Controversial Decisions…

Well, that didn’t exactly work out as we thought it would! Maddy spent a night in general hospital and a bed was found for her in an adolescent mental health unit the next day. Thankfully, it was one that was within an hour of home. However, given that this would be her 5th admission to a unit, they were adamant that they would only accept her on the basis of a maximum 2 week stay and that CAMHS would remain actively involved, providing two visits a week within that time. Strange as it was to have such restrictions, they were in line with what we already felt was necessary so everyone agreed. We packed yet another bag and left the general hospital to head off to the unit.

Sadly, things did not go to plan for here on in: we arrived at the unit, did the paperwork and were asked to wait for the Doctor to assess Maddy so they could formally admit her. The unit was attached to a general hospital, as was the doctor doing the assessment. We sat in a lovely room and waited and waited…..we waited for four hours. Two hours in, Maddy decided this was all too much and that she wanted to go home. (I will write another blog post about the ramifications of when a process works and when it fails for this is a huge topic that I can only scratch the surface on but it deserves it’s own post!)

Maddy had started to feel that she wasn’t important, that her problems were clearly insignificant and leaving was the only thing to do. Of course, fear, impulsivity and confusion were playing a massive part in her thought processes: impulsivity is one of Maddy’s greatest risks and it often presents itself in her sudden change of direction. She had wanted this admission; she knew she needed it because she couldn’t keep herself safe but now she had switched paths completely and decided hospital was the last place she wanted to be and that she would be safe at home.

By the time the doctor arrived, Maddy was frantic and although my heart was aching watching this unfurl and bearing the brunt of it, I was stoic in my resolve: I could not, would not, take my daughter home and risk her dying. Somewhere, in the middle of all this, when the doctor had left to get another doctor to fully assess Maddy, she agreed to stay just one night. Whether she had realised they would possibly section her to keep her there or not, she agreed that she would stay, see the consultant in the morning and we would discuss it when everyone was calmer. They said they would speak to our CAMHS team first thing and then Maddy. Battered and bruised, my heart in my boots yet again, I left. Yep, I cried most of the way home.

Something went very wrong the next day: Maddy rang me at 11am to say no doctor had seen her; I rang CAMHS, they’d heard nothing either. CAMHS agreed that if we had any hope of Maddy voluntarily staying there, that the hospital needed to honour their promises to her and follow the process they had agreed the night before. CAMHS confirmed with me that Maddy was too high risk to be at home and that my gut instinct of sleeping outside her bedroom door 3 nights before had proved that to them: they trust my gut instincts more than I do! So they agreed to ring the hospital and confirm this position. We must have been on the phone a long time because as this call was finishing, Maddy rang my elder daughter, gleefully announcing she was being discharged. They had assessed her and decided that as she didn’t want to stay, and as she had assured them she was safe, that she could go home.

Many frantic phone calls then took place. I don’t blame the team at the hospital: turns out that they were wonderful, professional people. But they didn’t know my daughter; faced with an articulate, extremely intelligent child whose logic seems years above her age, they misread that, as most initially do, as the stability of a rational person. After frantic discussions with CAMHS and with me, they shot into action and agreed to reassess Maddy under the Mental Health Act and review their position. Meanwhile, Maddy is still making phone calls asking when she will be picked up.

My instinct is to say that something inside me snapped but actually it was the opposite: the mist cleared. The facts I was now faced with were: Maddy didn’t want to be there; the only way they could force her to stay was to section her; if she was sectioned again, that would spiral and would be months in hospital; a long term admission has proved to be of no effect to my daughter; she was high risk at home but if she was sectioned again, her anxiety would only increase, her desperation would rocket and home leave would become even more of a risk. And, most importantly, now believing she was coming home, being forced to stay would devastate her. I was also asked to be present whilst this happened so I had to face my child, who would scream and sob and beg me to take her home and I was expected to sanction this move, even though the reality would be that I had no control if it went this far. So the answer was simple: it couldn’t go this far.

I have never driven so fast before: I had jumped in my car without a seconds thought and gone to bring my daughter home. For the first time, I was fighting to keep her out of hospital rather than fighting her to keep her there. I hadn’t forgotten how chilling her own fears of her ability to die are; I hadn’t forgotten she was tired of the responsibility of staying alive; I hadn’t forgotten how high risk she is and I certainly hadn’t forgotten how we, as a family, are all at breaking point. But I also hadn’t forgotten that she is 14 years old, a baby really, and the the past 2 years of incarceration have not made her any better. Time for a change of direction.

The hospital couldn’t professionally sanction her discharge and she was therefore discharged against medical advice but after half an hour discussing things with me, they agreed that this was the right thing to do and that we were obviously experts in this arena!

So, controversial as my decision may appear, I have bought my daughter home. She is still unsafe and if things go devastatingly wrong, I will no doubt punish myself with blame for the rest of my life. But my little girl deserves a chance; a chance at a life that is not thwarted by forced incarceration, because that is not life. I have come to believe that to stand a chance, at some point soon she needs to make a firm decision to live or die. Dangerous as that may seem, it is what she does every day of her young life anyway: she fights her urges to die constantly. Of course, I am willing her with every fibre of my being to choose life, and I believe she will, but I want her to realise that this is a conscious decision. She may always battle suicidal ideation but if at her very core she knows she made a rational decision to live, then “all” she has to do is hold on and ride the waves. We will continue to reduce the risk as much as we possibly can and we will never give her permission to go but we all need to find a way to stop living in abject fear.

And if her ultimate choice is to die? What can I say to that? If she chooses to die, would me acknowledging that here, or on any level, as a possibility make a difference? Of course it wouldn’t. The only comfort I could take is that she chose it, it wasn’t accidental. I’m told that is some comfort. Of course I don’t believe that: I can only hope and pray that I never have to find out.

Stay strong x

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