( or WHY DOCTORS WOULD MAKE TERRIBLE SOCIAL WORKERS)
So, you already know how my morning yesterday ended. Then I had to go to me 'day job' and try to function. Then I came home and started this post... but couldn't stay awake long enough to finish it! So, after 12 hours of sleep - here's the back story!
Here's Deirdre's story - 17 yr old girl, born to a prostitute and her pimp - neglected for 2 years before she was removed from their care and adopted. Adopted father abused her - physically and sexually - for about 5 years. At 12 years old she and a friend decide to get back at the boy who just dumped her friend by toilet papering his house - then lighting fire to the toilet paper. She was arrested and sent to a Residential Treatment Center. Adoptive parents effectively abandoned her - at one point she went 19 months without a phone call, visitor, or leaving the campus except for school. Deirdre is generally compliant at the RTC. She does have a history of Major Depression and is a 'cutter' when she gets overwhelmed. At the end of her probation time she is sent to a transitional living center while her PO attempts to have her emancipated due to the lack of involvement from her adoptive parents.
At this time, Deirdre had been dating her boyfriend Nick, who she met at school, for a little over a year. She has gotten to know his family well - they generally pick her up and she is allowed to stay at their home for weekends and holidays. The emancipation falls through and the PO needs to find a suitable guardian or Deirdre will have to return to her adoptive parents. Nick's parents step forward and are willing to take Deirdre into their home. The first two months are fine - your typical honeymoon period. But about two weeks ago, Deirdre began to seem more depressed. She was more irritable and moody - she felt her medications were not working so she doesn't take them regularly. Unknown to her guardians (Jan and Steve), she starts smoking pot and drinking. Nick knows and tries to handle getting her to quit on his own.
Last night, two boys from Dierdre's school came by to hang out. They were hanging out in the backyard having a bonfire. Both Jan and her husband were home. Dierdre came through the house and asked if she could go down the street to house of one of her friends. Jan says this is fine. An hour or so later, she hasn't returned so Jan tells Nick to go get Dierdre and tell her to come home.
When Nick walks into the friend's place, he finds Dierdre drunk and groggy - can't even stand up. He tries to get her to stand up and come home but she's too out of it and the 'friends' keep telling him that they want her to stay. He runs home and comes back with his older brothers and his dad. They break up the ''party" - which obviously could have ended much worse - and got Dierdre home. This is when she confesses that she took 10 of her prescription migraine medication. Guardians both get upset, Nick leaves with his mom to go to a relatives home because he is so upset. During this time, Dierdre goes to the bathroom and cuts herself on her arm. Dad finds her a few minutes later and, being an EMT, bandages her up and calls Jan to come back and take her to the hospital.
They get to the hospital at midnight. For 4 hours only the nurses see them - Dierdre's cut isn't bad enough for stitches but they say they may glue it in some places. At 3:30 they call me and I arrive at 4:30 am. Doctor still hasn't even stopped by her room. Jan had to leave about 15 minutes before I got there because she has to go to work - Nick stays with Dierdre. I come in and begin my assessment.
Dierdre is fairly open and to the point - she has been through this before. She answers my questions before I even ask them sometimes. She isn't being smart - she just knows whats going on. She admits that she has feeling progressively more depressed for a little over a week. She explains that she isn't going to school because she has already taken all the classes before - she only really needs one of them to graduate. So, she skips all the others. She also tells me that she wasn't the only one to take her medication - she and both friends took it to see if it would make them high. She says that when she got home and realized all that she had done and how it had effected everyone else in the family - she got completely overwhelmed. "I didn't know what to do, I felt awful, and I just needed to cut myself", were her exact words to me. I asked her if she wanted to kill herself, she responded "no". I asked her if she still felt like cutting, she told me that usually after she cut she didn't feel the need for at least a couple of days. I asked her how long it had been since she'd last cut herself. She told me about 2 months, since right after she came to live with the family. I asked her what she thought she needed now. "Counseling" she said, "I have been needing it for a while, I just didn't want it anymore." I ask her if she thinks that she should go to the hospital, "No, Its never helped me before, I don't think its gonna help me now." Fair enough.
I call Jan and talk to her for 45 minutes - she was initially somewhat angry and defensive. But she calmed down pretty quickly and explained that all of this was very overwhelming for her. She has family experience with substance abuse issues and mental illness. She is the mother of 6 children - Nick is the youngest. All of her children have grown up and been well adjusted. She says that she was trying to get Deirdre to commit to attending counseling. She knew that things were going downhill - but didn't know how quickly they'd hit rock bottom. She said that since she'd been home that morning she'd thrown all of the alcohol out of the house and locked up her medications. She'd also called Dierdre's old counselor and discussed what had happened.
We decided that we would only hospitalize Dierdre if it could be at the one adolescent psych unit in town. If that one is full we have to send kids and adolescents over an hour away to get to the nearest psych hospital. We both felt that being that far away from the family, who wouldn't be able to get there very often, would mitigate any good that going to the hospital would do for her. I called the hospital in town - no beds available. I knew that was likely to be the case... on to plan B.
We both agreed that if Deirdre was saying that she wanted counseling now, it would be better to get her into our 'hospital deflection' program - which would mean a therapist coming out to the home 2-3 times a week and being able to work with the school and family. Jan was most concerned that Deirdre not feel like she was being 'sent away' or 'abandoned' by the family.
My other main concern was that Deirdre is going to be 18 in less than three months. In my mind, that means we (as in, her family and the mental health system) only have 3 months to prepare her to be an adult. Because a kid with Deirdre's history is at high risk of not managing her mental health issues. Also, because of her lack of appropriate attachments, that she will think she can "take care of herself" and won't handle anyone telling her what to do very well. So, we need to get her involved and invested in therapy AND get her feeling more secure with this family - all in the next 3 months. We are already racing the clock - Deirdre spending 2-3 weeks in the psych hospital is not likely to help.
I go out and talk the Doctor (who at this point still hasn't even met her) and let him know that we've decided that she should not be hospitalized. He looked at me like I was crazy so, I explained our rationale. He told me he didn't believe a word Deirdre was saying. He was completely sure that she was making a suicide attempt by taking the migraine med. I told him that she said she was attempting to get high. His response? "You can't get high on that med." Ummm - she's a teenager, she doesn't know that! I even told him that the other two kids that she was with took them as well - he still doesn't believe it.
Then he starts going on and on about the cuts on her arm. Yes, I tell him, I understand that she cut herself. But there is a big difference between self-mutilation and attempting suicide. He tells me that he doesn't believe that, and that if she went to the extent of actually cutting herself to 'get attention' (again, see this) than she needs to be hospitalized. I explain to him that the guardian has the final say about hospitalization (as far as we are concerned). And I again try to tell him that the guardian and I have agreed to a safety plan.
He says that because the guardian "didn't even bother sticking around" that he doesn't believe that they are really invested. I explained that Jan is the only person currently employed - her husband is working on an as needed basis - and that she is afraid she will lose her job if she didn't go today. I also explained that, when I talked to Jan, she had told me her husband was getting off work in an hour and would come to the hospital to pick Deirdre and Nick up. The husband would be home for the rest of the week to supervise Dierdre, as would her older son. Jan also has two relatives that live in the same neighborhood that were willing to help out so that Deirdre would never be unsupervised. Doctor decided it was a better plan to CALL DCFS AND REPORT THEM FOR NEGLECT. No, seriously. He actually did it.
Thank goodness whoever picked up the hotline had some sense. They told him exactly what I did - they have a care plan, they are the guardians, they can refuse to have their child hospitalized. Doctor is still not convinced. After almost 4 hours, multiple telephone calls between me and my supervisor, me and Jan, and the nurse and the doctor - who by this point had ENDED HIS SHIFT AND LEFT THE BUILDING without ever even meeting Deirdre - the Doctor finally decided that he wanted their in-house social worker/psych person to come down, evaluate Dierdre, and talk to Jan to come up with a safety plan before he would agree to release her. By this point all I could think was, "Seriously Doc - WHY DID YOU EVEN CALL ME OUT HERE???"
It took the hospital social work/psych person all of 15 minutes to talk to me, talk to Jan, who by this time had come back to the hospital and risked losing the only steady income for her family, talk to Dierdre, and decide that Deirdre did not need to be hospitalized and the safety plan we'd come up with 4 hours ago was completely sufficient.
To which all I could think was, "THIS IS WHY DOCTORS WOULD MAKE TERRIBLE SOCIAL WORKERS".
THE END - oh no, wait! NOT the end! Because I had to go work for 9 hours after all of that nonsense! GRRRRRR!