Monday, June 2, 2008

Following up on some stories

One of the nice things about this blog is that, even though I have removed the identifiers and changed the names, the stories that I am sharing here are real.  My patients and their families continue to grow and develop, and their mental illness/developmental statement;  these folks are living the changes that we are trying to implement, and the stories don't end at the points at which I choose to stop writing.

Last year, I wrote an op-ed about Misha, a 17 year-old girl whose mental health problems had ben ignored long enough to get her into juvenile detention, and whose insurance was going to force her to change providers when she left state custody.   When she left State custody at 17 and 11/12ths years of age, she was in the care of a psychiatrist, a counselor and a home-based service, on appropriate and reasonable doses of medication and headed back to school.
She came in to see me last month, even though, at 18, she should be transitioning to adult care.  She and her parents are still in conflict- she fired the "mental health team" after a couple of months, she has not completed school, and has worked in a minimum wage job since then.  She's now in the black hole of transition:  legally an adult, legally not in treatment, with a mental illness that may come back to trouble her in the future and perhaps able to make productive decisions regarding her future.  Still, she is currently optimistic, and we agreed to keep in touch as she goes forth into the adult world.
All childhoods must come to an end, and those colored by mental illness are no exception.  One of our hopes is that the new system under Rosie D and SB 2518 spend some time ensuring that all of the work we put into assuring care for children is not creating a new generation of adults with needs that we cannot address.

Ruel K is a young man whose family wrestled with the system back in the fall (see here and here)  He was last seen going into specialized day care, and planning to see a psychiatrist.  
He and his grandparents (now adoptive parents) were in the other day for a check up.  Things are going OK with the psychiatrist and counselor, he is on some medications that help somewhat, although his is still a high maintainence sort of life.  His mother was recently hospitalized for her mental illness and the family is currently looking to get him into preschool or Headstart in the near future.  Despite his oppositionality, his only diagnosis at present is ADHD;  I really think that his true diagnosis will come out over time.
Mental illness is often a family affair;  focusing on the child is essential, but it is not unusual for parents to have significant mental illness as well, and for that illness to affect the care of the child.  And, with kids, diagnosis is an evolutionary process that does not mesh well with DMH's procedures.

One more kid that I want to write about-  I'll back back later.

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