Sharing the Burden

Sometimes a huge barrier in my work with families is what we call 'the mental health piece.' This means that if moms, dads, or kids have a mental health problem like depression, bipolar or schizophrenia, progress is almost impossible because the individual with the mental health problem is essentially creating a roadblock for the rest of the family.

When that happens, we refer family members to a psychiatrist so they can get a mental health assessment. After the assessment, medication may be recommended or the psychiatrist may other treatment recommendations. If it is serious enough, it may be decided that our program will not be able to adequately address the client's needs. More than anything, the psychiatrist helps me share the burden of how to structure treatment with people that have serious mental health problems.

And why am I talking about this? A few weeks ago, a client admits he has been having suicidal and homicidal thoughts within the past month and also has a plan of how he would follow through with these thoughts if 'it ever got bad enough.' He also had a pretty high score on this legit depression inventory we give all clients at intake. Yikes, right? Right. Then within the next week, a whole bunch of other stressors occur; while he doesn't admit that he is thinking about suicide more, his affect is anything but cheery and I'm worried.

I put in a referral for him to see our psychiatrist (a free service) but the client doesn't want to go and is upset (probably an understatement) with me for putting in this referral. The client's dad also thinks I'm blowing things out of proportion and tries to normalize the kids thoughts.

That sort of conversation is actually really stressful. I am a private person so I totally understand not wanting to talk to a stranger about my most serious problems. YET--the burden of being the only who knows that this kid is having fairly active suicidal thoughts is not fun. In fact, it is rather scary. In addition to worrying about the overall safety and welfare of this kid and his family, I can't help but worry about the liability of having a kid die on my watch. Furthermore, if something (heaven forbid) were to happen, how would I handle the guilt, horror, shame, sorrow, etc while continuing to working in this field? That is the sort of thing you think about as you fall asleep at night. I hope it gets easier as I get better at having those conversations.

Needless to say, when my client showed up for his appointment, I did a jump for joy and breathed in some relief. Knowing that another mental health professional is in the picture to share the responsibility of keeping this kid safe is immensely comforting.

Luckily this kid is OK. The psychiatrist agreed that his depression was serious enough to warrant some professional monitoring on his end, but didn't think the kid needed hospitalization, medication, or something more intense than I could provide. In the month that has passed, his moods have improved as his situation has and I no longer worry about suicide. He has his follow -up appointment later this week and of course, he is mad at me for making him go again. At this point, I don't even care about his attitude. Having someone else confirm my instincts or point out something I didn't know is worth more than I ever realized.