“My young adult son has serious mental health problem, is living outside the home, using illicit drugs, out of work, and refuses to get help. What can I do?”
This is an all too familiar cry for help from parents who decry their or society’s inability to engage these young people in accessing needed services. Our society is not equipped to address this problem of refusing help unless the young adult acts out in some bizarre way, threatens someone, tries to commit suicide, or does something illegal. Even if the young adult gets picked up by the police or an emergency mental health team and ends up in jail or a locked psychiatric hospital facility, there is a good chance they will not be able to hold him for more than seventy-two hours. This is particularly true if he was brought in for mental health reasons such as a suicide threat or attempt. He only needs to convince the hospital staff that he is no longer suicidal, and they discharge him. One young adult I worked with would cut his wrists and threaten suicide prompting the parents to call for an ambulance to take him to the hospital, only to have him released the next day because he said he was no longer a danger to himself.
What’s A Parent to Do?
In most cases, these young adults need an intensive outpatient program, sometimes called day or partial hospitalization but may require an inpatient hospitalization or residential treatment. Rarely will these defiant individuals agree to anything this restrictive. Obtaining a civil commitment is almost impossible but should be considered. In one case, parents were able to get a six-month civil commitment of their son to a psychiatric hospital only to have him released after three days by the hospital because they needed his bed for a needier patient. Parents should investigate residential treatment programs and be prepared to introduce this if the young adult hits bottom, so to speak, and expresses a willingness to pursue this level of care. If hospitalization or residential treatment is not an option, what can a parent do?
Parents need to acknowledge that their young adult has the right to refuse help from parents or service providers. They can thumb their nose at their parents, cut off communication if they don’t like what they hear, and live off the grid. There are shelters, food shelves, and specific welfare programs that exist to ensure a young adult can survive. Parents can pursue social security disability in some cases, but social security isn’t easy to acquire for mental illness. I have no magic answers but try to partner with parents and understand, support, and help explore different options. The challenge is to continue to reach out in love by balancing messages and actions that reflect both support and backbone.
Start with Love
The foundation of every communication and action must be the love that we have for our young adults. You are loved no matter what needs to come across loud and clear. This provides a secure base out of which both the parent and young adult can interact. It means that your love is unconditional, and you will always be there for emotional support and assistance in acquiring services. Parents I have worked with have communicated this in word and action. Beyond saying this, here are some examples of acts of love by parents:
- Paying for all or some portion of education.
- Providing a place to live and food.
- Covering the cost of insurance- health, dental, auto.
- Covering the cost of counseling or life coaching.
- Paying for part or all of an apartment if living away from home.
- Paying part or all of transportation costs for work or school
- Paying for medication costs.
- Paying for career assessment and counseling.
If living outside the home:
- Take a box of groceries to the apartment weekly.
- Provide some gift cards to be used for gas or food.
- Take them out and buy some clothes for them.
- Pay for a haircut if they say they have no money to do this.
- Invite them to family events so they feel they still belong.
Love is Not Enough – Backbone is Required
Backbone by parents is necessary to foster independence and self-sufficiency. If only love in the ways outlined above is given, they will never have to step up and become responsible. Backbone is saying “no,” setting limits or boundaries, being clear about what you won’t do for the young adult, and then, most importantly, standing firm and following through. Parents will often stumble on this last step of following through. Along with backbone, by standing firm, we say they can manage their lives, or at least we expect them to do so. When we cave in, we are saying just the opposite- “I know you can’t handle your life and need me to rescue you.” Here are some ways you can demonstrate backbone:
- Be clear about deal breaker rules for living at home. These are typically rules they would face in society, such as no drugs in the house or smoking/vaping, violence, or threats of violence, damaging property, stealing, personal, abusive verbal attacks and an expectation of work or school attendance. This is a short list to which they need to adhere or choose to live elsewhere. I remind parents when the young adult violates these rules, they are asking to live elsewhere. We are not kicking them out. If they leave and want to come back, the rules don’t change – they are non-negotiable. A parent is not doing a favor by looking the other way or excusing such behavior.
- Don’t do things for a young adult they can do themselves. That said, you can offer to work with them to apply to a school or apply for employment. Sometimes it takes meeting them halfway or giving them a little boost – call the clinic for counseling and hand them the phone.
- Don’t give them money outright or for no reason. The reason must be something that advances their independence and self-sufficiency. Offer opportunity to work around the house (e.g. wash windows, paint, mow lawn) to earn gas money, pay license tabs etc. It’s important that they learn there is no “free lunch” in society unless they like soup kitchens, the mission, and food shelves. Our actions should be teaching, consulting, coaching, and working with them in some partnering way.
- If they destroy things like a laptop or phone or sell these for drugs, don’t replace these even though they will not be able to get ahold of you. This is tough because we think they may be in trouble and can’t call us without a phone. Most young adults who are street savvy can borrow a phone to make a call. They can also go to the library to use a computer.
- If they are abusive, blaming, and attacking when they talk with you in person, on the phone, or in a text, indicate that the conversation is over. They can try again later without the abusive language and attacks. It may take 3, 5, 20, or so times of this cutoff for them to realize that if they want to talk to you and discuss their needs, they must reign in the attack language.
How Do I Know When I am Balancing Support and Backbone?
There is no way to list all the love or backbone actions, but parents can evaluate a decision or action in terms of the following questions:
- Am I acting out of love and not fear, anxiety, anger, frustration, resentment, etc.?
- Am I doing what is right and sending the message that our young adult must take responsibility for their life?
Let me make one final recommendation – don’t go it alone. Living with the awareness of and limitations in helping an impaired adult child is one of the most physically and emotionally exhausting experiences a parent can have. There are resources such as Al-Anon for parents of adult children with substance abuse. NAMI is a great national organization to learn about resources for adults with mental illness. Also, below are links to some relevant blogs that might be helpful. It’s important to remind ourselves that the keys to letting go, to launching our young adults, and to helping them stand on their own is our willingness to demonstrate both love and backbone.
Resources and Further Reading:
- Al Anon
- National Alliance On Mental Health (NAMI)
- Getting Help When the Young Adult Refuses
- Parent Burnout and getting Help for Yourself
- Parental Burnout is Real
- Substance Abuse
- Tips for Saying “No”
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