Finding Her Tribe

Picking up where the inpatient story left off, and continuing on with the saga of partial hospitalization…..

During her inpatient discharge we were told that youth are typically in the partial hospitalization program for 7-10 days. 

Two weeks.  Okay, I thought.  I can handle this and then we can start getting our lives back to normal.

Except that Rachel was not typical.

Rachel spent 26 days in the partial program. 

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The partial hospitalization program is located in a medical building on the same campus as the hospital.  As opposed to inpatient, kids in this program are divided into different groups by ages.  Not all kids in this program have been patients of the inpatient program, but many have.  Even more have returned to the partial program for additional treatment.  Patients are there for a wide variety of illnesses including depression, schizophrenia, bipolar disorder, anorexia, etc.

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For two weeks we had settled in to a routine of hospitalization from 9am – 3pm every weekday.  Parents wait with their kids until staff come to get them.  It was during these times that a song from Sesame Street kept going through my head; One of these things is not like the others, one of these things just doesn’t belong.  

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Rachel and I were the ones that didn’t appear to belong.  We weren’t a foster family, we weren’t low income, and Rachel lived with both of her biological parents who were happily married.  In this setting, we were most definitely the things that didn’t belong.

But then a funny thing happened.

Rachel found that she had more in common with this group of kids than either she or I would have imagined.  They understood her.  They didn’t judge her.  She was just part of their group without having to try.  In your teen years that sort of thing just doesn’t happen.  It was new and she liked it.

Rachel liked the security that the partial hospitalization program provided.  She fit in.  She had found her tribe.

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I asked her if she missed her friends at school.  She only missed a few.  For the most part she preferred the kids at partial hospitalization.  When I inquired why she responded “Because they’re actually nice.”

Wow.  Let that sink in for a second.  

Given the choice, she would choose schizophrenics and drug dealers over classmates because at least the mentally ill and the criminals are nice.   I began to wonder how toxic the school environment really is…..

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Her progress at the partial hospitalization program was slow.  Rachel was extremely guarded in the program because she was afraid of being sent back to inpatient treatment, which occasionally is necessary.  They struggled to determine the root cause of her depression which meant that therapy was often ineffective.  

In multiple meetings the psychiatrist seemed determined to find something disastrously wrong at home or some trauma that had occurred to explain everything.  Having a patient who lived with both of her biological parents was a rarity for her and she honestly seemed at a loss as to how to help Rachel and proceeded to prescribe various psychiatric medications.

Despite all of this, April 2019 started with a safety plan meeting at her middle school.  She had been in the program for 11 days and this meeting was required before she could return to school.  Plans were made for her to begin the transition back to school on April 2^nd with mornings at partial hospitalization, and afternoons at school. 

I was looking forward to getting back to our ‘normal’ routine. 

I was hopeful things were on the right track.

I was wrong.

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When I picked her up on April 2^nd to take her to school she was nervous, but that made sense since she hadn’t been there for weeks and knew her classmates would be curious about her absence.  Her counselors had prepped her for how to deal with questions from classmates.

On the lengthy drive from the hospital campus to school she began to have a panic attack.  This was new for her.  We got inside the building where one of the counselors eagerly welcomed her and enthusiastically asked “how are we doing?” with a big smile on her face.  I responded ‘not good’, she looked at Rachel and rushed us into the counseling center away from the other students. 

Another counselor worked to get Rachel calmed down, even taking her for a walk outside while I stayed with the other counselor. 

While Rachel was out of the office I asked the counselor what our options were.  At first she didn’t understand my question.

“If she is unable to ever return to school and function normally, what are our options?”

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She resumed the partial hospitalization the next morning.  Days went by and this became our new normal.  We were living in our own version of the psychiatric ward.  Anything she could easily use to self-harm had been locked up and hidden, and the same had been done with all medications.  She was never left alone (except to use the bathroom and shower) and was required to spend virtually all her time at home on the main floor where we could maintain visual contact. 

It was a miserable way to live.  At times I lost hope that she would ever get better.  I wondered if we would ever get back to our previous life.  Rachel had found her tribe and honestly preferred being at partial hospitalization to being at school. 

But then motivation came from an unexpected source.  Insurance indicated that since she was not showing sufficient progress they would not continue to provide coverage for the partial hospitalization program.  She was either making improvement and could return to school and her regular therapist, or she would be transferred to a 6-month long-term care at Boys Town.

With little more than a month left of middle school and our refusal to allow her to be admitted to Boys Town, Rachel managed to return to school and resumed appointments with her therapist.  Curious classmates mostly accepted her response that she had been absent ‘for medical reasons’.  

Unfortunately, one classmate prodded for details until Rachel hit her breaking point and yelled “I WAS IN A MENTAL HOSPITAL!!!”  This was not the technique the counselors had suggested but was extremely effective at getting classmates to leave her alone.  

(I should also note that her best friend knew where she was the whole time and did an EXCELLENT job of not telling anyone anything.  That had to be a hard secret to keep.)

Was she better? Not really, but she did her best in her medicated state and finished the school year.  While she did that, I began working with the high school to prepare for the challenges we knew lay ahead. 

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The story of partial hospitalization continued in October when Rachel received the Beacon of Light Award for being their ‘patient of the year.’  Although wishing she could still spend her days with Miss Michele (one of the partial program therapists), Rachel has worked hard to keep her treatment moving forward without needing to return to ‘partial’.  I don’t know the statistics, but for many of the kids it was not their first time at the program so she is still in many ways a rarity when it comes to the partial hospitalization program.

Despite finding her tribe there, hopefully now she is one of the kids who is well enough to say they are ‘one of those things that doesn’t belong’…..

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