Opioid abuse is not like other problems. With very little use, pain meds and heroin can quickly become an addiction. This addiction has unusual drug dealers. Some are intentional (Big Pharma like Purdue Pharma, Cephalon, Janssen Pharmaceuticals, Endo Health Solutions and Actavis) that exploit our pain and desperation. Other’s are likely well-meaning like primary care doctors most of whom are manipulated by the pharmaceutical companies to write prescriptions.
If you or a loved one is prescribed pain meds, take this seriously. Use as little as possible and work closely with your doctor. If you can’t stop, get help immediately. The longer someone abuses opioids, the harder it is to get back on track.
Most of the students with whom I work have depression, anxiety and mild substance abuse. One of the easiest, cheapest and most effective tools for combating these struggles in college is detailed planning. Below, I’ve outlined the Top 5 things I tell every student to implement as they are showing up for Fall semester.
- Syllabi Dates. Encourage your college student to plug-in all dates into their calendar from the syllabi they receive over the coming days. Once all the test dates are put in, reverse engineer two weeks prior to the test dates and put study dates into the calendar for no longer than 90 minute chunks. If it’s not scheduled, it will get pushed off till the last minute.
- Professor Office Hours. Everyone will want to meet with professors the Thursday and Friday before Thanksgiving. Have your above-average college student pull their professor’s office hours from the syllabus (yes, all professors put office hours on there) and plug into the calendar.
- Download Your University’s Academic Calendar. In June, I downloaded the Indiana University’s academic calendar for Fall 2016. It is a small file from Indiana University’s Academic page for any student or parent to view or download. Once downloaded, your college student can upload it into their calendar. Now, they’ll know Add/Drop dates, Fall Break, Winter Break, Finals, etc.
- Don’t Talk Every Day. Plan to talk 2x/week – (eg. Wednesdays and Saturdays). It’s time to intentionally create more autonomy, build trust, and not feel like you need to hover over them.
- Set up Counseling Early. Counselors and mental health providers get slammed since there are so few of us in most college towns. There are even fewer psychiatrists for medication management. Start looking for a counselor/therapist now before the semester gets in full swing. Psychiatrists are often scheduled out 2-3 months.
Good luck and please reach out for more suggestions and strategies to mitigate the challenges your college student is facing with depress, anxiety or substance abuse. Don’t go it alone.
For years I have listened to parents’ tales of wasted time and money as they shifted from one therapist to another, one residential treatment program to another without experiencing the progress they anticipated. What parents don’t know costs them big time. Tens of thousands of dollars in expensive, non-evidence based treatments along with countless hours searching generic databases that don’t really help someone understand the differences in care and how to tell good interventions from bad.
Yes, this happens to be one of the services Fonthill Counseling provides but even if you do not use us, take these suggestions to heart. We offer a free consultation and will help you determine if higher level of care like residential treatment is even a good fit for your struggling teen or young adult child.
1. Professional Advisement
Chances are, if you’ve ever bought a house or had surgery, you consulted with a professional within the respective industry. So what do parents think when they start their online searching for treatment options? Do they honestly think they know how to determine the quality, effectiveness and safety of a program from reading through a website or spending 10 min on the phone with an ‘admissions counselor?’ There is WAY more to choosing any sort of therapeutic intervention than the list your insurance provides or what you find on Psychology Today.
A high quality professional advisor (aka Educational Consultant or Therapeutic Placement Consultant) will know if insurance will cover expenses AND (…and this is the important part) how to actually GET insurance to pay. They know when a kid is appropriate to remain at home and start/continue with outpatient therapy and when they are no longer appropriate for home and need a higher level of care. They will also know the positives and negatives of programs that are clinically, financially and logistically the best fit for your loved one. One program we worked with for years had lots of staff turnover which resulted in 2 suicides in close succession. We no longer refer to them. Guess what? That program does not advertise about the suicides.
Even if you are just doing preliminary search to see what might be available for your acting out son or daughter, whether you’re thinking about therapeutic boarding school, residential treatment for substance abuse or an eating disorder, or you’re looking for a treatment program for depression or anxiety, find a professional.
WARNING! Stay away from any ‘professional’ that is offering advice for residential treatment, therapeutic boarding school or a therapeutic wilderness program but does not have any clinical credentials. Look for professionals that have at least a master’s degree in counseling, psychology, social work or marriage and family therapy. Also, and this is REALLY important, make sure they are licensed in some clinical field (Licensed Professional Counselor, Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, etc.). Many, many professionals are providing advice without really having a formal, clinical background.
Every parent asking us for help starts out by saying their highest priority is ‘quality’ or ‘effectiveness.’ But once we start drilling down into details, reality mandates compromise. One of the biggest realities is cost. Cost matters… and it should. It’s not healthy, and certainly not necessary, for parents to think it’s appropriate to spend any amount to fix a problem. Residential treatment can cost between $400 per day up to $80,000 per month. Insane. What many parents don’t realize is the ‘retail price’ quoted by a treatment program admission counselor (…price is almost never posted on their website) is often not set in stone.
Let me explain. If a parent calls Fonthill Counseling and needs to find an eating disorder program in the mid-West for their college-aged daughter, it’s likely we’ll contact Timberline Knolls (pretty good program located in Illinois). If the parent calls Timberline directly, they’ll get a daily or monthly rate quoted to them with a minimum length of stay. Now, if Fonthill Counseling calls, we can negotiate a lower rate along with other accommodations (ie. single vs double room, admission date, etc.). Most programs also have ‘scholarships’ or supportive funding they can tap when their numbers are low. They’d rather have full client roster but less income per person rather than few clients and even less income since their overhead costs do not change much based on census.
But now we have to back up a bit and talk about insurance. Bottomline – insurance does NOT want to pay for residential treatment. Ever. It’s vital that if you think your son or daughter needs a higher level of care, you have your professional get a) a psychological evaluation conducted and b) preauthorization. Here is a link to more details on getting insurance to pay for treatment. If you do not submit that to insurance or if the residential treatment program fails to submit it (and they are in-network) your chances of having insurance cover treatment is very, very, very low. If your insurance covers medical inpatient and residential treatment, they are required by law to pay for mental health residential treatment. Insurance companies will argue with you on this but its the law.
Unless the client is very motivated to participate in treatment, we recommend having your professional find a transport service to transition from home to treatment. These are not thugs in black shirts that throw a bag over your kid’s head and drag them to a running van. These are often well-trained professionals using counseling skills that create enough rapport and trust to get your kid to voluntarily get into the car. Like any service, there are sketchy people trying to make a quick dime and true professionals with exceptional interpersonal skills (we’ve used Right Direction Crisis Intervention many times with great success). Insurance will never cover this but definitely worth the cost.
Why not have parents escort their own kid? Unless you have great rapport and the issues leading them to treatment have nothing to do with trust issues, running away, drugs or medically complicated issues, parents do not have the clinical skills in supporting kids during a powerless experience like transitioning from home to residential treatment.
4. Quality Control
At Fonthill, we call this ‘oversight.’ Hiring a team like Fonthill ensures through regular email, phone and treatment team meetings their is unbiased, third party oversight over the treatment plan, therapy and communication at the residential treatment program. Most of the time, we are talking with the therapist and interpreting their clinical impressions back to the parents. Since parents are not clinicians, the terms and progress may not make sense but to us, we can sift through and quickly understand how things are going. Residential programs also treat clients with greater attention to detail than those without the same oversight.
How do you know when your child is ready to leave? When can you trust the treatment program is being honest about progress? What should be set up at home, in the community or back at college to ensure your money was not wasted when they transition back to real life? In our humble opinion, the first day of intake should be the first day of discharge planning. We ensure the residential treatment program has a measurable treatment plan with clearly identifiable goals.
As we get close to discharge, as the professionals circle up and agree that he or she is ready to return home or back to campus, Fonthill Counseling will often link with a therapist, psychiatrist and case manager and make sure all appointments and documentation is set up way before. This is sometimes called aftercare, community-based living, or step-down. The final discharge meeting should just be a big hug-fest since all the prep work has already been done.
We like to have the first therapy session take place within 24 hrs of discharge. First medication management appointment should be within the first 72 hrs. Case management continues to provide that oversight and continuity, making sure the treatment plan from residential treatment is modified and extended into real life. Typically, we are providing parenting support, on-call support if something goes wrong, and linking with school personnel to help the kid get back on track.
Finding residential treatment is much larger a task than what folks realize but with a little support from a professional, you can avoid wasting resources that would be better spent on your family.
Virginia Senator Creigh Deeds was Stabbed by his 24 year old son Austin (Gus) Deeds who then killed himself with a shotgun at their rural home just West of Charlottesville, Va.. Austin Deeds had just been ‘psychologically’ evaluated just hours before at Bath Community Hospital under an Emergency Custody Order (ECO). The ECO is only good for 4 hours with a possible 2 hour extension if ordered by the magistrate. Hospital staff stated, working within the maximum 4 hour window, they were unable to find a treatment facility to address Austin Deeds’ psychiatric needs despite several hospitals reporting they did in fact have availability.
Here is some analysis/questions from someone (me) that’s been in this profession for years. I also provide some ideas of solutions if you know of someone struggling with a similar situation:
1. Diagnoses: If the hospital was looking for a treatment facility this means that something the evaluator found indicated Austin was either a threat to himself or others or needed a a level of medical intervention not available at the current hospital. I’m also thinking about the type of evaluation that was conducted and why it was even done at BCH, what the evaluator’s credentials are, and how it was reviewed with Austin and his family.
2. Discharge: If there were no options (which there clearly were), I wonder if and how the hospital communicated their findings from the evaluation as well as their concerns about safety to the parents and authorities. I’m also wondering what kind of discharge meeting took place. When a client is stepping down from a hospital or residential setting, we always facilitate a comprehensive treatment team meeting to talk about discharge so everyone leaves understanding what the next steps are – action steps. When we work with families struggling with similar issues, we don’t wait for the hospital to give updates. But as mental health professionals, we are able to navigate the bureaucracy much easier and get clear answers much faster.
3. Responsibility: Providers, whether big hospitals or little, ole’ therapists, have an ethical and legal responsibility to communicate to authorities if a patient is in eminent danger. So who is responsible here? If you ask the hospital, they’ll probably point fingers until the next news cycle. If you ask an attorney, they’ll go through the policy and procedures for the hospital regarding intake, evaluations, referrals, discharge, etc. and anyone of making decisions in that chain could be liable.
4. Intervention (Placement Options): The hospital staff at BCH clearly did not consider referring outside of the traditional placement list (psych beds at hospitals). It’s unlikely that it was due to financial constraints and certainly not due to a lack of treatment centers as some have speculated (Yes, there are certainly a lack of medicaid-funded psych units in VA). There are facilities all over the country that are extremely well-equipped to accept, stabilize and work with patients just like Austin. Most hospitals, though, follow a tired, out-dated protocol of calling three near-by psych hospitals to find out if they have a bed avail. If they here no at all three, patient is discharged with a list of therapists to contact to set up an appointment. Sound ridiculous? You’re right.
5. Solutions: In my humble opinion, Austin would be alive today if earlier intervention had been provided by a treatment team including a psychologist, psychiatrist, therapist, and case manager. The psychologist provides the initial psychological evaluation to identify the issues, what is causing them, and create a specific list of interventions for the rest of the team. The psychiatrist (though in limited supply in Bath Co, VA) performs an initial psychiatric (medical/medication) evaluation and identify what, if any, medication is necessary to compliment any individual counseling being performed. The therapist provides weekly counseling either in-office or in the family’s home to address areas identified within the psychological evaluation. The case manager is the project manager for everyone and is on-call 24/7. This person also facilitates regular treatment team meetings to ensure updates are provided to the family and all professionals. For instance, if the therapist starts seeing signs of bizarre thinking patterns which are historically correlated with dangerous behavior, the case manager can alert the rest of the team and monitor the client more closely while also increasing the frequency of support. If a higher level of care (ie. psychiatric hospitalization) is recommended by any member of the team, the case manager not only identifies a placement but completes all intake paperwork. The case manager also provides psychoeducation to the family to help them understand the client’s diagnoses and what they can do to most effectively support him.
If you or someone you know is in a similar mess, do not assume your local hospital has the expertise to handle the situation. Contact a mental health professional to find services that can manage the entire project from assessment to placement to discharge and aftercare.