Dear Dr. Wes & Julia: My daughter has always been a good student, popular and well-adjusted growing up. Now that she's past 18 she's beginning to have mental health issues. She is severely depressed, cutting and tried to commit suicide a few days ago. How do we as parents help her? According to the legal system she is an adult now, and we have no control over treatment or anything. I am grasping at straws here and need to know how to help her and show my support.
- Online chat participant
Julia: In this kind of situation, your immediate involvement is necessary - don't make suggestions or try and let her do it herself; get her help. Once she is in a more stable mind-set, figure out what is causing these extreme anxieties of hers. The fact that her depression and so-called "adulthood" began at around the same time doesn't seem like just a coincidence. I wouldn't suggest saying "you're too immature to be on your own, move back in" but try to figure out what is causing her extreme behavior - maybe taking on too many things at once, having relationship or friendship troubles, anything difficult she is trying to deal with alone - and offer to help her get things back under control. She could be nervous about supporting herself and taking on the endless responsibilities that adulthood holds, or she may not be quite ready to be completely on her own. Your daughter may be living on her own, but she still requires help dealing with her problems.
I would advise that you intervene with her immediate troubles and get appropriate help. Then, talk to her about how life on her own is going. If you just listen to her voice her experiences as opposed to directly asking what is wrong, you might get a better perspective on what is causing her problems. In the end, she may just be very stressed or have more serious diagnosable problems. Either way, she still needs your help as parents. The legal system may call your daughter an adult, but being 18 doesn't automatically take someone out of their parents' care.
Wes: In our profession these are not uncommon cases and they seem to be on the rise. They are, however, particularly difficult given the age and severity you describe. A major cause is arbitrarily setting the age of majority at 18 - despite the fact that kids aren't even out of adolescence until age 20, and not at full psychological development until about 23. For most young people, that poses little more than a rough patch on the road of life, and I'm not suggesting we need to change the law. However, for troubled teens and young adults, years 18 to 21 are a precarious time in which they have almost all the rights of the majority yet none of the maturity.
The law sets a very high standard even for what we refer to as an "outpatient order of commitment," much less an actual hospital commitment. In fact, young people 14 and up in Kansas have the same rights of refusal as the majority. However, the principal standard for overriding anyone's rights is the danger he or she poses to self or others. The problem is proving that to a hospital screener, whose job it is to filter out all but the most severe and risky cases or a judge whose job it is to balance the individual's rights and safety. Based on what you've noted, your daughter has posed this level of risk. If you haven't done so already, be prepared to push the issue hard at the next incident.
Though we're seeing even earlier onsets now, this is still the age when serious psychological symptoms tend to appear. Those you describe could fit with either bi- or severe uni-polar depression, or an emerging personality disorder. Only a mental health provider could really figure out which, and because of the turmoil your daughter is in, even that will take time and several contacts.
If you can't get some form of commitment, the only real shot is working to maximize your influence over your daughter through other means. Many families bring their young person into treatment with the understanding that the parents will pay the bill, help keep them afloat, let them live at home, etc., as long as they participate. If they refuse, things get dicey, but if the parent holds firm and the kid doesn't find an alternative income source or living space (use your imagination), this often works. Sometimes a lot of pressure is necessary, and in other cases, a gentle approach is best. And of course substance abuse and addiction complicate matters tremendously. But typically distressed young people want help, whether they will come right out and say it or not. I've seen many of these cases that seemed terrible at first, and then turned out okay in the end. Hang in there.
Next week: It seems impossible that another Double Take year has passed, but next week we say goodbye to Julia Davidson and hear her thoughts on entering the senior year of high school.
- Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. Julia Davidson is a Bishop Seabury Academy junior. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues (limited to 200 words) to firstname.lastname@example.org. All correspondence is strictly confidential.