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Discussion

Discussion. As of 7/6/12. Outline. Background What’s happening now The treatment landscape Options Next steps Proposal: Two options (private and public) Preference: Private option Position: Love and support either way Process: Loved one to decide. The Family. Philosophy.

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Discussion

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Presentation Transcript

  1. Discussion As of 7/6/12

  2. Outline • Background • What’s happening now • The treatment landscape • Options • Next steps Proposal: Two options (private and public) Preference: Private option Position: Love and support either way Process: Loved one to decide

  3. The Family

  4. Philosophy • Mind + body = 1, not 2 • Not just biochemistry • Trauma: a huge factor • Interdependence • Open dialogue • Inclusive. Collaborative. • Psych Rehab

  5. Preferred Approaches • Recovery model (EBP) • Recovery = “finding new meaning” • Person-centered, self-defined & directed • Holistic. Based in hope. • Full supports, community-integration • Non-linear, time-unlimited • LT continuum of care • Psychology • Reflective listening, CBT, motivational interviewing, etc. • Listen, Empathize, Accept, Partner (Amador) • Medications • Judicious, minimalist

  6. History • 2003 • Difficulties at Rutgers; withdrawals • DWI in two towns • Drug use in Worchester • Difficulties at Dynamy; withdraws • 2005 • Difficulties at Pratt; withdraws • 2006 • Community college for credits • Re-enters Rutgers; lives at home • 2007 • Difficulties at Rutgers; withdraws • 3/30/07: First psychotic episode • Carrier, Princeton House outpatient • Princeton House inpatient, outpatient • 2008 • Self confesses addictions to amphetamines, marijuana • Second Nature Entrada • Difficulties at WestBridge; terminated • Princeton House inpatient • Pasadena Villa: admission refused

  7. History, 2 • 2009, 2010 • Walmart jobs, etc • D&D • ER visits • Lost while driving • 2011 • DWI • Princeton House detox • Difficulties at New Hope Foundation; withdraws • Discharged to own apartment • Continuing visits to Dr. Steubben

  8. More recently… • 9/17/11: Arrest after episode at Princeton University • Inebriation  Trespass  Outburst at Muslim Students dinner • Arrested, charged with four crimes, including Class 4 bias felony • ALCOHOL • 9/20/11: Call to county crisis center fails • 72 hour evaluation thwarted by Haldol, lack of HIPAA releases • Fuld releases to the street • No referral, no discharge plan, no change in medications • ALCOHOL • 10/1/11: Involuntary commitment to Hampton House • ALCOHOL

  9. …, 2 • 10/18/11: Involuntary commitment overruled • Judge orders release. • 10/20/11: Botched discharge from Hampton House • Released to Mercer County PACT Team… • …without PACT’s knowledge. • 11 days without services • 11/1/11: Admitted to Princeton House Outpatient • Dr. Stanley in charge • False start; leaves when hearing voices • Starts again; deemed “inappropriate for outpatient”

  10. …, 3 • 11/7/11: Enter Princeton House Inpatient (Voluntary) • Doctors want faster meds change; resists proposed meds changes • Dr. Kazi’s compromise accepted: injectable for more time voluntary • 11/11/11: Committed to Princeton House STCF (Involuntary) • Dr. Pahl in charge. Time limited. • Within 48 hours… • Stripped off Zoloft; blasted with Thorazine, Invega, Lithium • No family meeting; rushed decision before Thanksgiving • Dx on discharge: Schizoaffective; GAF = 20. • 11/23/11: Transfer to TPH • Dr. Ghazili in charge (Drake Unit) • Dx upon admission: Bipolar I, GAF: 35

  11. …, 4 • 12/7/11: Leave TPH; Enter Princeton House Outpatient • Dr. Stanley in charge • Lives with parents to support recovery, overcome institutional trauma • January, 2012: ICMS engaged • Patty Crater • 1/26/12: Court appearance: PTI approved. • 40 hours community service; completion of treatment plan • February: Beck Institute engagement begins • 1x per week • March: Step-down to Princeton House IOP

  12. …, 5 • April • Leaves Princeton House • Engages APN Peter Njili at Greater Trenton • Begins weekly at Beck Institute (Dr. Cotterell in charge) • May: Relapses (2 small episodes) • ALCOHOL • 5/24/12: First family participation in Multi-Family Group • 6/10/12: Enter Princeton Hospital ER • Voluntarily. • “Bored” • ALCOHOL

  13. …, 6 • 6/12/12: Failed AAMH admission • “Can’t handle groups” • 6/13/12: Enter Princeton Hospital ER (3 pm) • Massive relapse; 420 ml in 30 minutes; BAC: .38 (Lethal dose: 40) • $: CDs pilfered from home • Botched discharge • Refused for Princeton House inpatient, released at 4 am. BAC ~ .20? • ALCOHOL • 6/17/12: Mother and sister to Singapore for a month.

  14. …, 7 • 6/30/12: Enter Princeton Hospital ER • 150 ml in one hour • $: cash pilfered from father’s wallet • ALCOHOL • 7/1/12: Enter Princeton House Inpatient • 7/17/12: Mother and sister to return from Singapore

  15. What’s happening? • Voices • Constant, loud, denigrating • Depression • Desperate to avoid • Discomfort with groups • Can’t discuss voices (AA) • Can’t discuss deeply personal issues • Anxiety about school • Anxiety about self • Identity • Appearance • Anxiety about life • No cash, no car • Uneasy with ADLs • Highly dependent on others • “Bored” • Understimulated • Underappreciated • Uncertain

  16. The recent crucible… • Police • Arrest; overcharging • Inappropriate release • 5 encounters since September • 72 hr. “crisis” watch (Fuld) • Sedated with Haldol • Released with no plan • Hampton House • Involuntary • 3 unit changes in 18 days • Uncoordinated judicial ruling • Rushed, botched discharge • PACT • Dropped handoff • 11 days without services • Princeton House • OutPx: “Inappropriate for PHP” • InPx: Voluntary  Involuntary • Major meds changes • But only 2 weeks… • TPH • Different diagnosis • Overcrowding, fighting • Psychiatrist assaulted

  17. …, 2 • Princeton House • “Why TPH only 2 weeks?” • PHP, IOP • Greater Trenton • Depressing experience • No psychiatrist contact • Problems in adjusting meds • Beck Institute • Long trips • Inconclusive results? • Legal case • Stressful preparation • Court appearance • Community service • Reporting • Job search • No support • No responses, except… • CVS’s response • 3 ER visits in 2 weeks • Family stress

  18. In the last 10 months…

  19. Result?... • Police encounters • Legal record • Botched transitions • Changing treatments • Harsh medicating • Lack of care continuum • Oscillating moods • No available job • Stigma • Voices • Fears of depression • Anxiety, Doubt • Uncertainty • Unresolved issues • No control • Side effects + Trauma Pain  Despair?

  20. Recently expressed desires • A simple job • Good health and body • Music • Become a Mason • One on one counseling • Live at home • Esoterica

  21. What these need… • Diligence • Consistency • Skills • Achievement • Sobriety • Symptom control

  22. How to get these?... • Reduce the voices… • Medications carefully applied • Therapy mindfully engaged • Arrest the drinking… • Supports firmly established • Temptations avoided (i.e., “Boredom”) • Go at the right pace. • Enhance skills, increase experience • Grow more confidence

  23. Best approach?... • Holistic approach (not just meds) • Full family and team support • Patience, consistency, steadiness, calm • Good resources and methods • Time

  24. A future vision • In 5 years… • Five years sober • Fewer voices • Finishing school with B.A. • Working PT in music store • Member of Masonic lodge • Living in supported housing • Friendship group membership • Wellness training • Sharing with parents • In 10 years… • 10 years sober • No voices • Assistant manager • FT job • Financially more secure • Working to exit SSI/SSD • Significant other • Wellness living • Helping parents

  25. Optimal Tx Plan 1. Hospital 2. Treatment Residential 3. Supported Residential Need (IDDT) SuppEmp/Ed 4. Independent Residential 4. IOP

  26. The Gap Hospital Gap (Integrated Dual Disorder Treatment) 4. Independent Residential

  27. Public System Services Hospital Hospital Local PHP PACT Gap (IDDT) State Hospital Local Supported Housing Local IOP 4. Independent Residential 4. IOP AA/NA

  28. Private Sector Possibilities Clinical Residential Hospital Hospital Hospital Group Residential Farm/Work Residential Apartment-based Community Need (IDDT) 4. Independent Residential 4. IOP

  29. What Private Sector approaches? • Long term residential clinics

  30. … 2 • Private long-term residential therapeutic communities

  31. “Public Option” Hospital Princeton House PHBH PHP PACT Gap (IDDT) TPH SERV Supported Housing PHBH IOP 4. Independent Residential 4. IOP Note: Staying at 50 Balsam Lane not possible

  32. “Private Option” (12-18 months?) Menninger (8 weeks) Hospital Princeton House Austin Riggs (6-8 months) CooperRiis, Spring Lake Ranch, Hundred Acre Homestead, etc. (6-12 months) PHBH PHP PACT Gap (IDDT) SERV Supported Housing Need (IDDT) PHBH IOP 4. Independent Residential 4. IOP

  33. Private Option requirements • 30 days of sobriety • No benzodiazepines • Interviews • Consultations • Documentation • Sizeable prepayments • Travel arrangements • Research and clarification of options • Personal motivation

  34. Future ways ahead • Private Option • PH  Therapeutic Clinic  Therapeutic Community  Transition Residential  Local SuppHous and SuppEmp, etc.  Independent Living • At 50 Balsam Lane, if desirable • Public Option • PH  PHP  IOP  Local SuppHous and SuppEmp, etc.  Independent Living • At Griggs Farm or elsewhere

  35. Next Steps… • Think and talk about this… Take time to decide… • Timing: assure enough to bridge smoothly • “Private option” is time-unlimited • But, likely only available once • What will be its “value”?

  36. To do • ICMS • Mobilize for public option • Supported housing, supported employment resources, day programs • Mobilize psychiatrist • Help integrate private and public options • Facilitate court reporting • Princeton House • Provide bridging to transition • Accommodate preparation requirements of private option • Assist loved one with one-to-one counseling in the decision making • Facilitate loved one’s access to Family Therapist and ICMS worker • Family Therapist • Be available to loved one • Assist in consideration of options • Consult with PH and ICMS • Advise individuals and whole family • Attorney • Facilitate PTI accommodation • Guard client against undue legal actions • Family • Mobilize for private option • Support its loved one • Assist all possible ways • Loved one • Be open minded; talk to others; state preferences • Choose

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