Since Abby’s youngest brother, Adam, in his early 20s, still lived at home when her mother came home from the hospital, he attempted to monitor his mom and take care of her. When this situation contributed to Adam’s anxiety, her sister Julie and her husband moved in to help monitor Mandy. Day treatment programs did not have openings for three weeks, which meant follow-up treatment was not immediately available after discharge.
Abby's father, Ken, accompanied Mandy to her psychiatric appointments, because he wanted to know the plan for treatment. When Mandy’s psychiatrist did not seem to be helping her, he sought to find another psychiatrist but could not get an appointment for weeks. Meanwhile Mandy continued to get worse. Since Ken was traveling for work, her sister Julie slept in the same bed with her mother because Mandy would not sleep by herself. Julie told Abby her mother “got this crazy look in her eyes and couldn’t calm down.” Once again Mandy needed inpatient care.
During her second hospitalization, Mandy was diagnosed with an eating disorder and had a nasogastric tube inserted for nutrition since she was not eating. She said the devil told her not to drink water, so she would not take a shower or brush her teeth. After two weeks in inpatient care and no change in symptoms, the family was offered three options—an eating disorders program, ECT (electroconvulsive therapy), or a day treatment program. The family opted for either the eating disorders program or day treatment. However, Mandy did not qualify for either program because her mental illness was deemed too severe. She had six ECT treatments and was released once again with no aftercare program. When Abby’s father switched jobs, Mandy could not get care for another month until eligible for health insurance.
Note: ECT (electroconvulsive therapy) may be prescribed when medications do not work. ECT, which produces mild seizures, seems to cause changes in brain chemistry that reverses symptoms of certain mental health conditions. Although much less traumatic than in the past, a side effect could be temporary memory loss.
People [family members] were trading off basically babysitting her. I was pretty removed from it. I have a child. I can’t take care of my daughter and me and mom. I can’t do that, so I stressed that if it’s to the point where people can’t help anymore, she needs to go back into inpatient care. Julie [Abby's sister] has not been able to set boundaries. Then Adam (Abby's youngest brother] moved in with Julie because my mom was following him around when he was living there. His anxiety got really bad because my mom talked a lot about the devil and going to hell.
When the family discovered they would need to wait two or three weeks for an opening in day treatment, Mandy was hospitalized a third time once health insurance was in place. She remained in the emergency room for five days until a bed on the unit opened up. She again received ECT treatment. During Mandy’s hospitalization, Ken was scheduled for surgery for cancer on the same day Mandy received her eighth ECT treatment.
Although Ken is now back home, he is not up to managing the additional stress of caring for Mandy. She is currently in a crisis residence, and going to day treatment. Abby sees improvements with Mandy’s current therapy, which includes ECT.
She’s finally out of the fog, which is good, but it’s really hard for her. She knows she missed the wedding in September. She’s having a hard time. But it is good she finally knows what’s going on. She said she’s feeling like things aren’t evil anymore.
Although not all family members agree on the best treatment for Mandy, they are communicating about possible options for aftercare for her, including a stay at an Intensive Residential Treatment Services (IRTS) facility.
Note: Intensive Residential Treatment Services (IRTS) provide mental health services in a 16-bed residential setting that focuses on managing symptoms and medication, learning coping skills, and socialization. Stays are up to three months, but may be shorter if the client is stable and has a safe living situation in the community.
Abby’s aunt (Mandy’s sister) criticized the family’s response to Mandy’s crisis. While at home Mandy had called people saying she was scared and was going to get killed. Abby’s aunt decided to help, but her actions were not helpful for family members. During one of Mandy’s hospitalizations, her aunt sent texts to Abby and Adam, admonishing them to go visit their mom.
She sent me a text the day after my dad’s surgery telling my brother and me that we need to go visit my mom. We just didn’t respond. I had a really big work project for my new job. It was Monday, my dad’s surgery, and my first big work project. Thursday was my next work project presentation and she ended up texting me also on Thursday—a group text to 10 people saying, “Abby, when is the last time you visited your mom?” My dad ended up talking to her. “This is not what my family needs right now.”
Abby did not know how to deal with her aunt and was grateful for her father’s advocacy. She is juggling a new job, parenting, and an upcoming move to a new house. She explained that she and her brother have a right to choose their level of involvement and do not need to feel additional guilt in response to their aunt’s actions.
I know from the outside it’s so easy to say someone should do something differently. But when you’re in it—we’re in survival mode right now. Everyone is doing as much and as best as they can. . .They don’t know what you’ve been through.