So confused

[Carina16]

My step daughter is 18 but with a mentality level of a 12 year old. Today, she got upset and tried to commit suicide. She had a fight with my girlfriend(her mother) and took off to cool down. She has done this before with no problem. She came back and got my daughter and told my daughter she had taken 22 50mg Topamax. She took off again and her boyfriend went and found her and made her come home.

I gave her a choice of us taking her to the hospital or calling the sheriffs department and an ambulance. She was given this choice because I live close enough, I could get her there before the ambulance could. While getting her in the car, we found several pieces of sharp broken glass in her pockets.

I would have thought they would have given her charcoal or pumped her stomach. They didn't. She admitted to being suicidal. They talked to her while under the effects of the medicine and asked her if she thought she would be safe coming home. Of course, she said yes. So they are sending her home with a safety plan. I wouldn't have a problem with this, except she has a history of this. She just aged out of placement and was sent to live with us and had a safety plan in place at the time this happened. I'm just really confused as to the different way this was handled as it was when my daughter did the same thing.

[telecom_goddess]

so she had all that Topomax in her system and they didn't remove it? I took ONE of those pills a day and felt like a zombie. Wow.

[Sapphire Silk]

"Pumping the stomach" or gastric lavage is controversial. There is a risk that the patient can aspirate, leading to a serious respiratory condition called ARDS (Acute Respiratory Distress Syndrome) that can be life threatening. The benefit is very small unless the pills were consumed within a 30-60 minute time frame.

The same goes for activated charcoal. There is no evidence based work in the literature that shows it even works, but it carries the same risk of aspiration and ARDS.

What concerns me is that she was not put on a 72 hour hold. Did they check a tox screen? Topamax itself is not usually fatal by itself, but if there is polysubstance abuse the risks go up.

Unfortunately, even with a 72 hour hold, cases like this are treated in a similar way. Once a contract for safety is obtained, the patient is often treated outpatient.

She needs a good therapist. Medication is not going to be enough for her; she has issues to deal with regardless of her mental level.

[Carina16]

Well, after talking to several people in the medical field, I understand a bit better why they observed her rather than trying to purge her system. The concern for me now is that they didn't place her on any kind of hold. The doctors at the hospital that night felt it was because she was off one of her meds. However, the med she was off of was not for depression. My problem is now that she refuses to abide by the safety plan they gave her that night. She was seen for an intake appointment the next day at the local mental health center. They gave her another more in depth safety plan, which she also fails to abide by.

We've had to restrain her twice since then to stop her from hurting herself. We called the crisis number and had them come talk to her, only to have her refuse treatment, stating she felt we could keep her safe and it was left at that. They said if she refused, there was nothing they could do. The local mental health center is awesome and did wonders with my own daughter, however, she can't be seen by them at the moment. My step daughter just moved out here with us so her Medicaid is from a different part of the state and they will not cover services in this part of the state.

[trailerparkmedic]

Is the crisis number the police or a mental health agency? I ask because in my state, the police can bring people in on an involuntary hold but mental health agencies can't, though they can call the cops.

I don't know that a hold would necessarily help unless your daughter isn't being seen by a psychiatrist in the ER. In my state a 72 hour hold means a patient must be seen by a psychiatrist within 72 hours but doesn't mean they will be admitted or that they'll stay for 72 hours. Many of the people determined by psych to be stable are gone within 24 hours, especially if they have follow up (as your daughter seems to have).

If she's not being seen by a psychiatrist in the ER, maybe you could call the cops to get a 72 hour hold. Or maybe you could try a different ER. If you live in a big city, or near one, is there a psychiatric ER in the area? Is there a county hospital in the area that cares for the indigent? They will be very familiar with psychiatric problems.

Do you have guardianship? Can you get it? Is she disabled enough to get SSI and Medicare? In my state, Medicare is much more flexible than our overly convoluted Medicaid system. Do you have a social worker or case manager to talk to? Can you talk to the intake people or psychiatrist at the center she is at and tell them about your concerns?