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Reply #103: "The kids definitely don't mean what the adults insert into the exchange." [View All]

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vickitulsa Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Jul-23-06 04:11 PM
Response to Reply #70
103. "The kids definitely don't mean what the adults insert into the exchange."
True, but as to whether a child's comments might indeed indicate a state of mind we should be concerned about, well, that's another and somewhat separate issue. IMO, it all depends on the child and the circumstances of his or her life, what s/he might be overhearing these days in adult conversations around him/her or on television, and so on.

I'm not surprised that this subthread got some serious attention. The last fulltime job I held before my disability forced my retirement was for a "managed care management" company in Dallas. Putting it as briefly as I can, what that sort of corporation does is hire a bunch of office types, the usual, plus a psychiatrist or two, a half-dozen psychiatric nurses with many years of experience, and of course, a support staff. Then their clients (such as Prudential and other huge insurance operations) hire that company to do all the evaluations of claims of their customers who have bought policies providing them (or so they thought) with psychiatric care if and when needed.

Well ... of course our main purpose was to make our customers, the big insurance ops, happy by helping them save money. So what they really wanted from us was to find technically legitimate and legally defensible ways to DENY CLAIMS to their customers!

We had a "hotline" which was a number given out to all the customers who'd bought the insurance and which these psychiatric nurses manned. At least two of the nurses had to be on call 24/7 for suicide/homicide threat calls, and all six of them stayed very busy (read "overworked") during "regular business hours" with calls of every type, extreme and not-so-extreme.

Once the insurance customers filed their claims as they sought treatment for themselves or their family members, it was up to our staff to turn over every stone we could to evaluate the situation and give our client the ammo they needed to deny the claims. Or in a small percentage of cases to honor them.

I was an executive secretary in the support staff but was actually working mostly for the top exec in our regional office; and because I had a psych major background, lots of experience in the field, and could also take shorthand and type 130wpm, I was assigned the job of taking minutes at committee meetings. The scariest and most stressful task of the many I performed on a regular basis was taking minutes at the "High Risk Committee" meetings which were held once a week. These were attended by the staff psychiatrist and the nurses who weren't left to man the hotline, plus exec types and at least one "observer" from our client list of the big insurance companies.

What we did in those meetings would scare the pants off of anyone who believed they had purchased protection in the event they had a psychiatric problem serious enough to require treatment -- often emergency treatment. Mainly we had to justify the denial of initial claims or the termination of claims that had been approved for payment for a time, so that our clients would be legally protected if, say, someone whose claim was denied subsequently committed suicide or killed someone else!

I tell this to alert people here but also to respond to the posts in this subthread. Because in my two years at this company before the stress and disgust caused me to resign and move back to Tulsa, we had many cases for which I typed up denial letters that simply drove ME nearly insane with outrage!

ONE of those cases was a nine-year-old boy whose parents had discovered a suicide note in his room, and they were very concerned about whether it might be possible that he was actually serious about it. After much evaluation by our staff, it was determined that this young boy was intellectually gifted, had been depressed for at least three years already (major depression, multiple episodes), and was quite calmly serious about his planned suicide. He exhibited all the indicators: he had the ideation (thoughts of suicide), the plan, and he had obtained the means to carry out his plan -- all even though he was only nine f'ing years old!

This was one case that was NOT denied. Probably only because it would have been legally indefensible to do so, but at least the child received treatment. I have no way of knowing how it turned out for him, of course, but I've never stopped thinking about him. I READ HIS SUICIDE LETTER, and it was so chilling I just shivered as I typed this, remembering my initial reaction.

So without pretending I can "counsel" anyone here about their children's scary comments, I just wanted to give this "sample alert" from real life. If a kid has suicidal ideation -- mentions it, asks about it, seems to be feeling really down and talks about doing it or about friends who have done it or considered it with them -- that's a reason to pay attention. If you discover a child has a PLAN -- could be expressed in scribblings on school notebooks or overheard when s/he is talking with visiting friends -- you can believe s/he is getting serious about it.

And the third, critically worrying thing, if a kid gathers the "tools" or equipment or drugs that would enable him or her to actually follow through on a plan, then intervention is necessary to prevent a death or at least a devastating attempt. Noticing that a particular upcoming date seems to be extremely important to such a child would be a four-alarm flash meriting an immediate hotline call or a trip to an emergency room without delay.

I don't wish to scare anyone needlessly, obviously! Actually, I'm just trying to do the opposite -- to ease some worries that scary comments made by a very young child might cause. The comments might indicate suicidal ideation, but nothing more alarming than that. It would still be a good idea not to ignore such statements, I would think, but I doubt a child would go from exploratory comments about suicide to making an attempt instantly.

(It might also be important for people to be aware that, contrary to popular belief and for either children or adults, repeated statements about suicide or threatening suicide ought NOT to be treated as inconsequential. Rather, it's been shown that those who threaten suicide repeatedly do very often end up attempting it, not the opposite as some think.)

Anyone here at DU who is an actual shrink and who can confirm or correct my commentary is very welcome to do so! I don't usually give out "advice" in a venue like this for sure, but I view it simply as information; and the original post in this subthread concerned me enough for me to at least try to offer some (hopefully) helpful input. If what I've said is NOT helpful, then just discard it! :)

I was going to respond after reading Will's OP by saying "thanks for the nightmare material," but I see others have done that in abundance, so I'm offering this instead.


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