Monday, December 14, 2009

From dual diagnosis to partial hospitalization to...

It turned out that the second dual-diagnostic unit, at a facility specializing in substance abuse, was a "high point" in our story, even though they were more restrictive about visitation. Our son's case supervisor, Rose, who we never got to meet personally, was a caring, patient individual who spent as much time as we needed on the phone, advising us on what to expect and how to advocate for our son. We were allowed a visit with our son in the presence of another case supervisor (Michael), who clearly knew the background of our son's case and facilitated a conversation about how we could secure the best future for our son. I can't thank these people enough; Rose has been a valuable resource even after Greg left their care.

The "plan" was to move our son into a residential facility; e.g., a group home. He seemed to be looking forward to that, inasmuch as it represented a path to less restrictive setting and eventual employment.

Unfortunately, the insurance company seemed to have different ideas; the result was a move to a "partial hospitalization" program in a facility much further away from our home. In this program, our son receives therapy for six hours a day, and lives in housing on the hospital campus the rest of the day. He is able to sign himself out of the facility at will; in fact, he was required to do so, because he medication was prescribed by the facility but he was responsible for having it filled at a local pharmacy, even though he had been transferred there without his wallet, which had been taken from him much earlier in the custody chain. Fortunately, the pharmacy accommodated him until we were able to deliver his wallet, and even give him a ride to fill the prescription.

The "ride" was our first opportunity to spend unsupervised time with our son since he was arrested and subjected to the emergency evaluation. In a way, it was disappointing: he seemed very "down" on himself and unwilling to accept the diagnosis. But I think we were able to communicate to him how much we care, and much we don't blame him (any more) for our past crises.

Our major frustration with the current facility is that they seem to be insisting that our son be the point person in arranging the next stage of his own care, and, frankly, we don't think he's up to it. He's never been well-organized in arranging such things (after all, he has a thought disorder), and his communication skills are also lacking. He has been emphasizing his (history of) substance abuse as his dominant problem, mainly, we think, because it enables him to ignore his other diagnosis.

We were recently informed (by our son) that his insurance coverage for his current facility will lapse on December 22nd, before we have had any chance to discuss what the next stage of his treatment should be. We're reluctant to bring him back home without substantial support services (which we haven't been able to line up, yet). We have an appointment to talk with him and his case supervisor in a couple of days (almost a week after he arrived at this facility); we're hoping we can establish a plan for well-supervised care when and if he comes home with us.

Wednesday, December 02, 2009

Moving from dual diagnosis to... dual diagnosis

Our son is being moved today from a dual-diagnostic unit in a psychiatric hospital to a dual-diagnostic unit in a facility that specializes in substance abuse (which we do not think is our son's primary problem), but which offers relaxed levels of care that we can hope he will move into sooner rather than later.

All I know is that the rules will change for us; stay tuned...

Tuesday, December 01, 2009

Early stages of treatment

Where are we, and how did we get here?

As I have mentioned, my son was thrown out of two colleges, moved into (and lost) an apartment, and moved in with us. In late September, he was fired from a job at a local fast-food restaurant, and on that evening he got horribly drunk (on nearly a fifth of bourbon) and became belligerent. We eventually called the police, who placed him in protective custody for the night.

His behavior deteriorated since then: more episodes of talking to himself, often in our presence, and not interruptible. An increasing reluctance to go out of the house and be seen in public.

A couple of weeks ago, he found another reason to get drunk again (not a common occurrence), became belligerent again, and again we called the police. This time he (apparently) took a swing at a cop, and instead of protective custody, he was under arrest.

On the advice of court officers, I filed a request for evaluation for substance abuse problems (for which he has a history). It turned out that he was "pink slipped": sent to a local emergency room for a psych evaluation by a local mental health agency. Their findings (unknown to me at this time) resulted in sending him to a psychiatric hospital's "Adult dual diagnosis" unit. "Dual diagnosis" alludes to a combination of substance abuse and additional psychiatric problems; not unreasonable in my son's case.

The doctor's at the hospital applied the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, version 4), and reached a diagnosis of schizophrenia. We were shocked and in denial at the diagnosis, but when we read the diagnostic criteria, we recognized our son in 12 out of 12 criteria.

Our son was prescribed Zyprexa, one of the second generation "atypical anti-psychotic" drugs. He resisted the treatment at first, and has continued to deny that he has a condition that requires treatment, but he has markedly improved. His speech is clearer, he makes eye contact in conversations, and he will acknowledge that the treatment seems to helping, even while denying that he has a condition that requires help.

He will probably have to move out of the dual diagnosis unit (since, thankfully, he doesn't have an active substance abuse problem), but we're on pins and needles wondering where they will decide he belongs next. We don't think he should come home yet; the issues that triggered his belligerence here twice have not been resolved. And he doesn't freely acknowledge that he has a condition that requires continued treatment. But what will be proposed?