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.

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