Very lost young woman - How would you advise her mom?

[BeachGal]

On 10/8/2018 at 9:40 AM, Jenny in Florida said:

The daughter is in therapy. She sees a psychologist weekly and a psychiatrist monthly. She is taking medication. She is mostly cooperative with these things, but doesn't seem to be making any progress at all in stabilizing or improving her situation. 

Sometimes, I think my friend is enabling too much, but there are complicating factors. The family has a history of depression, and at least two family members -- including my friend's nephew/the daughter's cousin -- have committed suicide. So my friend is absolutely terrified of losing her daughter the same way. 

 

The daughter is showing signs of complying with treatment and that is a positive sign.

It may be that her therapy and treatment are ineffective and could possibly be making her problems worse. For example, of those who are prescribed SSRIs, about 25% will worsen.  I don't know if she's taking an SSRI but other meds can cause problems as well. If you hang out on a forum for psychiatrists, you'll quickly see how different their treatments can be.

That the family has a history of serious depression could point to some genetic underpinning(s) that could be playing a part. So far, about 74 different genetic variants that increase the chance of developing depression have been identified (research done at King's College London). This doesn't mean that having those variants guarantees someone will develop depression but if combined with certain environmental stressors, depression could develop.

 

[moonflower]

22 hours ago, bolt. said:

Yes, you are quite right that my initial perspective might not continue to make sense with all the actual factors and potential factors of the real situation. The addiction and the role of enabling in addiction is something that might make care like I’m suggesting either impossible or completely inappropriate.

I’m only thinking it’s worth a mind-shift to see if there are any applicable ideas that come out of a chronic illness and dependant adult mindset.

I’m not accustomed to ranking the priorities of people’s medical needs based on how much money people have. I can see how that would be seriously complex. I’m not really qualified to think that part through.

However, I’m thinking it’s probably not  *more* complex (or more expensive) than having a sick child. It just feels different because the child in this scenario is a dependant adult. I imagine (probably?) that families are *also* bankrupted and/or forced to make decisions of prioritization between the medical needs of family various members iif a child, during childhood, becomes ill in an expensive way.

(I’m sorry, I just have to pause and say: that’s appalling, and the American medical system really is, itself, the heart of this problem — much more so than the mom, the adult child, the illness itself, or the addiction.) (Okay, probably the addiction is a pretty huge component too. Treatment for addiction is not great no matter what medical system you have.)

I think, probably, the mom feels differently about an sick adult (especially mental illness) because during childhood, no one blames the ill person, and no one imagines the child could or should self-manage the condition. With adults, especially with mental illness, we tend to imagine those things.

 

I doubt that even in Canada, drugs (the previous poster meant street drugs, not prescriptions), alcohol, and repeated expensive higher education that is abandonded halfway through a semester is included gratis along with universal health care.

[bolt.]

1 hour ago, moonflower said:

 

I doubt that even in Canada, drugs (the previous poster meant street drugs, not prescriptions), alcohol, and repeated expensive higher education that is abandonded halfway through a semester is included gratis along with universal health care.

Of course not.

What’s covered:

Student mental healthcare is (all through school), many addictions programs, (especially the ones for teens, but also some for adults) inpatient and outpatient care for mental illness when it can be diagnosed, and group homes for adults who need ongoing care (the kind of situations that might work out better with adult dependants not living in the family home long term). Those things would go a long way towards helping someone who is reasonably compliant and has a support system. 

Plus there’s also a basic-but-robust system of welfare and disability payments that can keep many people’s struggles above the deep dark levels of poverty. Even people who can’t work and are addicts can *sometimes* successfully (independently) pay rent, eat food, and not die — which makes boundaries easier on the hearts of family members when they are needed.

It’s not utopia, and we could certainly do more to actually help addicts in particular — but it’s a lot smoother that the situation discribed by the OP.

Also, everybody’s MRIs are covered, so nobody is too broke from their own medical events to continue to feed and house a needy family member (if they choose to do so). It’s not usually a choice between ‘caring for yourself’ and ‘caring for others’ financially, when dealing with the costs of basic medical care. 

Edited October 10, 2018 by bolt.

[hippiemamato3]

On 10/8/2018 at 11:37 AM, Jenny in Florida said:

 

The daughter has not worked nearly enough to qualify. She did briefly get herself on food stamps, but that seems to have ended.

You don't need a work history to apply for SSI. 

[GoodGrief]

4 hours ago, bolt. said:

It’s not utopia, and we could certainly do more to actually help addicts in particular — but it’s a lot smoother that the situation discribed by the OP.

 

FWIW, the population in our state that has the highest rates of mental illness/addiction/homelessness is the population that has 100% health care coverage from birth.

Re: your previous post, it does get more complex dealing with a ill young adult child as opposed to a minor. The adults have more freedom to make decisions that complicate the situation, and when mental illness is involved those complications are the case more often than not. You do ultimately have to have some boundaries/limits in place.

 

[Pen]

7 hours ago, GoodGrief1 said:

FWIW, the population in our state that has the highest rates of mental illness/addiction/homelessness is the population that has 100% health care coverage from birth.

Re: your previous post, it does get more complex dealing with a ill young adult child as opposed to a minor. The adults have more freedom to make decisions that complicate the situation, and when mental illness is involved those complications are the case more often than not. You do ultimately have to have some boundaries/limits in place.

 

 

What population has 100% health care coverage from birth?

[Jenny in Florida]

I do think it's an interesting thought experiment to consider how things might be different from this family if the daughter were coping with an obvious physical disability. I mentioned it to my friend, who took a few minutes to ponder. Right off the top of her head, she pointed out that, if there were a diagnosed physical issue, her daughter would likely have more and better access to treatment covered by insurance. Her father, who has chosen to more or less wash his hands of her, would also likely be more willing and/or required to provide more financial assistance.

I think the issue is coming to a head now for a couple of reasons. First is that the daughter's issues seem to have worsened significantly since she's become an adult. She began struggling seriously during her senior year of high school; that's when she did her first in-patient stay, and she hasn't really recovered since then. In high school, she was an honor student, first chair in the student orchestra, etc. So, at first, it seemed like she had just hit a rough patch, caused by stress and maybe grieving about her cousin's suicide. I don't think it occurred to my friend as even a remote possibility that it was, actually, the beginning of some kind of "new normal," that instead of hanging on long enough to help her daughter get back on track, she would, in fact, spend three years watching her daughter get worse.

Also, from a strictly practical viewpoint, my friend just plain can't afford to keep up any longer. Three years ago, she was spending down the last of the life insurance her second husband had left her and was in the process of selling their home and buying a smaller one she could afford on her own. She is now just barely (most of the time) keeping up with her basic expenses. And, in the meantime, her own health has become more precarious. 

It is simply not sustainable for her to continue as she has been, but she can't see an alternative.