Family and Caregiver Schizophrenia Discussion Forum

At what point should someone be discharged?


#1

I’m sure this has been covered a zillion times but since I’m new I’m going to ask for some advice. The social worker called today to ask us what we would have to see in our son for us to be ok with his being discharged. Now mind you, he cannot tell you where he lives, he does not talk to the dr directly and tries to walk about of the room, he doesn’t remember seeing us or having family meetings, he can’t tell you who his nurse is or his brother and sisters names. He echos, paces and is having auditory and visual hallucinations. And we answered that they should tell us when they see enough changes then they should come to us and we will tell them at that point if we feel he is ready to come home. Because right now he cannot. I cannot care for him at the level of care that he needs.

However, reading some of these posts there are many people who are living at home having hallucinations, paranoid, non verbal/non sensical, not taking care of themselves well hygiene wise and struggling with other symptoms he has. At what point is it ok to say this is going to be a ‘new normal’ and go home? When they have never been the normal before. A total lack of cognitive skills as well, but these things don’t seem to concern the hospital. They scare the living wits out of me, because I’m his primary caretaker and he is closest to me, so when he was home for the first month in his acute psychosis I never went out. If I tried to go out he would stand there and cry until I came home or tried to follow me out to the point the housekeeper would stop working lock the door and stand in front of it so he could not leave. (thank goodness she hasn’t quit yet, but I’m worried about it!!) I can’t imagine having him home like that again. Where he has to be lead everywhere like a child, dressed like a toddler and hand fed. Do they really send home the kids/adults like that? I’m terrified they are going to because they say we are so educated and supportive. I’m not going to pretend not to be so they will keep him but I will admit to being tempted!! Maybe if they felt we were ignorant about things and unsupportive they would keep him longer? I have no idea. Has anyone been sent home at a point they felt was far, far too early to be truly safe? And how did your family, or how did you, if you are the family, handle things?


#2

Is he diagnosed with schizophrenia? Or schizophrnia only?
I feel there’s more about your son.

I don’t know his diagnosis and what his treatment plan, so I’m not sure what your doctor is going to do with him, but basically, doctors won’t send home patients who are not safe yet. They will do the opposite.

Schizophenic ppl can live an OK life with hallucinations or delusions as long as their cognitive abilitis are intact.

I think his hospitalization is not only for him but for you too. If you are the primary care taker, and if you don’t feel able to cope with handling things, then your son should stay in hospital until you feel able to cope with it. And I think you can tell so honestly to your social worker. Your the one who take care after the son, and they can’t make you do what you can’t.


#3

I answered your other post. Me and your son are vastly different. Or at least our symptoms are. But my symptoms when I was 19-21 were very severe and I suffered a lot. I spent 8 months locked up in a psychiatric hospital. I think your sons case may be worse than mine but mine was pretty bad. My comment is this and I think you will see my point. When I was in that hospital, I never improved. I went through hell until the last day I was there. So my patents didn’t wait for the right moment to get me out or they didn’t wait for me to improve. They just arranged for me to move out of the hospital into a nice residential treatment home. So one day, I am suffering in the hospital and a week later I was living in a nice house in a nice neighborhood and THEN I started to improve…

So I guess I am really making two points. One: In my case my parents didn’t wait for the best moment to get me out and Two: My environment helped me to improve more than anything. When I moved into a nice neighborhood I started getting better.


#4

I am the (ex-) patient. Having no family to care for me, I was made a ward of a close friend to whom I gave power of attorney to act in my behalf. He was and actuall attorney, and he wanted to do the best thing he could for me. He took steps to get me on SSDI, protect what money I had left via bankruptcy (which was more liberal in those days), and put me in a private, long-term, residential facility for the mentally ill.

I lasted two weeks. It was hell in there.

I’m sorry to say that it is likely to be hell-ish at best in virtually any l/t res facility now, even including the most expensive and “best.”

But there is a better way IF the patient is medicinally compliant and not a risk to his or anyone else’s well being: long-term residence in a board-and-care specializing in the care of the mentally ill. It is more affordable than l/t hospitalization (which is agreed by most mental health pros to be bad for pts because of the wretched interpersonal conditions in them; and he may need to do a few weeks in one to figure that out).

Get with the social worker at the hospital or clinic that is managing his case and see what is available.


#5

The fact the your son’s memory is so wiped out right now makes it very scary to think of him not in hospital.

If he walked a few blocks away from home… would he remember how to got back? Would he remember any number enough to call and get help…

My parents took me back when I could get through my day a bit better… not so much with the hygiene… as much as can I feed myself… if I did go for a walk, could I get back… could I talk to others in any way that was coherent.

I did a small stint in a group home after one of my hospital stays… it was OK. There were people on-site who could help us out.

It does sound like some outside help might be a good thing in this case.
Also, for a while, there was a visiting nurse who helped my Mom out when I was first brought back home.

Visiting nurses… case workers… wellness check teams are available and that might help as well.


#6

The key thing is that he is not flouridly psychotic - the major delusions, and auditory and visual hallucinations are controlled. In hospital environments they typically discharge very early (i.e. too soon) because of pressure by insurance companies or just for cost containment. In other treatment facilities they may stay much longer.

Generally - you want him in condition where you feel he is safe to be with, and on the road to recovery and moving strongly in a positive direction. The most common mistake we see as families is that the person is released too soon, goes off their medication because they think they are not sick (the family is sick) and then the cycle continues - perhaps to homelessness or other negative results.

This is a great opportunity to get him on the road to recovery - don’t let it slip from your hands. You may not get another chance to get him into that facility.


#7

when the person is well enough to leave


#8

This is his 7th time in this particular facility. He’s been in 3 others as well, multiple times. Another issue is that he turns 18 in less than a month and so even if they place him somewhere right now they will have to move him the day he turns 18. Which makes anywhere we choose at this point at best a very temporary situation. I’ve asked about other options and the Dr. hasn’t given any. I’m pretty frustrated with the lack of information and assistance. It seems they just want to get him okish and send him home.


#9

The fact that he turns 18 soon is very potentially problematic (I’m assuming you’re in the US or Canada) - because then he’s an “adult” and you lose a lot of influence in the treatment program - you become a complete outsider.

Here are some good readings about how to get the best treatment for your son - I recommend them strongly:

http://schizophrenia.com/family/FAQgen.htm#bettercare

and

http://www.schizophrenia.com/family/bettercare.html

and even our general FAQ here might be of value:

http://schizophrenia.com/family/faqindex.htm

Yes - the bias on the facilities is always to just get them functioning so that they “are not an immediate threat to himself of others” and get him out. They really are not at all about optimizing the outcome of the patient.

You might talk with other families in the area via NAMI and find out the best longer term care facilities if they exist - who are not hospitals but have rigorous treatment programs. Try contacting your local nami from this list:

Scroll down the page until you find “Find Your Local NAMI:”

http://www.nami.org/

In Canada the organization is http://www.schizophrenia.ca


#10

I’m actually in Panama (the USA right now for treatment for him) and they have zero adolescent psychiatric hospitals. They do have what appears to be a good adult hospital in the city about an hour and a half from where we live, but my son speaks limited Spanish so that is an issue. There are only around 12 or so psychiatrists in the country. We’ve looked into ECT and he was refused because he was doing pot and drinking. I’m thinking once he turns 18 it may be easier to get ECT to help the depression and suicide attempts when he’s not in a psychosis. He’s been very close to being successful, ended up on life support in Jan after an OD and threw himself out of a car in April. It’s been a very difficult 4 years now. It was difficult before then, but it’s been worse the last few years.


#11

I’m sorry to hear about your family situation - I know from experience how hard it can be. I’m sure its even more challenging given your cross-border issues.

I’m sorry I don’t have more ideas on how to help… suicide is a big potential issue you have to always be aware of, especially early after treatment when the medications have just taken effect and depression is common. The ECT might be a good option given your description of the challenges.

Perhaps other people can add their suggestions…


#12

I’m stating the obvious and I know it’s very hard to get a teenager to stop but he CAN’T be doing drugs and drinking. If he is still doing those things it will effect his recovery significantly in a bad way. Pot is terrible for a lot of people with schizophrenia and probably for your son. If he is smoking pot he may never improve. I doubt he is smoking it in the hospital but you never know. When I was locked up for 8 months in the hospital I know people were sneaking pot in and smoking it and I saw one poor guy I knew who smoked it and completely freaked out and started crying and wailing and scaring people.

I beg to differ with @SzAdmin when he says “you become a complete outsider” when he turns 18. maybe it’s different now or maybe it’s different in Panama but when I was in my late teens and early twenties my parents were in charge of my treatment. They did not need A court order or and legal papers but they are the ones who arranged EVERYTHING for me to be put in hospitals and group homes. They were in touch with all the hospitals and visited me every day. Maybe it’s different now.


#13

It is very different now - much more legalistic. Also - I depends on the position of the patient. If they want their parents to be involved and sign that off with the staff - then its probably better. But if the patient decides against the parents, then it can be very difficult after age 18.


#14

Wow, are you saying that a schizophrenia in the throes of psychosis would be responsible for checking himself into a hospital if he needs it? If an 18 year old can’t even take case of himself and his own basic needs how is he supposed to navigate the mental health system? How can they leave the responsibility of his own treatment up to an 18 year old.(i.e. going it alone without his parents). I guess that’s just the way it is though.


#15

I agree that it’s impossible, but I’ve read enough accounts on the Family side to see that that’s exactly how it is. Very frustrating.


#16

I will be blunt and unpopular (but you can ask others here if I care when the truth is at stake). Everything I have read thus far suggests a control-obsessed parent who wants someone else to fix the problems they themselves manufacturered.

I am working at this very time with a mother of a drug-abusing, anti-social (pre-sociopathic) and borderline (but not quite fully psychotic) son about six years older than yours who has come to see how the moral perfectionistic obsessions she picked up from her own parents plus her own defense mechanisms of alcoholism and sex addiction play in the family drama. It’s a typical story.

Nothing I say here is going to change what you think or do, of course. You’ll pretty likely go right on thinking, saying and doing what you have been saying and doing because it fits the beliefs and programming you got from your own parents. But you may some day wake up from your trance enough to notice that your obsessions made your son’s life worse and worse, and that it would have been far better for him if you let HIM decide what he wants to do with YOU rather than the other way around.

Okay. You (and the other treatment-resistant “programees” here) are free to have temper tantrums while I go to my office at the beach and work with people who have moved through their denial / pre-contemplation and contemplation / consideration to acceptance / identification and commitment / action.


#17

there are a lot of different possible contributing factors in psychosis. Sure - stress from family environment might be one such factor - but its only one of many, and to focus solely on that one factor to the exclusion of all others probably is not helpful to anyone. You know that “Biology, Psychology and Social” environment and factors all likely play a role.

Anyway - yes - there are possible benefits to making sure the family environment is a positive one, but given the situation far from the only factor to focus on.


#18

Jeezus man, relax. This is a worried mother with a suicidal schizophrenic son, not a boxing puppet.


#19

notmoses Alright, I started saying something rude but I will not answer that way. First of all, mental illness is an illness, a chemical imbalance, not something manufactured. When my son is in the midst of an acute psychosis and is unable to cognitively and mentally function, to speak, to make decisions, to reason and to take care of himself, when even something as basic as eating is impossible, how is he supposed to make decisions? Truly? That is just ignorance on your part. I would much rather have my son able to make decisions and function then make them for him. As for expecting others to solve a problem I made, yes, I expect the hospital and medical community to assist in helping him get better, the last I checked that was their job. I, on the other hand, unlike you, did not go to school for psychology or psychiatry and need assistance. So yes, I’m looking for support/assistance during this time. And I also think I read that this site is for support for family members. Bingo! So here I am. So thank you for your opinion, now go back to the beach and bury it where it belongs.


#20