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Suzanne
Suzanne, Mental Health Professional
Category: Mental Health
Satisfied Customers: 919
Experience:  LCSW, RN. Mental Health, Relationship & Parenting issues.EMDR, Hypnosis.
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My 40-year old step daughter (I will ficticiously call her

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My 40-year old step daughter (I will ficticiously call her Linda) was diagnosed with bipolar with schizophrenic paranoia at age 19, the first time she was hospitalized, while still living with her biological mother. Shortly after she moved in with her father and me. At age 22 she was again hospitalized.Outpatient treatment followed by therapy left her well enough to establish her independent life; i.e. moving to her own apartment and holding a job. She then met and married her husband. He was starting a business at the same time as they had two daughters 18 months apart. Many stressful things happening within a very short period of time, proved too much for Linda. Approx 10 years after the previous episode she was again hospitalized. It took approx 1 year for Linda to recover and function. She has been on disability since then. In the past 8 years she has been taking her medications and regularly seen a psychiatrist and therapist. She functioned fairly normal. She is a great mom, very involved and attentive. The only thing that seemed unusual was her inability to focus on more than one thing at a time. Her husband would have to handle cooking, cleaning and other household chores while she was mothering. This spring she again experienced a few stressful events and in May recognized that she was "in crisis". The day she was sitting on her stoop handing out small pieces of papers with "911" written on them to all the neighbors, we as a family, her father, her husband and I, decided that she again needed to be hospitalized. She agreed to go if I would take her. Since she went in voluntarily she was admitted into the non-acute department. She spent 3 weeks at the clinic and has now completed 6 weeks of full-time outpatient treatment. Next week she will start part-time at Catholic Charities. The family found it odd that we did not see much improvement while she was graduated through the program. When released from the clinic, we decided to have her live with my family to protect her children. My 2 college children have spent the summer driving Linda to and from outpatient care and taking care of the children, while her husband has been running his business. Linda is considered to be extremely intelligent, feels that she is a "pro" when it comes to mental health treatment and talks about "the game" that she likes to play. She knows exactly how to behave and what to say in treatment. I am afraid she has the health care providers fooled, they all think she is well enough to move back home. As a family we are all at our wits end. Her husband, her father, her sister, her brother and myself are all seeing a person we do not know. This is not the woman we all love and cherish. Linda's 10 yr old daughter can only spend short periods of time with her, before she needs to leave, because "mom talks strange". We can all see that Linda seems a little better than she was so it would be natural that health care providers who have known her for such a short period of time would see improvement, but she is nowhere near who she is. We are 5 adults who are on the same page but Linda thinks we are all wrong. She claims that she is well but at the same time defers to being sick when it is convenient. Any conversation is twisted into something completely different or she forgets about it altogether. She is very angry, with her husband and I being the main targets. All we want is to get her back? The health care providers have no interest in our input. The 1/2hr family sessions consist of 20 min on how well she is doing and 10 min where her husband tries to communicate his side. That is quieted down because Linda "doesn't want to talk about that". Linda asked her father; "do you know more than a PHD?". His response "when it comes to my 40-year old daughter, I do". My kids say "this is not our sister". We have all known her so intimately for so long that we are in a much better position than anyone else to determine what is normal. We are all in agreement that this is not the time for her kids to be subjected to her anger and inability to cope, but the summer is coming to an end. My kids are moving on with their lives. I find it increasingly difficult to have her in my home. We've discussed the possibility of getting her an apartment but are afraid to have her living on her own. She forgets about turning off the stove and smokes incessantly. Any input on our options would be greatly appreciated.
P.S. Linda has decided not to inform her biological mother, who lives in a different town, about these events. They have sporadic contact, about twice/year and Linda is convinced that her mother has an undiagnozed bipolar condition.
Submitted: 7 years ago.
Category: Mental Health
Expert:  Suzanne replied 7 years ago.

Thanks for bringing your question to JustAnswer.

Linda is very fortunate to have such a devoted family. I'm glad to hear you are all on the same page, and that there is no divisiveness in the family. You will need to support each other through this difficult period.

It makes me mad that the mental health professionals did not listen to you who know Linda best. Would it be possible to have her evaluated by someone else for a second opinion? If so, putting together a list of the irrational behaviors she's exhibiting can help the new person understand just what is going on. She sounds as if she needs a medication adjustment, at the least.

If that isn't possible, getting her an apartment in an assisted living facility or a place in a group home for adults may be an option. Being on disability makes her eligible for these services, in most areas. A group home will have the advantage of staff on the premises, meals cooked for her, and medications given at the correct times. They will also be in a position to have her hospitalized if her condition deteriorates further.

If this is not possible, check with your local county mental health department, and see if there are ACTT services available. (Assertive Community Treatment Team). This will be a team of MH professionals who are trained to deal with SPMI (Severely and Persistently Mentally ill) clients. They will visit her in the home to check on her safety, provide a 24 hour a day crisis response, and can get her involved in some on-going outpatient treatment, like a day program. If you get her an apartment, it would be wise to also involve an ACTT team or a Community Support Team (similar services as ACTT, but less hours per week).

A day program is less intense than partial hospitalization, but gives the person structure for her day, and they can attend indefinitely. (You can also get information about day programs from the county MH department). Some areas of the country even supply transportation to and from the day program.

Lastly, I don't see any benefit at present for involving her biological mother since they don't have a close relationship.

I hope that this has given you some ideas of the services available for the chronically mentally ill. Please ask if you need more information, or click on ACCEPT if this has been helpful.

I wish you well as you deal with this difficult situation!

Suzanne

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