Inpatient or Impatience

First of all, an apology for the self pitying nature of the last post. I’m a good mother, I know, but too prone to self doubt, a state not helped by the consumption of Benylin and red wine. The Benylin is for the ongoing flu symptoms; this isn’t a cocktail I invented, honestly.

And now the week ahead, when L will visit the inpatient unit to discuss readmission. A refusal of treatment on her part would lead to s3 of the Mental Health Act being considered. But what if, on the basis that there has been a change in the last few days, I asked for her to remain at home to continue eating as she has done since Thursday? I know that really, this is too late. If only this change had happened a fortnight ago, perhaps if I hadn’t been ill, her weight wouldn’t have dropped again over Christmas. College starts again tomorrow and L seemed genuinely taken aback when I said she wouldn’t be returning. Even if she could carry on eating at home, college would give her an opportunity to restrict and I cannot take food to her throughout the day. I talk to my mother on the phone about options and she gently suggests that it would be easier for all of us if L was an inpatient, as I describe the daily battles with food.

My question is therefore; who is helped more by inpatient treatment: L or her family? Her therapy team all agree with me that the sole purpose of treatment at present is food and weight gain. Is inpatient treatment a place where we outsource the dispensing of food to the NHS because we are simply exhausted? And if so, could we not have it as back up, a place to send her at will. The answer of course is, No, because this is a ‘place’, a ‘bed’, in a newly refurbished single ensuite room facility, and this ‘place’ may be needed by another child. I wonder if it is possible to send her on extended days, for meals from breakfast through to her evening snack. I am older and wiser now. I know I can ask these questions, that my constant view that L will not get better until she has achieved a healthy weight has been proved right. But somehow I have to ask myself the biggest question of all – is it ok to ask L to be admitted against her will because we are all exhausted? Are we sending her away because we’ve had enough? She has wept and pleaded not to eat and to leave this until she is an inpatient, she has told us she can’t do this at home, that she can only eat in the unit and I have persistently told her she won’t be well until she can eat normally at home. I have promised her that no matter how hard it gets, I will not give up. Will admission feel like giving up, a long term equivalent of sitting on the stairs as a consequence of bad behaviour. Should she become an inpatient because of our impatience? The truth is I don’t know.

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6 responses to “Inpatient or Impatience

  1. Is it possible for L to do daycare? I’ve just completed 7 months of daycare programme in london, mon-fri, gradually reducing my days over the period. I found it really helpful because like you say, it allowed me to transfer the learning from the unit to home so I could eat at home. This programme was just two snacks and lunch but others incorporate all meals and snacks, gradually reducing the amount of meals you have on the unit. May be worth enquiring about?

  2. Onemoremum,
    I am 21 and recovering from anorexia, and have been in the same position as your daughter is right now, as well as having 3 admissions. I remember that at one point, when threatened with an admission and a s3, I said “I’ll eat everything and anything” so to avoid the admission. I lasted less than a day until the anorexia leaked back in and flooded all my food decisions. I have no doubts that by how you describe both yourself and daughter right now, that you are both being so strong; it’s not that I doubt your daughter’s ability to beat the anorexia, but can her food choices be sustained at home, for long enough for her to reach a healthy BMI? When will the deliberating and bargaining and compromising start? When will it take over?
    Your daughter’s anorexia is a strong thing, and although you are evidently stronger – dealing with not only your own struggles, but all of your children’s – I think it has gotten further than “the point” at which your daughter can turn things around.
    The inpatient stay will be as long as necessary; remember, at home, you can’t force her to eat, no matter how much you beg and plead, if she says no and doesn’t eat, then she doesn’t HAVE to. In hospital, it will be different – any refusals will lead to a MHAA and s3, then she really will have to eat. I know this seems harsh, but I think this ultimatum is what she needs right now.
    If she stays at home, how long will she be able to do the “hospital at home” thing? When will she start going out, going to her boyfriends, having “snacks and lunch” with him? I can only imagine how much turmoil you must be going through when deciding about an admission, but I think you should remember that really, it isn’t your choice. There are laws when even if the parents refuse the admission too – and depending on the age of the child, the Children’s Act or the Mental Heath Act, come into play and the professionals will take charge.
    Although I can empathise with you feeling like it’s due to your impatience or tiredness, that you think impatient care will be “easier” it isn’t. This is about your daughter, and if you honestly feel that she alone can overcome it – because that’s really what it boils down to – and if she can prove it by eating EVERYTHING she’s supposed to, then maybe outpatient will work.
    However awful this sounds, I remember when it was touch and go as to whether I was admitted, even in the most desperate of times and when I was apparently eating everything I was supposed to, the anorexia was still strong…. The purging and exercising took over further.
    I don’t mean this to sound as negative as it seems, because I believe you are SO strong and your determination and courage is just amazing. From a sufferer/recoverers point of view, I’d say she needs the inpatient care… This might not be for as long as you think, and she could maybe be discharged as an outpatient to attend for days – breakfast to evening snack – once her weight has increased a bit. Do you know where she will be admitted? Is it the same as before, or a different EDU?

    • Thanks, that really is incredibly helpful. It is the same unit as before, a generalised Adolescent MH Unit, where around half of patients are ED patients.

  3. Hi OMM. It’s definitely not impatience driving L’s readmission. I think you’ve done everything you possibly can to help her to recover at home. There are times when all the love, caring and commitment in the world just isn’t enough and you have to hand over to the professionals. It feels to me that L has reached that point and that the best thing you can do for her now is to support inpatient carer for her. But that won’t mean you have it easy anyway. Look back on some of your blogs when she was at the Unit before and how it impacted on the rest of the family.

    It is an agonising decision for you to have to make, especially after a few good days recently. But it doesn’t seem realistic to imagine that literally overnight there has been a permanent change in L’s condition. You aren’t giving up on her. As always you are doing your very, very best for her. And after that it has to be up to L.

    Wishing you courage and strength for the days ahead.

  4. Impatience will not be the cause of IP treatment. If it were just impatience then it would not be suggested by CAMHs. I’m going to compare this with physical illness as that is the area I have most experience.
    If a child or teen has a significant, fairly chronic (longer than 6 months), illness, the family may be able to manage their treatment at home even if that requires intensive, invasive, distressing treatment that is administered 6+ times a day.
    However, if things get worse or do not improve as they are supposed to treatment has to intensify further. There is only so much additional treatment the family can do and sustain themselves too (earning money, self-care, looking after other children) so inpatient treatment is arranged.
    This situation is no different to yours. You are having extreme difficulty (or perhaps cannot) in giving L all the care & treatment she needs, looking after yourself, looking after K &J and working. There is no shame in handing L’s treatment over to specialists who are able to give her the amount of specific attention in treatment that she needs.

  5. Hi, I am writing this after reading your most recent blog, the one after this. There you say that you have now realised you cannot do it alone – but in no way does this mean you have failed, or that it is your impatience that is the driving force behind the admission. Remember, anorexia can and does kill. That is the tragic truth. L needs help, and lots of it, because anorexia can be all powerful. You have done so much, but now L needs the help of a team of people. You also need a rest to recharge your batteries, so you can help her with the next phase of her journey, whatever that may be.

    I have no personal experience of anorexia (but plenty of professional experience), so I am pleased that you have had comments from others with the experience that I lack. VMK has shown via her wonderful comments that there is still the person beneath the anorexia – they are just very well hidden by the effects of starvation. Your job is to hold onto the L that is still there, buried deep beneath the anorexia. She cannot see or connect with that part of herself at the moment, so she needs someone who can.

    Finally, I always say to others (and myself) that it is not a weakness to ask for help. Strength is recognising when we need to ask for help. L can’t do that for herself at the moment, but it is so important that you hold onto the belief that it is not just OK to accept help, it is the strong thing to do. Perhaps this is important example for L to learn from.

    Good luck with whatever the next step may be. And remember, you ARE a good mother!

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