Navigating My Daughter's Severe Depression and Self-Harm Crisis

Is my daughter going to need "assistance" again?

I'm sorry to hear about your daughter's situation.
It's important to seek professional help and support.
Please consider reaching out to a mental health professional or crisis intervention service for immediate assistance.

Wei Nan De Mu Qin, 40~49 year old female. Ask Date: 2010/08/03

Dr. Ding Shuyan reply Psychiatry

Hello,
As mentioned in your letter, your daughter has a history of depression and her recent emotional state has been unstable, with frequent suicidal preparations and a past of self-harming behavior, placing her in a high-risk situation for suicide.
Professional intervention is essential at this point, aimed at crisis management and establishing a stable therapeutic relationship with a provider your daughter can accept.
You might discuss her past experiences with hospitalization and outpatient treatment, identifying which physician or professional left a positive impression on her.
We can then seek help from that provider, as your daughter may be more willing to continue treatment with someone she trusts.

In the long term, building a stable therapeutic relationship with a trusted provider is a crucial foundation for your daughter's recovery.
Cases similar to your daughter's are not uncommon; they tend to be more sensitive and can fluctuate with changes in their external environment.
Whether hospitalization is necessary is typically assessed based on several criteria, including the presence of self-harm or harm to others, and the refusal of treatment leading to a deterioration of mental symptoms.

Hospitalization has both advantages and disadvantages.
The primary benefit is the protection of the individual from self-harm or harm to others, as well as the establishment of a comprehensive treatment plan involving medication and psychotherapy.
My experience also indicates that hospitalization can facilitate the development of a good therapeutic relationship with healthcare providers and enhance the patient's understanding of their illness.

The drawbacks of hospitalization mainly include a lack of privacy and convenience, as well as potential conflicts with other patients.
Fortunately, mental illnesses are not contagious and are not influenced by others' conditions.
Hospitalization can lead to some improvement in symptoms or at least help resolve certain issues; otherwise, this system would not continue to exist.

Additionally, individuals in self-harm or suicidal risk situations often struggle to make the best choices for themselves, sometimes becoming quite irrational.
I suggest you encourage her to visit an outpatient clinic or, in urgent situations, the emergency department, where hospital physicians can assess the level of assistance she requires.
Whether involuntary hospitalization is necessary will be advised by the hospital's medical staff.
As a family member of someone in this situation, how can you cope? It is natural for a parent's heart to fluctuate with their child's condition, and this burden is something you cannot easily set aside.
I recommend occasionally stepping back from the emotional turmoil to maintain a longer-term perspective and a moderate sense of optimism.
Reflect on past experiences where situations have changed from good to bad, and vice versa.
When facing a crisis, we must confront and manage it seriously, but our emotions do not necessarily have to align with sadness, anger, or anxiety.

Laughing and crying alongside her does not equate to true empathy or love.
If your child is like a ship lost in a stormy night, we should be the steadfast helmsman guiding her toward the lighthouse.
The calmer and more composed we are, the quicker our children will stabilize.
Wishing you and your child a swift return to brighter days.
Sincerely,
Dr.
Ding Shuo-Yan

Reply Date: 2010/08/03

More Info

Navigating a crisis involving a loved one, particularly a child suffering from severe depression and self-harm, can be an incredibly challenging and distressing experience. Your daughter's situation is serious, and it is crucial to approach it with care, compassion, and a sense of urgency. Here are some insights and recommendations based on the information you've provided.

Understanding the Situation
1. Severity of Depression and Self-Harm: Your daughter’s actions indicate a deep level of distress. Self-harm is often a coping mechanism for emotional pain, and the fact that she feels the need to harm herself to "feel better" is alarming. This behavior is a sign that she is struggling to manage her emotions and may feel overwhelmed by her circumstances.

2. Resistance to Treatment: It is common for individuals with severe depression to resist treatment, especially when they feel hopeless or believe that nothing will help. Your daughter's statements about not wanting to take medication or see a doctor suggest she may be feeling trapped in her situation, leading to a sense of helplessness.

3. Threats of Self-Harm and Violence: The threats she has made regarding self-harm and harming you are serious. They indicate a level of desperation that requires immediate attention. It’s essential to take these threats seriously and to ensure her safety and the safety of those around her.

Recommendations for Action
1. Immediate Safety: Your first priority should be ensuring her immediate safety. If she is actively threatening to harm herself or others, it may be necessary to seek emergency assistance. This could involve calling emergency services or taking her to the nearest hospital. In many cases, hospitals have protocols for assessing and treating individuals in crisis.

2. Consider Involuntary Treatment: If your daughter is a danger to herself or others and refuses to seek help, you may need to consider the option of involuntary hospitalization. This can be a difficult decision, but it may be necessary to protect her. Involuntary treatment laws vary by state, so it’s important to understand the regulations in your area.

3. Engage with Mental Health Professionals: It’s crucial to have open communication with her mental health team. Discuss your concerns with her psychiatrist or therapist, and express the urgency of her situation. They can provide guidance on the best course of action and may recommend a more intensive treatment plan, including hospitalization if necessary.

4. Support at Home: While at home, create a supportive environment. Encourage her to express her feelings and let her know that it’s okay to seek help. Help her manage her stress by breaking down tasks into smaller, manageable parts, especially regarding her schoolwork. Encourage her to take breaks and engage in self-care activities.

5. Educate Yourself: Understanding depression and self-harm can help you navigate this situation more effectively. Consider reading up on these topics or joining a support group for parents of children with mental health issues. This can provide you with valuable insights and coping strategies.

6. Explore Alternative Therapies: If she is resistant to traditional treatment, consider discussing alternative therapies with her mental health provider. Options such as art therapy, music therapy, or mindfulness practices may resonate with her and provide a different avenue for healing.

Addressing Your Concerns
1. Impact of Hospitalization: While hospitalization can be daunting, it often provides a safe space for individuals to stabilize and receive intensive treatment. It is not a failure but rather a step towards recovery. Many patients benefit from the structure and support that a hospital can provide.

2. Peer Influence: Concerns about her being influenced by other patients are valid. However, hospitals typically have protocols to ensure that patients receive appropriate care and support. Engaging with peers who understand their struggles can also be beneficial for some individuals.

3. Long-Term Solutions: If hospitalization is necessary, it’s essential to work with her treatment team to develop a comprehensive aftercare plan. This should include outpatient therapy, medication management, and support systems to help her transition back home.

4. Open Communication: Keep the lines of communication open with your daughter. Let her know that you are there for her and that her feelings are valid. Encourage her to express her thoughts and fears without judgment.

Conclusion
Your daughter’s situation is complex and requires a multifaceted approach. It’s essential to act swiftly and seek professional help while providing her with the support she needs. Remember, you are not alone in this journey, and there are resources available to help both you and your daughter navigate this difficult time. Prioritize her safety, engage with mental health professionals, and continue to provide a loving and supportive environment at home.

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