Bipolar girl's mom needs help

[aunt-b]

I have an 18 year-old niece that has been dealing with bipolar disorder for years. Up to recently, her mother was kept informed about her state by her daughter's doctor. However, now that she's 18 my sister can't talk to her daughter's doctor without her daughter’s consent, and anything she says to the doctor has to be disclosed to the daughter. This has complicated my sister's ability to understand, cope, and help her daughter, who still lives with her mother.

The latest problem she's seeing is that my niece has been skipping her medications so that she can drink alcohol. (She doesn't like the way mixing medications and alcohol makes her feel.) Right now she's in a manic state and my sister is very concerned with her behavior. It has gotten to the point where she thinks her daughter needs to be hospitalized, but she doesn't know her rights about doing so. She's even wondering about whether she can somehow get guardianship. They live in the Cleveland, Ohio area.

I'm asking on my sister's behalf because she doesn't want to discuss this sensitive topic online on her computer at work. I myself am bipolar, but my onset was as an adult, so I can’t help my sister with many of the issues she’s dealing with. What can she do, or where can she go, to get answers about how and whether or not, she can get her daughter hospitalized or acquire guardianship?

 

[Suz]

Welcome to the forum and to our little corner of the board.

I don't know Ohio's laws but if they are anything like PA's, your sister is pretty much sunk. Here in PA at the age of 14, kids can refuse treatment/medications/parental involvement in their mental health treatment. It's ridiculous but it's law.

Please do a signature for yourself. You can find the directions on the FAQ forum. It helps the rest of us remember your story and keep each other straight.

I suspect you can be a great resource for your sis....since you also have BiPolar (BP), if you took yourself back to age 18, what would have worked for you?

Suz

 

[witzend]

Welcome to our little corner of the world! While your sister can't force the healthcare worker to communicate privately with her, she has a huge bargaining chip that she may not recognize. While her daughter is living with her, she can make rules about medication compliance. There are programs out there for her daughter to get low income housing. It's not nearly as comfy as living with mom, but it's an option when mom says "take your medications or move out." I hope your sister will stand up for herself - and for her daughter to make the right decisions.

I hope your sister will come talk to us. Sometimes we're a tough old group, but we earned our scars the hard way.

 

[Suz]

Sometimes we're a tough old group, but we earned our scars the hard way.

Very true. If you've lurked for any length of time you will already know that we tell it like it is...with love...even if it doesn't sound like it sometimes.

Suz

 

[witzend]

Very true. If you've lurked for any length of time you will already know that we tell it like it is...with love...even if it doesn't sound like it sometimes.

Suz

I suppose it never sounds very pretty, does it?

I'm having a rough week myself this week. I hope that I can help. If not, please take me with a grain of salt. I have some insight and mean well. I just plain have some rough edges today.

 

[DammitJanet]

Welcome. I also have bipolar but my onset was childhood even though I didnt know it back then. I also have a son who had childhood onset bipolar.

Suz and Witz are both right in that once a kid hits a certain age, and most certainly 18, things get problematic. I was rather lucky in that my kid always let me in on his psychiatric care. Even now he wants me with him at all his doctor appointments. Actually we are both signed as a people who can share information for HIPAA at doctor's offices. It works both ways...his docs can talk to me and mine can talk to him.

You can tell your sister that while she cant actually force her dtr to get treatment or take medications, she can make that a condition of living at her house. Or a condition of some other luxury...say that cellphone she provides, or computer, or car privilege. There are many goodies that can be used. Carrots so to speak that can be dangled.

 

[Hound dog]

You can tell your sister that while she cant actually force her dtr to get treatment or take medications, she can make that a condition of living at her house. Or a condition of some other luxury...say that cellphone she provides, or computer, or car privilege. There are many goodies that can be used. Carrots so to speak that can be dangled.

Janet has made an excellent point. Many of us have to use this tactic with our grown kids. It's not fun, but it's about all we have.

I live in ohio....waaaaay down at the southern end. I have a daughter with the BiPolar (BP) and borderline dxes. It is not easy when they're unstable.....and of course that's an understatement.

How is Mom's relationship with the girl? Do they get along for the most part? When Nichole turned 18 Nichole had me down on her HIPPA list of approved persons that medical info could be shared with. Because she knew I could be objective about her state of mind and I went along on visits anyway because she'd forget to tell or ask things of the psychiatrist. But despite Nichole's gfgness.....we've always had a very good relationship.

If your neice is unstable enough right now (and periodically not taking her medications to drink can most certainly do that) that Mom is worrying she might need a psychiatric hospital stay.......Well, if she's really worried, she can still call the psychiatrist and let them know what's going on. Once the psychiatrist gets this info, what he/she decides to do with it is up to him. But Mom will know she tried. Of course this could really make her daughter mad......

It's really a good thing your neice doesn't want to mix her medications with alcohol.

When Nichole turned 18 I explained the HIPPA laws to her. I also explained that someone with BiPolar (BP) disorder can not always tell when they're manic or slipping over the edge as well as someone who knows them well and is on the Outside Looking In type thing. psychiatrist also helped Nichole understand her rights as a patient....while backing me up that it's a good idea to have an objective person who can provide input into her condition when it's needed. So Nichole added me to her list.

It hoovers major once a difficult child turns 18. You're hands are tied unless you can get creative enough to come up with a workable solution you can get difficult child to cooperate with.

But I was also lucky enough to know that psychiatrist would've taken any info I'd given her to heart even if I wasn't on that darn HIPPA list.......

I know HIPPA laws are supposed to be a good thing. But personally I've only seen them be a major PITA myself.

Welcome to the board.

((Hugs))

 

[Nomad]

I do wonder if her daughter would consent to signing a waiver at the doctor's office allowing the doctor to speak with the mother. Perhaps as soon as she is in a more stable state of mind, this should be addressed.

It would concern me that she is abusing alcohol and may be heading toward a dependence issue.

What type of physician is the daughter seeing? Is she seeing a therapist? She likely should be seeing a therapist, as well as a doctor for her medication. Are you able to speak with your niece? Sometimes another relative has more influence than a parent.

Your niece should begin formulating a sort of little support group...a "go to" group in her head of persons to seek advice from when she feels hypomanic. This COULD be you and a therapist, FOR EXAMPLE. It very well might NOT be mom. She could use this technique called the "two person feedback rule." This simply means if two folks in her support group (folks she really trusts) tell her something is not good for her, then she has to seriously consider stopping the behavior.

These techniques and others can be taught be a therapist interested in bipolar disorder. Until she sees a therapist who is interested in this disorder...one she trusts...she wont be getting the skills she needs. This, in my humble opinion, might be the best thing mom could do...steer her into the hands of a skill professional...AND by the way, it could be a Mental Health Counselor or a social worker...not necessarily a Ph.D. psychologist

As a side note....of course this person whill emphasize the importance of taking medications daily and discourage (strongly) the use of alcohol.

Also...mom might pay careful attention to see if daughter is abusing alcohol in a major way. I'm not too sure if there is a lot she can do about it, but if this is an issue, AA might be something to consider.


Sending good thoughts...

 

[susiestar]

I agree with those who suggest using things as carrots to dangle in front of difficult child to get the needed behavior.

It is about the only thing you can do.

If she is a danger to herself or others she can be admitted for a 72 hour hold. It is often called Baker Act-ing. That is the law that lets you do this.

This is HARD. I hope it gets easier soon.

 

[katya02]

Welcome! I haven't much to add to what's already been said, except that HIPAA does not require a doctor to tell the patient everything a family member has communicated. This particular doctor must have that policy, but it's not law. You can tell a doctor any concern you have about your relative; but the doctor can't talk back to you, so to speak. It's unfortunate that the doctor isn't willing to accept information from your sister without passing on the content and source to your niece.

I agree that house rules are about the only way to go with an 18 year old, and the parent should be careful drawing them up and be prepared to back them up. Rules unenforced are worse than no rules at all. If your niece appears to be a danger to herself or others, her mother can have her evaluated on an emergency basis. As someone else said, she can be admitted for 72 hours so a more thorough evaluation can be done.

I'm sorry - this is so hard. It's terrible to watch someone you love getting ill. The same laws that give patients greater freedom and autonomy also often prevent them getting needed care in a timely way.

 

[CrazyinVA]

Youv'e gotten some great advice here. The only thing I wanted to add was to suggest your sister find a support group for families of the mentally ill, through NAMI or your county's mental health department. It's very frustrating once our kids turn 18 and they flaunt that "adult card" in our faces, and circling the support wagons around us is more important than ever.