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Figuring Out Mental Health Care For Teens In Crisis

Figuring Out Mental Health Care For Teens In Crisis

By Mir Kamin

Got tweens/teens? We’re trying a new advice column here at Alpha Mom to address your questions for the older-kid crowd. We hope you enjoy! And if you have a question to submit, hit me up at alphamomteens[at]gmail[dot]com.

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I received a long, detailed, and pretty heartbreaking request from a fellow mom dealing with two teens with varying mental health issues. Because I am not a professional (and I don’t even play one on the Internet), I cut this down to remove specifics and address the overarching question. She asks:

The question in short form is this… how does a parent go about identifying and selecting appropriate professional mental help for a teenager? (Side note: And why, dear God WHY, is it so freaking hard?)

I am astonished and dismayed at the level of difficulty it is to find quality help. It’s been expensive, frustrating and time consuming. We’ve tried our family doctor, family counseling (both church and secular), peer counseling, marriage counseling, inpatient care, family meetings, etc., etc. Part of the issue is that we live in a rural community with a low population density and high percentage of people with significant issues. The system is overwhelmed, resources are depleted and community ignorance/resistance is rampant.

I know mental health is not a one size fits all kind of thing but how do you make your way through this confusing world?

As anyone who’s been reading me through the years knows, this is a topic near and dear to my heart. A huge part of the answer is already part of your question: The system is overwhelmed, resources are depleted and community ignorance/resistance is rampant. There is a nationwide shortage of mental health providers for children and adolescents (the linked article is from California, but similar articles can be found about every state in the nation). The reasons are complicated—the pay tends to be crummy, insurance companies often don’t want to pay for needed services, state-funded facilities are being closed all over the nation (leaving available/affordable inpatient care at an all-time low), parents who lose a young person to mental illness are arguably more likely to sue providers than when an adult loses the battle, and this is just a very demanding field and not for the faint of heart, etc. There are not enough psychiatrists and psychologists willing to treat minors, not enough facilities, not enough community support. There’s just not enough, period.

That’s the bad news. And you already knew it, so I hope it’s not too awful to hear it again. For whatever it’s worth, I’m sorry.

Here’s the good news: I believe that we are (very slowly) experiencing enough pushback on this lack of services that change is happening. Insurance companies are changing their policies (our HMO provides unlimited counseling with no copay; I guess they finally figured out that’s cheaper than paying for a crisis); schools are receiving increasing training in spotting and supporting families with mental health issues; community agencies are working together to provide resources to families in need (here in Georgia we have something called the Local Interagency Planning Team, where a bunch of different agencies come together and brainstorm support/solutions for community families); some providers in big cities are offering phone/Skype services to families who aren’t local (the Marcus Autism Center in Atlanta comes to mind). Help exists. It’s just a matter of persevering.

So let’s get to the meat of it. You asked: How do you make your way through this confusing world?

Philosophically: You keep going, telling yourself that you are your child’s best advocate and you’ll keep searching for help until you get it. Pragmatically: You work your way up the food chain in every possible direction.

When your child first has an issue, it makes sense to start with their pediatrician and ask for a referral to an appropriate mental health specialist. Ask around, too, to get some recommendations or feedback. This may end up being your first roadblock; in a small or underserved area, you may discover that, for example, there’s only one psychiatrist who sees minors, and maybe they’re not taking new patients or the wait time is months. If that happens, call your insurance company. Explain that your child needs help now and the only covered option doesn’t have a reasonable wait time (or is actually unavailable). They may be able to get you in sooner by calling the office directly, or they may approve an out-of-network provider if you can prove that’s the only reasonable option. Insurance companies have case managers whose only job is to help people in situations where they don’t have reasonable access to the care they need, so don’t feel like you’re being difficult or asking for the moon. Their job is to help you.

When it comes to therapy, you already know there are a ton of options. Psychologist, LCSW, MCSW, “counselor”—there’s lots of different paths to ending up as a talk therapist. Personally, in the case of a serious issue, I’m biased towards psychologists and psychiatrists (but that doesn’t mean there aren’t social workers and clergy and other people who also happen to be really good at their jobs). There’s lots of considerations here: finding someone who specializes in whatever you need, actually getting in to see them, and whether or not they click with your child. I can’t even tell you for sure how many therapists my child had over the years—many of them perfectly capable, I’m sure—who were just not able to reach her in a way that made for progress. And it’s not like you can always figure this out beforehand, either. You just have to make your best guess, try someone for a while, and see how it goes. Keep going until you find someone you trust whom your child likes and trusts. But if you’ve been down this road (sounds like you have) a bunch already, start with phone calls and ask for a meeting interview for you to explain the history and feel out the provider before bringing your child in for an appointment. (I made over 30 phone calls and did five interviews before my daughter started with her current therapist. I not only laid all her issues on the table, I explained her propensity to chew through therapists and looked to see how potential providers reacted to that. It was a huge amount of work and time but they’ve now been together for years and she’s made huge strides. Worth it!)

So you start with the child’s doctor for a referral and look for appropriate specialists. At the same time, gather community support and find your proverbial oxygen mask for yourself. I recommend:
1) Individual therapy for parent(s) dealing with a troubled child.
2) Consult the child’s school (guidance counselor, psychologist, or social worker) about community options in your area like the LIPT I mentioned earlier.
3) Al-Anon was developed as support for the families of problem drinkers, but the philosophy and model can be useful to any family dealing with a member who is out of control (even in a non-addiction sort of way).
4) NAMI (National Alliance on Mental Illness) provides resources, discussion boards, a HelpLine, and local support groups. You may discover (as we did) that your area either doesn’t have a group or claims to have one but it’s been disbanded, but even the online information/connections can be useful.

I wish I could wave a wand and make it easier, faster, and more affordable. I can’t. You’re right that it’s hard, soul-sucking, and expensive. But… that’s parenting, right? If you keep going, keep advocating for your child, hopefully you will find what makes things better for all of you. I think my teen would agree that for about three years, it felt like we were all in hell. We tried a lot of different avenues for help, and some of them—I’m not going to lie—were mistakes. I’ll tell you the same thing I tell her: I always did the best I could with the information and resources I had at the time. My heart was always in the right place, even if my decisions weren’t always the optimal ones. We learn and do better as we move on. Life isn’t perfect now, but it’s much better. She’s better. We’re better. And (as I’m sure you know) progress has been a zig-zag, never linear, and things will be less better again and we’ll deal with it until it’s more better. Perhaps most frustrating, some of that time was spent with perfectly reasonable and useful supports available and my child fighting it all tooth and nail, because it turns out that you cannot force someone to get better if they’re not ready.

So you do what you can do. And you hang on by your fingernails until you feel like you can’t do it anymore… and then you keep doing it. I promise you can do this, and you are not alone.

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Don’t forget that you can submit your own question to alphamomteens[at]gmail[dot]com.

Mir Kamin
About the Author

Mir Kamin

Mir Kamin began writing about her life online over a decade ago, back when she was a divorced mom trying to raise two regular little kids and figure out what she wanted to be when she grew up. Now ...

Mir Kamin began writing about her life online over a decade ago, back when she was a divorced mom trying to raise two regular little kids and figure out what she wanted to be when she grew up. Now her life looks very different than it did back then: Those little kids turned into anything-but-regular teenagers, she is remarried, and somehow she’s become one of those people who talks to her dogs in a high-pitched baby voice. Along the way she’s continued chronicling the everyday at Woulda Coulda Shoulda, plus she’s bringing you daily bargain therapy at Want Not. The good news is that Mir grew up and became a writer and she still really likes hanging out with her kids; the bad news is that her hair is a lot grayer than it used to be.

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Comments

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  • Amy

    I think the most important thing is to keep trying. When I was a teen and going through my own mental health crisis, I selected a psychologist and asked my mom to make an appt for me. She knew him professionally, and (likely correctly) felt uncomfortable setting me up with him even though he specialized in teen mental health.

    So – she did nothing and it was four more years before I got in to see someone. Fortunately, I lived through it but there were days I wasn’t sure I would. So please – everyone – just keep at it.

  • It’s heartbreaking. All of it. And I don’t know if it will help any moms out there, but here’s a part of our story.

    My boy is bipolar. We’ve struggled with doctors and medications for a long time. A lot of it was HIS struggle, more than ours. We didn’t know it, but he turned to marijuana to help, hiding or throwing away his meds. Long story short, he was arrested last winter for trading bipolar meds for other meds. On school property.

    Instead of a treatment facility, we sent him to a government run school/boot camp. It’s not the best choice for everyone, but it was the best choice for our boy. He dropped sixty pounds and came home a responsible adult. No treatment programs. No doctors and talk treatment. Just lots of yelling, exercise, school and discipline. He also got his GED while there, which I thought would never happen.

    Just putting that out there. Sometimes we don’t know all of the options. I wish everyone luck in their journey.

    • P.S. We’d been taking him to a naturopath prior to the arrest, so he was also on quite a few supplements, which he stopped taking. At the school, he was required to take the supplements every day. Made a huge difference, not having to fight him to take helpful supplements, but knowing he would be taking them. Now that he’s home, he’s diligent about taking them. He sees the difference it makes in him after five months of consistency elsewhere. Being there, in a sparse environment, with kids from bad situations, also gave him a new perspective on life. He no longer takes us and his lifestyle for granted.

  • Jan

    Just wanted to throw out another 12-step option in CoDependents Anonymout (www.coda.org). The program is very similar to Al-Anon (I’ve been to both), but the focus is more general.  I’ve met CoDA folks with spouses with mental health issues, families of origin in which there was abuse, even just jobs where forming boundaries are particularly important and difficult (child advocacy social work, for example).

    [In AA, the first step is admitting you are powerless over alcohol.  In CoDA, the first step is admitting we are powerless over others.  The ‘addiction’ being addressed is basically control.]

  • Jenn

    Just a few additions based on my own experience triaging a mysterious possibly mental condition. When you find out there’s a wait-list be sure to put your child on it, then go looking for other options. Sometimes finding the better option can take months. When you do get an offer of an appointment be ready to take it and rearrange your life to fit. And if the doctor calls you back, take her call no matter what you’re doing. She may not be able to call you back for months. She’ll be a pro at asking yes/no questions to give you time to get to a private place.

    (For some reason my browser is not allowing certain punctuation and returns, so this is the start of a new paragraph) We’ve all heard stories about money grubbing insurance companies and agents who will deny everything on the first try. And they are out there, but it’s best to assume you’re not talking to one of those until you know you are. Most agents want to help you and you’ll get further by assuming they do. (new para) If your child needs meds it can really help for them to see a psych who specializes in meds. They’re expensive but worth it. Good luck!!!

  • Kimtoo

    I know it can’t be easy to revisit that time, Mir.  But I want to thank you again for putting your experience out there.  You were so helpful when my 7yo saturated having problems, and my ADD diagnosis came hard on the heels of hers.  I am desperately hoping, and working very hard, to make sure her ADD doesn’t cause her self-esteem issues that I believe led to my teen age depressions. My youngest saw a pediatric neurologist on Tuesday, and she’s now on anti-anxiety meds.  We’re seeing a difference already.
    This stuff isn’t easy, but you have made and continue to make a huge difference in my parenting, and I am grateful.

    • You’ve very kind, Kim. Our family made a conscious decision to keep talking and connect with others rather than feeling ashamed or alone (and oh, how society wants us to feel ashamed and alone!), and I’m so glad we did. It’s been so helpful for all of us, and like anything else, the more you talk about it, the more people you find who say, “Us, too.”

  • Jessica (tc)

    This is something that is a major issue in the United States, and I feel like the biggest first step toward destigmatizing mental health issues is to increase the ability of children and teens to access appropriate and affordable mental health care. My local community opened a facility for children and teens in 2012, and I have been immensely grateful to everyone there who has helped many teens that I know and care about. Even though my husband and I don’t have children, this is something that I gladly give my time and money toward to make sure that it can stay in our community and can maintain the ability to help the kids in this city and the surrounding areas. Teaching children how to take care of their mental health is exactly what we need to have adults who are willing to speak out and take care of their mental health. Why isn’t this common sense yet?

    Mir, your family’s willingness to speak out is an amazingly wonderful gift to so many people. My mother has been dealing with mental health problems since I was a child, and the day she decided to quit being silent and ashamed of her mental illness was a very eye-opening day for me. You are right that our society wants people like my mom to be ashamed enough to sit around by themselves and think about their mental illness as a character flaw or some type of personal defect when it’s really just what it says it is: an illness.

    You rock, and I am glad to have you and your family on the team that is helping to shout to the rooftops about accessible and affordable care and treatment for people dealing with mental health issues. THANK YOU!

  • Great article, Mir. Thanks for all the good information. In my limited experience with the mental health system (my mother was briefly hospitalized due to issues with dementia/Alzheiemer’s) being a strong advocate for the patient is key – especially if what you think might be the best course of action disagrees with what a doctor might think is best.

  • Sandra

    This is appropriate for me right now as we just learned my 14 year old daughter has an eating disorder that evolved into what appears to be anorexia. But, we have Kaiser. Just starting down this road. Ugh.

    • Contact Juggling Jenn (jennatjugglinglife@gmail.com). She has a TON of information about treatment for eating disorders and she wants to share it.  You can also find message her via Facebook (Jennifer Denise Taunton Ouellette). 

      • Great recommendation. Thank you for sharing her!

  • Great advice, Mir! I would only add that you should talk to EVERYONE you know, in order to get the info you might not even know you need.  There were so many times that, by luck, we found out something important concerning how to work the system, simply because someone mentioned it in a casual conversation.

    And TRUST YOUR GUT. If you don’t feel that the therapist is helping, he/she probably isn’t.

  • Andrea

    Mir,
    i am quite certain my daughter isn’t alone in resisting going to see a specialist and I am curious if (and if, then how) you dealt with that. My daughter had seen a neurologist for several years for migraines and since she weaned off the meds for that, it became more evident to me she is most likely ADD/ADHD. Pediatrician is not sure since she holds it together at school (though that seems not uncommon) and my daughter worries about “being different” and is refusing to see someone. It is rough to see her struggling when I know there is, most likely, help for her. It is back to the pediatrician next week so I am starting there and hoping a referral from her will ease her concerns to the point I can get her in to see someone.
    Any insights you can share?

    • Sorry to hear you’re dealing with this, Andrea. I took a very hard line with what we consider needed medical care, and so it became “you can lead a horse to water but you can’t make him drink” up in here—there were (many) visits where she refused to speak or otherwise participate, but she went, because refusing to go to a doctor’s appointment I made meant immediate loss of, well, pretty much everything. “You can sit there and be pissed, but you’re still going” was my mantra for a loooong time. She was also very resistant to several components of her eventual diagnoses and my strategy was always to just shrug and say, “Until we have different information, we operate from this.” FWIW she gave us all manner of resistance to trying ADHD meds and now says she thinks they changed her life. Sometimes the unknown is just really scary for them, especially if they feel out of control already.

      Another strategy, especially with therapy, is to say it’s for the whole family (or both of you) to help everyone feel happier. Sometimes teens are astonished to sit in a therapy session where they’re sure the parent is going to say how awful and bad they are and instead hear that the parent just really loves them to pieces and is worried they’re not happy. BTDT.

      • Andrea

        Thanks for the insight, Mir. I think we’re heading where you went. I do think there is a very real possibility that meds will work since the meds used for her migraines treated many of the symptoms we’re seeing now.

        Thanks again for taking the time and more importantly, sharing your experiences!

        • Fingers crossed for a happier update from you soon, Andrea. 🙂

    • {sue}

      My son has been extremely hard to get to go to therapy. A few times he was told he couldn’t come back to school until he did. (And just because he went doesn’t mean he opened his mouth and cooperated in any way.) We got him to go to the most recent therapist by cutting off every little thing. Phone, internet, all money, rides anywhere. He couldn’t get a haircut or go to the dermatologist or even get french fries at McDonalds with his friends until he went. (And the therapist said, “Give me 3 appointments and then we’ll reassess.)

      Another strategy a few doctors and therapists have suggested is paying them to go. (My son wasn’t really motivated by money, but that might work for some kids.) Or each visit provides a contribution to something they want to work for (laptop or whatever). It sounds crazy, but getting him to therapy was critical.

  • Meri

    Andrea, that describes me as a teen. The ADD wasn’t a problem until grad school, somehow I managed to make it through college without really knowing how to study. Sleep deprivation helps me focus, I still prefer that to meds and I’m now in my late 30s. Can’t do caffeine because migraines.

    I did take ADD meds at the end of grad school for 2 months when I couldn’t sit down long enough to write a paragraph. It was clear to me at that point that the meds were worth the side effects for the limited duration I needed to finish my thesis.

    Both of my sisters started ADD meds in high school, had them dramatically change their lives, and no longer need them. They learned compensatory habits, etc., that they use instead. I’m amazed, one of them had a really severe case.

    It doesn’t have to be forever, is what I’m saying. Only as long as it’s a useful tool.

  • BA

    Thank you for this post. It has been so hard for me to find help for my 9 year old son. We tried everyone ok our insurance & IF we even got a call back they didn’t take kids. We tried community resources where he ended up being put on a waiting list & never got called back. We were lucky enough to find a wonderful therapist who was willing to see him for what our copay would have been if he took our insurance & it’s $40 a visit. Still kind of pricey since he goes once a week but obviously worth it. It makes me sick how hard it is to find help & thank God he is not suicidal. But what if he was & im sure there are many kids out there that are. It shouldn’t be that hard but it really, really is!! You would think there would be more compassion in that community especially because it’s obvious if we can help him learn how to deal with his anxiety & depression at an early age it will be easier for him to deal with it when he is older. So good luck to all the parents out there trying to find help & keep persevering. Eventually someone will help & hopefully it’s well before it’s too late.

  • skubitwo

    with whatever else you try, join NAMI and sign up for their email alerts on political action. they are a great resource and their family to family classes are wonderful, but they are fighting the legal fights to get help.
    i recently attended training with NAMI and visited with a woman from my town. everyone’s story is different, but NAMI fights for anyone with mental illness. What follows are things I didn’t know because my kid is schizophrenic – easy by comparison.
    did you know many states do not consider Borderline Personality Disorder a valid mental illness? Insurance doesn’t have to cover it. Did you know in many states if your kid is diagnosed during the K-12 years, to get treatment the school district must contribute to their treatment? so, even if your BPD teen attempted to knife you, the school district will say things to avoid supporting that diagnosis (she didn’t mean to threaten you, just high spirits) because they don’t have the money to provide support and don’t want the liability. did you know your teen can’t visit the adult treatments for BPD because they are a teen? as a result, in many states, the best treatment for your teen or legal young adult is quite literally to encourage them to stab you and be incarcerated, where they will be treated.
    NAMI is fighting to change that sort of stupidity, excuse my french, along with getting research and treatment to be considered.
    sorry for the speech. it’s just one of the few times i could say wow, so much easier to have a kid with schizophrenia since it gets more money for treatment, comparatively, and people really believe it’s a problem.
    sigh.