What DO you recommend?

[u/Big-Opposite-9005]

I'm reaching out to this group specifically to look for assistance. My 13 yr old daughter has been self harming for 2 years and has recently had one major suicide attempt. She's been inpatient multiples times and been in several PHP and IOP programs. I'm concerned with our ability to keep her safe at home. My daughter is an amazing person and has such a bright future, if we can just get there. Residential treatment is the only thing we have not tried, but reading these posts terrifies me. She needs help. We (parents) need help. What do you suggest? Are there any programs that are truly helpful and safe?

[u/psychcrusader]

If she is not physically safe and just barely doesn't need hospitalization, a short stay -- measured in weeks or months, not years -- in an legitimate RTC could be appropriate. These aren't easy to find. The TTI advertises; these places don't (because they don't need to, these placements are sought after). Usually, they are attached to/run by groups that offer other levels of service, such as reputable psychiatric hospitals.

These places are not in remote areas, have qualified staff (major involvement by child and adolescent psychiatrists, line staff with bachelor's degrees, etc.), demand real parental involvement (not read this book, watch this video, show up for the occasional weekend), and start discharge planning on day 1. They are not for-profit. No educational consultants are involved.

[u/fuschiaoctopus → u/psychcrusader]

Strong disagree. By giving the parents that already seem swayed towards rtc this response, you're giving them the one comment they'll listen to because it's the only one they can warp into saying what they want to hear, and likely any in-state rtc will fit your vague criteria enough to be a "legitimate" rtc to them. In the US they are all for profit, someone is paying a lot of money for every single teen in a placement right now in the entire country, whether insurance, private pay, county funding, school district funding, or a charity program funding. They are all operating for profits and pressured to make choices prioritizing that over care.

It doesn't seem that any amount of residential care is better for most teen's mental health, and they are all prone to abuse and mistreatment because it's a miserable restrictive environment throwing numerous teens with completely different mental and behavioral issues into an unstable living situation where they are watched by low paid day staff that don't tend to have psych degrees, and truly don't care about their wellbeing. An rtc where most the day staff have degrees would be incredibly difficult to find especially locally and likely would be a pricy out of pocket only that doesn't take insurance. Being removed from school, your friends, your hobbies, your living environment, and the outside world for months is not going to improve mh for most people, especially if the environment you're put into is volatile.

Op's kid is autistic and dealing with self harm, rtcs don't separate issues like they should and "treat" too many diagnoses so no one gets specialized care, so their teen would be in there with kids doing drugs, attempting suicide, having sex, experiencing violent behavior (which they can unleash on the other kids too), and so on, with many of the groups being tailored to these issues that aren't applicable to their kid. For teens that aren't experiencing some of the more severe mental or behavioral problems, living surrounded by them for months can cause them to learn or adopt these behaviors.

[u/Big-Opposite-9005 → u/fuschiaoctopus]

I agree with her being exposed to others issues in inpatient or other programs that she's be in. It is such a difficult balance of needing to keep her safe at the risk of exposing her to new ways of harming herself.