My response to the psychiatrist

Here's the letter I recently sent to Bear's caseworker. FYI, the attached document was only 1 page long! (That should be super impressive to all of you who know how long-winded I can be!).

I have attached a brief (well, brief for me!) document explaining our reasoning for this “med experiment.” We have the support of Bear’s therapist and really believe this is the best option, but are definitely open to alternatives.

I am hoping you will discuss this again with Dr. M, as we do not want to go forward without his support and the support of ___MHMR. We are doing this now because we feel that Bear is struggling, even with all the supports and services he is receiving (FYI he is currently failing 3 classes). In 9 weeks he is up for review by the ARD (IEP) committee to see if he should be dropped from Special School. He is therefore highly motivated to be cooperative with this experiment – if we start soon. Just continuing with status quo means Bear will be completely unsupported in less than a year when he turns 18, which puts himself and those around him in severe danger. I believe it would be morally wrong to allow this to happen, and we need to do everything we can to address this situation immediately.

Please contact me with any questions or if there is any way I may be of assistance.

Mary

ATTACHED:

Bear plans to stop taking his meds and attending therapy the moment he turns 18 (in less than a year) and move to a rural community. He is in denial about his issues/ diagnoses, and consequently sees no need for his medications (he also thinks eating certain foods and supplements are an adequate substitute). Currently Bear is fairly stable, is very closely supervised at all times, and presents well (his verbal skills mask his low IQ and issues) - therefore he is in danger of losing or not qualifying for many services, particularly after he turns 18. Our main concern is that if/when he stops taking his meds at 18 he will no longer be stable, will have no one to advocate for him to get the services he’ll need, and will be unable to do so himself. Off his meds I believe Bear will again become psychotic, violent and aggressive - posing a serious danger to himself and others.

We propose an experiment to see if we can help Bear, while he still has all of his support systems in place to protect him and those around him. Working closely with his therapist, Special school (program for severely emotionally disturbed youth he attends part-time), his public high school, and of course the ____ MHMR staff, we would like to help Bear taper off his meds so he and everyone can see what he is really like without them, then be right there to quickly get him back on and stable again. We hope to achieve several goals with this experiment:

1. For Bear to realize that he needs his meds so that he will advocate for himself to get them once he reaches “adulthood,” and be motivated to learn how to access services (if this is within his capabilities).
2. To reinforce to Bear that stopping his meds “cold turkey,” and without the supervision of a psychiatrist could make him very sick or possibly be fatal.
3. Bear’s services and meds can be very expensive (meds - $1300/month). We hope to convince him he needs to ask for help to access them, something he has great difficulty (often appears incapable of) doing.
4. Possibly to get Bear involved in the legal system again - We assume that once off his meds Bear’s severe issues will be more clearly revealed (he is already teetering on the edge even with medication). This most likely means his behaviors will quickly denigrate to the point where he will once again be involved in the legal system. The advantages of which could be:
   • Court mandated compliance with taking his meds – I believe under certain circumstances the court can legally require an adult to take medications.
   • Legal guardianship – we are considering pursuing legal guardianship of Bear based on him being a “vulnerable adult” who is incompetent to function independently. This would be easier to prove, if we have evidence of what he is like without meds and the strict supervision we currently provide.

This "experiment" is designed to ensure that Bear’s needs are exposed before it is too late to get him the help he requires - while keeping Bear and everyone around him as safe as possible. Without our intervention, I believe that within a year of Bear turning 18 he will most likely drop out of school (he will be a senior next year), become suicidal and (potentially fatally) aggressive, addicted to drugs/alcohol, and be homeless or incarcerated (assuming he survives). Even if he chooses to try to stay on his meds, he does not currently have the ability to get the services he needs to do so (filling out forms, asking for help, arranging transportation, making and meeting appointments...) while some of these things could be taught, I doubt we could do it in the time we have left - particularly because of his emotional issues (denial of his diagnoses and need for medication, inability to ask for or accept help, difficulties with problem-solving, waiting, being denied, giving up, paranoia, projection...).

I am very open to suggestions and alternatives, but failure to address these concerns in a timely manner would be morally reprehensible and possibly criminally negligent. Whatever path we choose, we will need the full support of all, especially ___MHMR staff. ~Yours in partnership, Mary Themom