Tag: teen rights

How to help your troubled teen after they turn 18

How to help your troubled teen after they turn 18

Most young people aren’t ready for adulthood by 18 years of age, but your troubled teen is especially unprepared. By 18, their legal status instantly changes to “adult” and they are free to fail at life’s countless tests. Your hands are tied and you can’t keep your son or daughter safe from themselves any more.

Pace yourself for a marathon

Your job as parent is far from over.  Parenting an 18+ year-old will feel the same as when they were 17 years 11 months old.  They’ve been behind their peers for a long time–emotionally or socially or academically. You’ve done everything possible to get them ready for adulthood, but they simply aren’t!  For troubled teens, the teen years last into the mid-20’s or longer. And this is really scary; suicide rates across all age groups are highest for people aged 16-24.  It’s the period of greatest stress, whether the person is suicidal or not.

Many people with disorders aren’t able to take responsibility for themselves until about the age of 30.

Over the past 16 years, I’ve asked this question of people with mental health disorders and addictions, or I’ve asked their parents, siblings, children, or their friends:  “At what age did (you, your loved one, friend) make the conscious choice to take responsibility for treatment?  When did you/they get a stable job, or live on their own, associate with healthy people?  I asked dozens of people. Their answer? Every single one told me they or their loved one didn’t turn things around until they were between the ages of 30 – 33In my experience, you start to see signs of awareness that they need help in the late 20’s, with limited attempts to face their problem.

True story: a co-worker once shared about his bipolar disorder and years of substance abuse.  I would never had guessed that this stable, wise person had had a troubled past.  I asked when he turned his life around; it was 30.  I asked what motivated him.  He said, “I couldn’t avoid it anymore.  I ran out of excuses.  I just hit rock bottom too many times.”

Why does recovery take so long?

  1. Anosognosia “a deficit of self-awareness” caused by mental disorders.  They simply can’t tell they are different from anyone else, so they resist messages that they are.
  2. They get good at coping.  They squeak by, or use others, or depend on parents to rescue them.  They try to delay the inevitable scary thought that there really is something wrong with them.
  3. Their brain or emotional development is slower than normal people.  They may need an extra 10 years to go through the final maturation phase into the adult brain.

Because of their mental disability, a child over 18 needs better life management skills than their ‘normal’ peers because they have so much more to worry about.  Besides the usual adult responsibilities, they need self-discipline and self-monitoring for mental and emotional stability. They need to be continually alert to their states of mind–the same as someone who’s an insulin-dependent diabetic needs to continually check blood sugar.  They need to remember to take meds and stay in therapy.  They need to avoid or limit fun excesses their peers can get away with, e.g. parties with poor snacks and alcohol.  They must stick with a healthy diet, exercise, and investment in supportive friendships.  You know your child, all of this is hard for them!

How much to sacrifice and how much to let go?

Parents have a tendency to rescue their adult son or daughter when a crisis befalls because it’s so hard for the child to recover from set-backs.  But rescuing too much makes them more dependent on the parents (or adult siblings).  On the other hand, pressuring a troubled teen to be an “adult” when they are not ready push them to dependence on others who might make their life worse.  Pressure can motivate them to cope with drugs or alcohol, or take unnecessary risks, or give up.

True story:  I met a couple in their 70’s who’d rescued their troubled 34-year-old daughter her entire life, and faced cutting her off financially because they couldn’t afford it anymore. They were heartbroken to let her go, and painfully afraid she would become homeless or suicidal, and they deeply regretful they unwittingly undermined her capacity for independence.  Don’t let this happen to you.

You must transition away from “parent” to case manager, therapist, and mentor.

  • Case manager – This is the busy work.  You are the one to fill out forms, make appointments, provide transportation, ensure prescriptions are refilled and taken.  Follow-up on calls and emails regarding anything: banking, waivers, police reports, insurance, appointments, etc.
  • Therapist – This is actually easy if you can keep your thoughts to yourself.  You listen.  You acknowledge their feelings without rescuing them or smoothing over issues.  You ask probing questions so you can get data that will help you help them meet their needs.
  • Mentor – Start by building trust.  When they trust you they’ll listen, and when they listen you can teach them all the things they need to know to be independent (like the self-management skills in the paragraph above).  Mentoring also means setting boundaries and expecting better of them.

A major challenge is where they’ll live.

At home:  Can you bear the stress if they live with you? or if they leave your protection?  How do you help them move on?  If your troubled young adult child must live at home full or part-time, adjust your rules and expectations. Rules can include a requirement for ongoing mental health care. Your troubled child of 18 or more becomes your guest who stays at your invitation, or a renter who contributes to the household and follows the landlord’s rules.  On the other hand, you’ll need to step back and respect their privacy and acceptable choices and activities.  This may not be easy with someone 18–this means compromises and letting go of being the parent boss.

In an apartment on their own:  This is the preferred situation, but who will be ultimately responsible for rent and utilities?  Who can pay the deposit, usually the first and last month’s rent?  Should the manager/landlord know about their condition in case there are problems?  Problems include property damage, inappropriate visitors (drug users or sellers, couch-surfers, party animals), neighbor complaints.  In one parent’s case, both the local police and management company were notified and given both parents’ phone numbers.  It helped at first when there were complaints, but as the complaints and calls to the police continued, their child eventually evicted along with the others who camped out there.

With roommates or housemates:  I do not recommend this unless you are willing to move your child repeatedly.  Even if your child is not antagonistic–maybe withdrawn due to depression–it is very stressful for housemates.  Your frequent calls and visits for a check-in will also be stressful to them.  And what about these co-inhabitors?  Are they safe for your child to be around?  Will they victimize your child?

With a boyfriend or girlfriend: the same concerns apply as for housemates.  This living situation is only as stable as the partner.  Some couples stay in a parents’ basement.  This too is only as stable as the partner and the parents.  Consider that these living arrangements are temporary.  Good luck if they have shelter for a year.

In the eyes of the law, you are not responsible for them anymore.

You really aren’t.  In fact, you have the right to banish your 18 year-old from your home and change the locks on the doors.  Parents who do this are usually in fear for their physical and emotional safety–not because they don’t care.  If this describes you, it’s understandable and forgivable if you feel forced into this step.  But know this, things change.  Your adult child will change.  Banishment need not be forever.

At the age of 18, broad institutional supports kick in. (don’t you wish that were sooner?)

  • Once they turn 18, people with mental health problems are protected from discrimination in their job/housing/education by laws that protect all disabled.
  • Insurers are required to provide mental health care on par with all other treatments and services.
  • Adults over 18 are better supported by mental health organizations that offer support groups, referrals to safe housing or job opportunities, social connections with accepting peers, and legal and legislative advocacy.
  • Educational institutions have special departments solely for supporting students with disabilities, and that includes troubled young adults.

This 4 things are what your troubled teen needs to function after 18. They are based on long-term monitoring of 1000’s of others in their 40’s and 50’s with mental health challenges who did well in life:

  1. Ongoing support from family, friends, and institutions

  2. A job or continuing education

  3. Ongoing mental health care

  4. A safe living situation


Adjust your expectations for how quickly they’ll progress.

Parents of any ‘normal’ 18 year old also revise their relationship with them, becoming a mentor and peer rather than a parent.  What’s going to be tricky for you is avoiding a default role as ‘parent’–watch out for this!  What young adult wants their parents telling them how to live their lives (even if you’re right)?  If you want their trust–which you do–dial back your ‘parenting’ and remove the power differential it implies.

Keep up regular communications with your child even if they resist.  Do everything you can to build a and maintain a relationship even if it’s difficult.  If not with you, than with another mature adult who can mentor them.

–Margaret

Please comment.  Your thoughts and experiences help others who read this article.


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Balancing teen rights vs parent rights when the teen has a mental disorder

Balancing teen rights vs parent rights when the teen has a mental disorder

 If you’re a parent of a troubled teen, how much decision-making power should your child have?

How can your teenager possibly make decisions for themselves if they’re brains aren’t functioning normally?  Maybe they hate you, or they say and do crazy things.  You want to guide them with incentives and consequences, but these haven’t worked.  You’re traumatized by their unstable behavior and it affects your thinking.  Perhaps you get stuck in a power struggle, or you give up power because asserting your authority just puts gasoline on their fire.  You know they can make good on serious threats, such as running or causing serious personal or material damage.  Or they may completely fall apart.

Many parents worry because their teen seems to have too many rights for their own good.

Problem – A teen’s statements to treatment providers are completely confidential after age 14.  Privacy is important, and the therapist needs the young person’s trust to help them with therapy, but some information could be shared with parents on a case-by-case, “need to know” basis.  A parent should be able to partner with the therapist, so they can structure interactions at home that support therapeutic goals.  For example, if the teen talks about dangerous activities with a best friend that the parent doesn’t know about, I think the parent could be coached to appropriately reduce contact with this friend or defuse the dangerous influence they have over the teen.  If a therapist can’t reveal this much, can’t they at least tell a parent what to watch for, what to set boundaries on?  How to respond?

Problem – A teenager has the right to refuse medication or therapy at age 14 (in practice, most providers are reluctant to force treatment at any age).  But if their refusal leads to a serious crisis, I know from experience that most parents have no option but calling 911 or using force to keep themselves and others safe.  Yet force undermines the parent-child relationship, and has led to undeserved charges of child abuse.

Problem – A young person can refuse school attendance even when there are consequences, and the parent can be held liable for neglect.  This is of special concern to a parent who risks losing custody to the state or to a vindictive ex.

Problem – A teenager can commit a crime and their parent(s) can lose custody for being negligent.  Sometimes crime is the only way for a young person to get the help they need, but sometimes this means they descend, step-by-step, into a justice system that presumes bad parents create bad kids.

Parents of troubled teens need greater control over their situation and abundant support to prevent loss to the Black Hole of their child’s disability.   The emotional, physical, and financial costs to family members are too high.  If a parent’s authority is undermined when others blame them for their child’s behavior, and an education and health care system focus only on the child’s needs, the parent rights are being trampled.

What about a Parent Bill of Rights?

  1. Parents and families have a right to personal safety including the safety of pets, and the right to protect themselves, their belongings, and personal space.
  2. Parents have a right to ensure and sustain their financial, social, and job stability, even if it means periodically putting aside the teen’s needs.
  3. They have the authority to create house rules based on respect, safety, and shared responsibility.
  4. And they have the right to enforce   and expect them to be followed.
  5. Parents and families members have the right to be human and make mistakes.
  6. Parents and families have the right to take time out for their own wellbeing and self-care.

Teens have rights too, which should be respected

The youth, because of their disability, has a right to make progress at their own pace, and choose their own path of learning.  They also have the right to reasonable family accommodations because of their different needs.  Like any human being, especially one’s child, they have the right to respect and support regardless of inconvenience.  They also have the right to negotiate for what they want, and to expect earnest efforts towards compromise.  The last, and this is very important, they have the right to choose incentives and consequences that work best for them.

You know your teen will reach adulthood and independence whether they are ready or not.  They will do what they want, perhaps suffer serious consequences, and there’s nothing anyone can do about it.  So do something about it now.

Teenagers today want two things.  Allow as much as appropriate:

  1. Freedom
  2. A say in what happens to them

Look at the future from their perspective. Young people in the mental health system face life needs and challenges different from peers. They often don’t reach 18 without experiencing significant setbacks due to their disorders.  They have missed opportunities for the education and life skills needed for adulthood, and lack of youthful achievements that boost confidence and self-esteem. Teens and young adults with disorders may have to manage these the rest of their lives!  Once age 18 is reached, supports they’ve depended on are abruptly dropped.  They are exported to an adult system where they must start from scratch to establish a new support network that will assist them towards an independent life.  Your job is to change from parent to mentor as these new supports are developed.

What are parent responsibilities?

Acceptance:  this is the nature of your child and it’s OK.  They will still be part of the family and get your support.  Your child would function better if they could.

Positive attitude:  yours is not a lost child, there are resources out there to help them, and you really do have the energy to find and use these resources.

Realistic expectations:  brain disorders are termed “disabilities” for a reason.  You cannot expect their lives to unfold like yours did, or even like others their age.  They will redefine what progress means for them.

Support without strings attached:  your teen doesn’t owe you for the life you’ve given them, nor must they pay you back for your extra sacrifices.

Take good care of yourself so you can handle your situation.

Access and use information on the disorder and it’s treatment regime.

Learn and practice an entirely different approach to parenting.

What about youth responsibilities?

My previous post, “Youth with mental disorders demand rights!” presents a document created by members or Youth M.O.V.E (Motivating Others through Voices of Experience), a peer-to-peer organization for teens and young adults http://youthmove.us.  I have a suggestion for M.O.V.E.:  consider developing a youth Responsibilities document.  I believe a majority of troubled young people are capable of being accountable when they have the right support and treatment.

The following list is a good place to look for other ideas.  It was developed by adult mental health consumers (part of this list has been de-emphasized because it does not yet apply to youth).  Everyone, regardless of their medical and mental health situation, should do what they can to take responsibility for their health treatment.

Adult responsibilities that could be applied to youth and young adults:

“In a health care system that protects consumers’ rights, it is reasonable to expect consumers to assume reasonable responsibilities. Greater involvement in their health increases the likelihood of recovery. Responsibilities include:

  1. Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
  2. Become involved in specific health care decisions.
  3. Work collaboratively with health care providers (teachers, parents) in developing and carrying out agreed-upon treatment plans.
  4. Disclose relevant information and clearly communicate wants and needs.
  5. Show respect for other patients and health workers (students, coworkers, neighbors, siblings).
  6. Use the health plan’s internal complaint and appeal processes to address concerns that may arise.
  7. Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
  8. Be aware of a health care provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
  9. Become knowledgeable about your health plan coverage and health plan options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
  10. Make a good-faith effort to meet financial obligations.
  11. Abide by administrative and operational procedures of health plans, health care providers, and Government health benefit programs.
  12. Report wrongdoing and fraud to appropriate resources or legal authorities.”

 


Youth with mental disorders demand rights!

Youth with mental disorders demand rights!

Troubled young people have rights, and a national organization is there to support them. Youth ERA (Mission:  “Youth ERA works to empower young people and create breakthroughs with the dedicated systems that serve them.”)  Youth ERA offers peer support, social and educational support, and advocacy for youth with brain disorders.  The Oregon Chapterin  partnership with Portland State University, wrote a Youth Bill or Rights for teens to young adults between ~16 to mid 20’s.  As you can see in the Rights document below, they believe youth should be allowed to guide their mental health treatment, and receive respectful, humane care.

“YOUTH ERA BILL of RIGHTS  –  We believe that all youth should have the following rights in their mental health care:

1) Youth have the right to be leaders of their psychiatric treatment plans.

Youth should be informed of the possible side effects of medications, how long recommended medications take to go into effect, and the possible long-term effects of recommended medication. Service providers should work with youth to explore possible alternatives to using psychiatric medication before medication is given. Communication between youth and all medical providers should be collaborative, clear, and with limited use of medical terminology.

2) Youth have the right to evaluate their mental health services.

Mental health counselors, social workers, psychologists, and other service providers should provide opportunities for youth to evaluate the satisfaction of their services throughout the duration of care in a respectful and non-threatening manner. This includes evaluation of the relationship with the provider, counseling plans, and implemented treatment models.

3) Youth have rights to services that are as noninvasive as possible.

When youth are transitioning into new services, mental health programs should strive to make the transition as accommodating as possible for the youth. Youth should be consulted on the ways they would like to end their relationship with the current provider and whether they would like the current provider to share their file with their new provider. Providers should share if there will be any changes in the costs of services and/or insurance coverage.

4) Youth have rights to get treatment from trained, sensitive providers.

Youth should have access to mental health professionals that are familiar with the unique needs and challenges of youth with mental health needs. All mental health professionals should have specialized training that fosters positive youth development and support. Youth mental health service consumers should be included in the creation and implementation of these trainings.”

This document was created and signed in 2009 by 30 mental health service-experienced youth gathered in Portland, OR, from the following states: California, Hawaii, Idaho, Illinois, Kentucky, Maine, Massachusetts, Missouri, Michigan, New York, North Carolina, Oregon, Texas, and Washington.

Youth ERA rights are similar to the “Mental Health Consumer Rights” developed by adult mental health consumers, which is appended at the end of this article.

Parents should support these rights

I say “bravo,” these are appropriate and necessary–anyone receiving treatment must be comfortable and safe with care providers, and treated with dignity and respect, period  But I’d like to see something similar for parents and caregivers, too, who also participate in treatment and need to feel respected and heard.

 – – – – – – – – – –

Adults with mental illness had already developed a bill of rights for the same reasons as the youth–to receive sensitive, humane services and participate in all aspects their treatment.

Adult Consumer Bill of Rights – for adults in mental health service systems

  1. Information Disclosure:  Consumers have the right to receive accurate, easily understood information and may require assistance in making informed health care decisions about their health plans, professionals, and facilities.
  2. Choice of Providers and Plans:  Consumers have the right to a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care.
  3. Access to Emergency Services:  Consumers have the right to access emergency health care services when and where the need arises.
  4. Participation in Treatment Decisions:  Consumers have the right and responsibility to fully participate in all decisions related to their health care.
  5. Respect and Nondiscrimination:  Consumers have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality health care system.
  6. Confidentiality of Health Information:  Consumers have the right to communicate with health care providers in confidence and to have the confidentiality of their individually identifiable health care information protected.
  7. Complaints and Appeals:  All consumers have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review.
  8. Consumer Responsibilities:  In a health care system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) established the Consumer Bill of Rights Workgroup to promote and implement the Presidential Advisory Commission’s Consumer Bill of Rights and Responsibilities in health care. http://mentalhealth.samhsa.gov/consumersurvivor/billofrights.asp

 

–Margaret