Thoughts on Afters and Nexts

Six years ago I started sharing our family journey navigating through life with a child battling anxiety. The writing has been erratic, coming in fits and starts when my head and heart could agree there was something worth sharing. Some things have stayed safely tucked away in our own inner circle. Those are the most tender and raw circumstances or the parts of the story  that belong solidly to my child and are not mine to share. Overall the goal has been to expand dialogue surrounding mental health and to personalize the narrative in an attempt to let other parents know they are not alone in this particularly frustrating and often frightening part of parenting. 

I pushed the publish button on the very first post on alittlebroken.org on April 9, 2016. 238 blog posts, a handful of speaking engagements, and almost 6 years later so much of that very first post still rings true today. The difference is the child is now a teenager and the stakes have become much higher. In 2016 our struggling child was 11 years old and we thought we could imagine a future where therapy and medication would become a footnote. In 2016, we thought there would be an “after”…a time where we had all the answers, had given our child all the tools needed for health, happiness, and success, and could move forward.  Now that child is 16 and we’re realizing that we all need to find ways to make space for a future where there is no “after” and will likely always include mental health treatment for our child. In 2022 we are beginning to readjust our frame of reference and understanding that moving forward sometimes looks like making a hard decision for the short term in hopes that it makes a lasting impact for the years that lie ahead. That’s the space we find ourselves in now.

At the beginning of March, following several months of an increasingly difficult and painful dive into depression and anxiety, we made the decision to admit our child to a full day, outpatient mental health program. When I say “we”, I mean WE….our child’s therapist and psychiatrist both recommended a higher level of care was the only way to stop the spiral we’d all been witnessing, The therapist found a “unicorn” of a program that is actually in the town where we live, and had an opening when we needed one. The psychiatrist agreed the program would be a good fit. My husband and I had long conversations with our child before we visited the program explaining our reasons for thinking this was next best step. We all wondered if we would need to convince our child it was time to take this step – but in the end that wasn’t the case. Our kid truly has been living on the edge of spiraling out of control for months. Given the opportunity to rest from the demands of life and the hope of reentering the world as a healthier and happier self – we didn’t have to do any convincing. It wasn’t an easy decision, but it was the right decision. We all truly agreed.

The technical term for this type of program is “partial hospitalization” or “PHP”. PHP is structured and intensive clinical care in an outpatient setting  – individual therapy, family therapy, group therapy, cognitive behavioral therapy, dialectical behavioral therapy, psychiatric evaluations, medication management, expressive and creative groups, wholistic exercise, life skills, nutrition classes, and a very decreased academic load – 7.5 hours per day, 5 days per week. The combination of duration and a multidisciplinary approach allow for both triage of the crisis that brings a kid into the program and long term planning for living successfully in the world with pervasive mental illness. In one word, PHP is intense. But we are beginning to notice glimmers of the prevailing mood in our kid being ever so slightly less tense.

We are exactly two weeks into the program, but do not have a clear idea of how much longer it will be needed.  We do know that, on average, kids are in this program for 4-6 weeks and then are “stepped down” to  the “intensive outpatient program” (IOP) where they go to their own school during school hours but return to the program 4 afternoons per week for therapy and life skills groups. Following a few weeks in IOP, the goal is to have patients healthy and steady enough to be in the world on their own terms. As a mother, I see so much deep and incredible hope in that goal. It is that hope which is sustaining me through the often sleepless nights and sometimes frightening days that are the reality of parenting my eldest child right now. 

As my child has gotten older, I have been increasingly cautious about the parts of our story I choose to share with the world. In the recent months when we felt helpless as we watched our child disappear into depression and anxiety, I kept choosing not to talk about how that reality was impacting my own well being. I decided it was more important to protect my child than it was to open myself up to the possibility of support and love. I was wrong. The truth is, I am better equipped to help, support and protect my child when I make space to let others help and support me. I know that’s a lesson I’ve learned before, but clearly I’m a slow learner. I’m a work in progress. 

So here’s the thing….if you ask me how I am right now, I will probably answer honestly that I am perpetually exhausted, frustrated by school and insurance systems that make it nearly impossible to get a teenager critical mental health treatment, frightened for my struggling child, worried that my other child is uncomfortable in our home, disheartened by the limited amount of time and energy my husband and I have for each other, and resentful of the fact that our lives are ordered around the schedule of the program. But I’ll also tell you how profoundly thankful I am for the ability to get our child help and how hopeful I remain for brighter days.

I won’t (and don’t) tell you all of this expecting a response. It’s a lot. I get that. Frankly, stunned silence is an appropriate first reaction and no hard feelings on my part if you have a hard time finding your way beyond the stunned silence. But if you do want to find your way beyond that initial reaction, know that I welcome conversation. Authentic conversation is what helps me to process and heal,  and it is the best way to chip away at the stigma surrounding mental illness. 

So ask! Ask me for updates – I’ll give them as I am able. Ask me for my thoughts on the numerous ways both the public school system and the health insurance system are failing our kids when they are in crisis – but only if you’re prepared to hear a lengthy rant. Ask me if there is anything we need – the answer will probably be no, but being asked acknowledges the truth that there might be things we need help with. Ask me what I’m reading or watching – as consuming as helping my child might be, there is still more to my days than the program and treatment. 

Ask. Answer. Hope. Repeat, repeat, repeat. It’s the only way I know to be both true to myself and strong enough to be the parent my child needs and deserves. We may never see a day where there is an after, but we can get to a day where there is a next. There will be a next, and it can be spectacular. That much I know is true.