain. We get frequent psych admits while they're medically stabilized and til we can find a pediatric inpatient psych place willing to take them. It's usually pretty clear early on where the problems started- at home.

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Why can you not involuntarily commit him if he is making threats at

school? In our state the school psychologist, or in an emergency

a police officer can sign the request for evaluation for involuntary

hospitalization. Police officer then transports to Psych emergency

department for evaluation.

The situation that you describe seems a recipe for danger, the

boy is escalating and running the show. It is clear to me that

he is asking for a time out from Mom and esp boyfriend.

Each time she rescues him, he will escalate more...

I am confused why your MD on call did not come in to

evaluate him directly...by the time he does, the boy may

be now carrying a knife or other weapon as this escalates in intensity.

He then may go into the court system directly depending on the

circumstances.

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Specializes in ER.

This is my take. At the point where he is stating he has a problem, and won't accept help with it (threatening suicide, declining treatment) he gets taken out of the decision making process. Parents are in charge, you state that in front of him, and state it repeatedly to his parents when you take them out of the room. Tell him they are going to make the decision, then give them a spot to discuss their options. Then go back to him, with a security guard and tell him what he is going to do, and the consequences if he doesn't cooperate. Security will keep him in the room, or if he leaves the police will be called to bring him back.

There was another option. If the boy is threatening to harm himself and the parents can't take control, CPS certainly can.

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