Mental Health and Addiction - Understanding Dual Diagnosis

Hello and welcome. So today we are going to talk about addiction and dual diagnosis and what exactly is a dual diagnosis, how can it complicate your therapy for mental health, et cetera? So mental health is a really vast issue. There are a lot of different angles to it. Last week we were lucky enough to have a member from Take 6 and his wife talk about pediatric mental health and what occurred with them and their sort of journey through this with their child. And this week we're going to delve into addiction. And specifically, um, we're going to deal with uh addiction and how it can complicate things. So, first, let me start off with a conversation around addiction because there are a lot of different things you can become addicted to. If you really want to know all the strange things you can be addicted to, there's a show called I'm Addicted to Strange Things. And that show actually goes over all the various things you can become addicted to. But I'm going to go through some of the main things that we see in our community and that impact our family and our loved ones. So the first one is the most obvious one, which is drug addiction. So drug addiction actually leads to uh overdose deaths, and we have about 108,000 people a year in America that die from drug overdoses. Um, and about three-quarters of those drug overdoses are opioids. And you know, I often have people say to me, What is an opioid? So I'm gonna go over what is an opioid. So an opioid is heroin. An opioid is morphine. You can also have synthetic uh uh opioids, and by synthetic, that means it's man-made. It can be made in a kitchen or a factory, it's not naturally occurring in the environment, it's actually man-made. So those types of um uh opioids are fentanyl, which people have heard about. Tramadol, we have a lot of family members that are on tramadol, and they do not know that that is an opioid. So tramadol is an opioid, methadone is an opioid, carfentanyl is an opioid, and you will hear more about carfentanyl because carfentanyl is sort of a more potent form of fentanyl. So, if you want to know how potent carfentanyl is, carfentanyl is used in veterinary medicine when you want to put down, like, let's say, an elephant. Okay, that's what carfentanyl is, and it's sort of entering into the streets. Some people call it fentanyl, but it's carfentanyl. When you look at things that are synthetic, whether or not it's fentanyl, carfentanyl, um, these are 50 to 100 times more potent than morphine. Um, and they have a higher risk of overdose. Um, we do use fentanyl in the emergency department for uh therapeutic use at very small doses. Uh, when we are doing things like um dealing with hip fractures or shoulder dislocations or hip dislocations, et cetera. So that's kind of what an opioid is. And what happens with opioid addiction is when people try to stop using, or when they stop using because let's say they get incarcerated or they don't have any money anymore, they kind of get excessive drowsiness, and we've, you know, they call them the druggies on the street kind of dozing. Um, they get nausea, vomiting, diarrhea, abdominal cramping, uh, muscle pains, and excessive craving actually to use the drug again. And the treatment for opioid addiction is there's a medic medication uh therapy. Uh, it can be either methadone or suboxone or also called buprenorphine, um, naltraxone. These are all medications that are prescribed to actually kind of get someone through the withdrawal process. And once they're no longer having the excessive cravings and the abdominal pains and the diarrhea, then they can really focus on cognitive behavioral therapy, support groups, and actually really looking at, you know, what was going on in their lives that led them down this path and how to actually recover from it. A lot of times with uh opioid addiction, you hear a lot about people talking about Narcan. And I want to just talk the most publicly known case of Narcan is when uh Prince had to emergently land his plane. I don't remember exactly where he landed it, and he was administered Narcan. That's probably the most publicly known uh case of it that we've had in our recent history. So Narcan is very interesting in that it's, you know, it's considered to be a life-saving drug. It's been around for a very long time. Someone can be in the process of overdosing, and it can basically take all the opioids off the opioid receptor, and literally the person will literally come back to life. Like literally they'll be out and unconscious, and we give them the Narcan and they literally wake up. Um usually they get uh they wake up and they're mad at us uh and they're cursing at us uh because we have messed up their high, right? And so um, although we save their life, we don't necessarily get a thank you when that happens. Um but the other thing to know about Narcan is that um Narcan can really um make patients more likely to overdose. So I don't know if everyone remembers, but when Prince landed his plane, about 30 days later, 60 days later, he was dead. And so one of the things about Narcan is it's really important if you use Narcan or if you have a family member who has had Narcan used, that they immediately get into some sort of rehab and some sort of treatment and get on some sort of medication-assisted therapy. Now, there are other drug addictions: cocaine, ecstasy, ketamine. We've heard a lot about ketamine. We've heard about ketamine related to Matthew Perry from friends who died of a ketamine overdose. We're hearing about ketamine today related to Elon Musk. Um there's marijuana, K1, LSD, um uh MET, I mean, there's just all sorts of things, but opioid is probably the biggest category as far as overdose and death. Now, the other big addiction that we're seeing, and we're seeing this more and more and more, particularly now that this is on our phones, and this is gambling addiction. Gambling addiction affects about 1% of the population, has severe gambling addiction problems. One of the things about gambling is it has a very, very high suicide rate. Um, and so if you have a family member struggling with this, um, it would be really important to actually get a handle on this. There is a preoccupation with gambling. They are always gambling on everything. Um, they want to increase their bets. There's lying and hiding about uh gambling. Um, there's usually also jeopardizing uh relationships or jeopardizing their finances. There is a uh Game Gamban, G-A-M-B-A-N, which is an app that will block all gambling sites from your phone if you have someone that's uh struggling with this. And then there's Gamblers Anonymous and other cognitive behavioral therapy. Then the other category, big category of addiction that I wanted to really uh talk about, there's two more, um, sex addiction and porn addiction. So, you know, we've probably seen this more porn addiction. Kirk Franklin talked about it, that he was um addicted to porn starting at the age of eight years old. Then there's also sex addiction. And what these kind of look like is compulsive thoughts around sex or pornography and inability to control their behavior. And the main thing is that oftentimes these patients will have negative consequences. So they will have negative consequences like maybe an arrest, or um maybe they'll be involved in a sting accidentally, or maybe they'll be arrested in some sort of situation with a prostitute, but their behavior continues despite those negative consequences. And so that's kind of like where we see folks with uh sex addiction and porn addiction. I've got a lot of questions around this uh related to what we're hearing about the P. Diddy trial. And as I tell everybody, I have never met P. Diddy, I have never examined P. Diddy, but certainly there is something there that requires investigation. Next type of addiction is food addiction, and this actually impacts 70 million people in the United States. Um, this is a big one. Um, and this is, you know, eating even though you're full, having very, very intense cravings. Like I have to, have to, have to have to have some ice cream, right? And going out for that. Um, also, a big part of food addiction is feeling guilty after eating. So maybe you eat the whole pint of ice cream and then you feel really guilty. Um, or you, you know, I know one of my one of my things when I was younger was I don't know what it was, I used to eat the whole box of vanilla wafers. Vanilla wafers was like my thing, right? And it is it can be very, very difficult to actually um um get over this. Um and some people uh to deal with this actually go to uh Overeaters Anonymous and all of that sort of stuff. Um and and it, you know, I think whatever you're dealing with is important to get a support group around it. So what I want to talk about today is how do addictions and mental health, I want to talk a little bit about that intersection, right? So, you know, we consider it to be someone having a dual diagnosis when they have a mental health disorder, and on top of that, they're using some sort of substance, right? So it could be that I'm depressed, so therefore I use cocaine. Um I have thoughts in my head, so therefore I use marijuana, right? So what happens sometimes is um the use of these medications can be used instead of going to the doctor and getting prescription medication, or it can be used in addition to going to the doctors and getting prescription medication. And how it sort of complicates things is one is a lot of times um patients will not tell us this, right? So on almost all patients that come through the emergency department for any sort of mental health treatment, we always do a urine drug screen all the time. Like I I don't even really ask anybody anymore if they use drugs or not, I just do the urine drug screen and I just let the urine drug screen tell me. Because what they tell me is like, I don't know, I just like Charlie Brown's teacher. Wamp womp womp, like I don't really need to hear it, right? So I just get the urine drug screen, right? And then once I get the urine drug screen, then I have the conversation with them. Okay, I know that you are using whatever it is, marijuana, uh cocaine. Um tell me a little bit about your use pattern. Um, and that will tell me whether or not they actually have a dual diagnosis. Um, it can be pot, you know, it's a little bit easier with drugs that are illegal, like cocaine. It's a little bit harder with things like marijuana or alcohol, because um, are they using it and using it legally and appropriately, or do they actually have an addiction? Right? But in any way, shape, or form, it can actually complicate um a person's uh actual mental health treatment because are there symptoms related to what they're using in the street, or are there symptoms related to their underlying uh disease? So, you know, when someone has a dual diagnosis, it's really important to really actually treat both disorders simultaneously. And um it's really important um that their recovery, that you actually prevent relapse of their addiction and use disorder as well as prevent relapse of their mental health disorder. This all can be very difficult and and and kind of uh is a lot to really sort out. Um the symptoms can be very much overlapping. You know, I wanted to actually bring on we have today um a special guest, um, and this guest dealt with some of these issues um with her with her daughter, and I'm gonna actually uh bring her into the conversation. So let's actually introduce our guest, and I wanna thank uh Andrea for joining us. Andrea is a uh parent of a child who who actually uh suffered with mental health problems and ultimately passed in December of 2017. And I want to thank Andrea for coming on this show and actually um sharing her story and so that it can help others because this is really, really important. We need to understand what's actually happening out there in the community and what to do when we have family and friends in our network that actually need to get help. So, Andrea, welcome. How are you?

I am well, Dr. V. Thank you so much for having me.

Great, great. So tell me a little bit about what happened with your daughter. So so tell just st you can start wherever you'd like.

Goodness. You know, you know, we love Christmas, and Christmas is is the time when when I lost my daughter, Dr. V, and it was December 26, um, 2017, and she was twenty-six years old. And it was um very interesting how how how we lost her life when it comes to mental health. And, you know, it just encouraged by this conversation that you're having on your show today, because many of us as parents, we feel like we're by ourselves and we don't know where to start having conversations with not just friends, but our family about what's going on in our lives, and and then we ended up losing my daughter um to to challenges that she was f facing inside of her health and her mental health.

So in December of 2017, when this occurred, tell me a little bit about kind of what happened before she lost her life. You know, a lot of times people, you know, was there a lot of times people talk about the stigma of healthcare, but was there was there reaching out for help? What was going on with her? Um tell me a little bit about what led up to it.

So December 2017, we're gonna go back. You know, we you look at those television shows, they'll say three months earlier, right?

Right.

At this point, let's go back three months. And this would be um right when school was starting. So end of August and September of 2017, my daughter was was having severe manic attacks.

Okay. Now wait a second. Now now wait, wait, wait. Let's describe uh when you say a manic attack, just so that everybody understands, what tell me the sort of things that you were seeing that made it a manic attack. So people understand what that is.

When they are in a manic attack, they can't we see it, they can't control their behavior. It is everything is urgent, none of it makes sense. They're um seeing things, someone may be following them. They cannot control this hyper behavior. And and we'll get into the early part of her life. We saw that early on when they had ADHD, right? Okay, and so now they're adults and it's now coming into this into this manic or mania.

Okay.

So none of it makes sense to us inside of why they can't reason.

Right. So everything has a sense of urgency, right?

Everything is a sense of urgency. Everyone is there to to come against them, no one's there to help them. Their reasoning isn't it doesn't make sense to us who aren't experiencing what they're what they're in in that moment.

Right, right.

And so what shows up is no one's there to help me, so I'm crazed. And we see it as they're being crazed. Or just what do we say to what do we say, hey, just calm down, settle down. It's kind of one of those things that's the worst thing to say to somebody is to calm down, right?

Right, right, right.

Settle yourself.

Right, right. So it's an agitated, it's a very agitated state, right?

Agitated very, very agitated.

Right. And some people in this agitated state, in a manic agitated state, will go out and buy a car. Uh some people will make these crazy purchases. Um people start cleaning the house nonstop, some people start messing up the house nonstop. Like it's very a very, very agitated, and whatever they want has to be done now. So I'm glad we kind of described that for folks. So so you saw that in August or September.

Absolutely. But even you know what else it shows up, especially for mothers who have children, they begin to hoard their children. They begin to protect these children as if there's going to be additional harm to them.

Okay.

So it can show up as that as well.

And your daughter had children.

And she had children. Okay. And three lovely boys.

Okay.

And what was happening is she knew it when she would go in and out, right? Mind you, in 2017, at least three years prior to that, Dr. V, she would have been, she was diagnosed with schizoaffective, okay?

Okay.

And she had been re she had been prescribed medication drugs, and we can get into that. Remember, I tell you, I'm not a doctor and I don't play one on TV, but I know one of these don't go with the other. And and so what happened is now we're we're three years after she's been diagnosed with schizoaffective, and he is now realizing that, hey, I can't control what's happening in my head. I'm scared that I might do something with my children. Okay to my children and as parents as as her mother. What do you do with that? How do you help that when they're in and out?

Right.

And so what happened at this point, Courtney continued to call the police. She would call the police, Dr. V, because she is asking to be admitted.

Okay.

And so this went on, Dr. V, on a recurring basis every week for almost two months.

For every every week for almost two months, she would call the police to try to get help. To try to get help. Right.

And so wait a second, ambulance out.

And the ambulance would come out. So yeah, tell me what exactly because I think this is really important because see people think that folks have a stigma and that they don't get help, want help. But my experience of folks with mental health disorders is actually completely opposite. I actually find that I actually find that they do reach out for help. So tell me. Yes. So when she would call the police and they came out to the house and the ambulance came out to the house, and and and describe to me, do you do you live near her or are you in a different state?

I'm in a different state. Okay. I have such such amazing sisters and family, and and they would be there if I'm not able to get up there.

Gotcha.

Um, but someone would be there, they would they would get there in time sometimes.

Okay.

When the ambulance is there. So this is what's happening. When we're dealing with law enforcement, we're dealing with paramedics, and they all show up at the house, right?

Right.

And, you know, we talked about, well, you talked about it last week on the show that, you know, law enforcement are not trained for mental health calls.

No.

That is not what they're doing there to do. They're there to keep the peace, right? And and try and cause no harm to anyone that's there. So when this is happening, the best thing for their them to do is to call paramedics. Right. And so what happened is, and I'll never forget this. I'm watching it as I'm telling you, and I'm driving up, and they're literally um taking her on the stretcher onto the parents, onto the ambulance, and she says, Mama, I just need some help. I just hope that they just keep me. So to your point, they call out for help. Are we listening?

Right, right.

Before it goes too far. They want help. Yeah, go ahead.

So what I would would like to do is if you could share with us a little bit about um what occurred when she got to the emergency department, right? Because that's I think that's a piece that people really don't know you know exactly. So so see she did call once a week, and and usually they do send them to the emergency department, which is where I work, right? And so let's talk about what happened once she actually got to the emergency department so that people can actually understand what occurs in this whole process. All right. So, Andrea, you were saying that about four, four months or so before your daughter passed, that she called out regularly for help. Um, and that about once a week she called 911 um to get help. Um, and that, you know, you remember her. Being um on the gurney, um going uh being loaded up in the ambulance, um stating to you that she really wanted to get help. So share with us and walk us through, you know, what what occurred after that.

You know, Dr. V, we know we know at his parents that there's something going on. And when she's on this gurney, she's going to the hospital, she is pleading for help. And when we get there, they are giving her um, you know, an IV for fluids or or uh they've given her another dose of her prescribed medication to try and control it. But what was interesting, I'll never forget this conversation that I had with the law enforcement, and he'd been there a couple of times, and I'd seen him there before. And I said, Well, how how can we get her admitted? Will you guys keep her? She's asking to be kept, not an involuntary Dr. V. This is someone voluntarily saying, Please keep me, help me get better. I can't I don't know what's gonna happen to me.

Right.

And the police tell me, hey, we've seen this before. It won't it this won't last much longer. And I'll never forget that man saying that to me.

So he was basically predicting, he was predicting her death.

Yeah, absolutely. Do I think he meant it to be to be ugly towards me or insensitive? What uh I'm not gonna go into that.

Right.

However, when they are called to the to our homes and we are we are pleading with with help, we're not equipped to handle it with our children. We're trying to get them on the medication.

Right.

We're trying to get them the counseling. We're exhausted because we don't we don't we're not experiencing what they're experiencing.

Right.

But when they are calling out for help, I I plead with our parents and our family and our friends to do what we can to try and help them.

Right.

And these are things that they can't control.

So why do you think that she did not get the inpatient help? So if she's voluntarily willing to go into an inpatient mental health, she was trying and trying for four months before she passed. Do you think that do you think it was discrimination? Do you think it was because of maybe insurance issues? Um, do you think that people weren't taking it seriously? What what do you think was the reason why all of these cries for help were not listened to?

First I will say insurance, because she's she's not insured for that type of coverage, right? And who's gonna foot that deal, Dr. V, Dr. V, as an adult person, right? Right.

So she was uninsured or was she uh on an insurance that insurance that gave you difficult that gave you problems?

She you she would she would have been uninsured.

Okay.

All right.

She would have been uninsured.

Okay.

Underinsured. How about that? Underinsured. Okay. Um you know, so so that so there wasn't insurance coverage for that type of inpatient um uh care.

Okay.

And so what they would do is they would stabilize her because oftentimes our loved ones are gonna show my daughter showed in many, many points of her day that she she could manage. She's in her right frame of mind. Right. So if I'm showing that in the hospital, and again, you you're in the emergency room, Dr. V, so you you answer that. They can say, hey, they look like they should be okay to go home. There may not be a room available. There's no insurance to take care of this. Put her back on our meds and send her back home.

So, so so well, yeah. So let me actually, so let me actually go, let me just go over a little bit how that process works. And I've I've worked in several different states, right? And so, you know, we do actually first do a medical clearance, right? We do labs, and we also do a urine drug screen to see whether or not there are any drugs in anyone's system and to see whether or not there's any medical reason for the particular symptoms that they're having, right? So once someone is medically cleared, and if they decide that they want to actually go into a voluntary commitment, um, we have them sign paperwork and then they do a bed search, right? And so we do have people for whatever reason, and sometimes it's because they're a dual diagnosis patient, where or sometimes it's because of insurance issues, where there's no bed available. Right. And then the decision is made, well, um, can we move up their appointments, their outpatient appointments? Um, can we adjust, you know, can they see a psychiatrist in the emergency department? Um, and can we adjust their medications a little bit? And are they safe enough to go home? Do you do you know that she did she ever, you know, what did they even do, I don't I don't know what state I I don't know what state your daughter was in, but did they uh did they even get as far as doing a bed search?

I don't I don't believe that they did. And and so even even hearing your protocols, and again, we we don't know this as the as the as the patient, as the family, you know, it it's good to hear this more on your side of what you're doing, right? What the hospital is doing and the care. What we see is why can't you help them? That's all we're saying.

Right, right, right. That's it. Right.

And you mean to tell me that they're asking you for help, and all you're telling me is I'm gonna send them home on their meds? Well, we know what happens with the meds. For my daughter, who's who's a young mother, and you know, she had her own business, Dr. V. She was she was an amazing girl. And and she couldn't function on the medicines. You know, she's you know, she's on the, you know, look, uh uh uh alazepine and and she's on these other medications, you know.

Right.

And she can't function. She says, Mom, I can't take care of my kids. It's gonna make me stay in the bed all day. Right, you know, and and then what it does is that if they already have some precursors to or, you know, of some autoimmune disease, it might be Crohn's. She was suffering from Crohn's as well. She was dealing with that sciatic nerve as well. So you're complicating things, Doctor, Dr. V, with hey, I'm trying to take care of my kids, I don't physically feel good, and I'm dealing with the schizoactive, and I gotta take medication. I'm overwhelmed just explaining it.

Right, yes, yes.

You know, so what do you do with that? And so when she was taken to the hospital, every single time, Dr. V, they would release her.

Every single time they would release her.

Every single time they would release her.

Can you share with me what state was she in? I'm just kind of curious.

She was in Oklahoma.

She was in Oklahoma. Okay. Okay. It is absolutely so so it is absolutely more difficult to get care in a red state. I hate to say that, but it's true.

You know, the the evidence is there. Even with me making a calculated um, I put a team together, right? I put her landlord together, I put a hospital together, I went and found her a room to put her in. I went and got a uh a psychiatrist to come meet me at the house. And so I said, this is what we're gonna do. If she calls again, okay, we're gonna, if if she calls again, everybody, we need to have a team in place to get her out the house to get her admitted.

So, so so a couple of things. Do I have a caller on line two? Okay, yeah, I'm sorry. Uh I've got a I let me let me take let's take this call. We've got a caller on uh uh line two, uh, Brother Brown.

Um, Sister Andre, I'm so sorry for your loss. Um, I can feel the pain in your voice, but you are a trooper, you are making it through. And Dr. V, thank you for um having this uh type of platform. Um, but my question is when one is admitted to a hospital, and if they think they want to harm themselves or somebody else, they automatically are on a suicide type of a watch. And they automatically supposed to keep them at least 24, maybe 48 hours.

Yeah, so you're talking about um a 72-hour associated a 72-hour hold. Yes, associated with mandatory. Right. So so a couple of things. So when she called 911, Andrea, was she attempting to hurt herself or was she having problems with her activity of daily living?

Activity of daily living. So so he has a good point. Yes. So they're gonna ask the questions are do you feel like you're going to harm yourself? Do you feel like you're going to harm others? Should they say no?

Right.

And that, you know, then then they've taken they've checked that off. They're not gonna harm anyone. They don't feel like they're going the the the the you know that spirit, that activity that's going on in their head may not be present to say, yeah, I'm gonna do this, or yes, I'm gonna do this to someone else. So there's the answer no. Right. Go ahead.

Yeah, so I was gonna say, so there's a lot of people who have problems with activity of daily living. They're not taking care of themselves, maybe they're not paying their bills, maybe they're not taking a shower, maybe they're not combing their hair, maybe they're not going to work, and their their their mental health disorder does not actually um present itself as I want to kill myself or I want to hurt or kill someone else. It could just present with I can't take care of myself, right? So we see that with the homeless population, right? You can't go around and lock up the homeless people for 72 hours because they're not suicidal. They're just not able to actually create a stable home, go to work, and do those sorts of things for themselves. So um so so Brother Brown X, does that does that explain it to you?

Well, well, no, but that boy, hold up now. But and Andrea, you said she she called about eight about eight times.

Mm-hmm.

You know, eight eight times or eight a a month. So I'm just saying, and the hospital's familiar with her. And I don't know, I don't know. I would have it's you know, that, you know, if you go underline with that, it was more than that, the activity to me. Now I work in a hospital myself. I'm just more um and that was that would been my intuition. It's little more deeper than I'm gonna buy a car or I'm not gonna pay a bill. Because you have children at the house. And when you have children, that means if you do something that might come through neglect of those children. And we're talking about three babies. Okay, um, that's all I wanted to say.

So so Andrea, let's let's let's so great qu great, great, great uh uh Brother Brown X, thanks. So so let's keep on going with that. So Andrea, what did they what did they do related to the children?

Absolutely. And and and Dr. Brown, I uh uh you know, to your point it doesn't make sense. None of it makes any sense.

Right.

And and if she's being released and whatever these protocols are at this hospital at the time, that's what we had to deal with. Right. And so as this continued on, and again, if she's saying I they allowed her to function as a as a decision-making adult, even to the point where I am physically there and the and the police are in her home and they say your mom is standing outside, she wants to see you. Can she come in? She tells the police no. So the police say, Well, she said no, she knows what day it is, she's in her right frame of mind, I cannot let you in the home.

Right.

Now, 30 days prior to her di her passing, her third, you know, she began, as I described before, that she they begin to hoard the children.

Right.

So my daughter quit sending the children to school. So this is November 2017.

Mm-hmm.

At this point, I'm trying to get a hold of her because as she has locked herself and the children in the home in the home. So now we're getting to the point, are you going to cause harm to yourself or others?

Right. And what did they and what did they do?

And so, Dr. V, this is what happened. I was out of town and I called the her school, the children's school. And I say, I need somebody on the phone, and I get the um assistant principal on the phone with me, and I say, Listen, I need you guys to do a wellness check. I can't get the police to go over there and do a wellness check. My daughters, I answer in the phone. I said, You see that the children aren't there. So I'm calling everybody I can, Dr. G, to try and intervene on her behalf. I call the school and I finally get to the assistant principal. She says, I can't do it. I said, I'll tell you what, she can be mad at me, but I need you to do the wellness check. She says, I can't intervene that way. She says it to me two or three times. I said, I need you to talk to me as your girlfriend, your sister, and those are your children sitting in there.

Right.

And I need you to send the police immediately. And she says, I'm on it.

Good.

Had she not sent the police from the school to do a wellness check, we don't know what would have happened.

Right.

D can I sit here and say she would have done something to herself or her children? We don't know, but I know that she was hoarding the children.

Right. And what happened as a result? What happened as a result of that with the children? Did the children stay in her care or what happened as a result of that?

So immediately after that, so this full day I'm going, me and the principal are going back. The police go over and they knock on the door and they finally set a police. So now it's now the school district is involved.

Right.

They set a police out in front of her home. This would have started about 10 o'clock that morning. It went until probably midnight. So all day. All day. They finally got caseworkers, okay? They finally got a caseworker out there. And the caseworker says, Hey, we gotta remove the children, but she won't open the door.

Mm-hmm.

I said, okay. And this went on all day. The police knocking on the door, the caseworker knocking on the door. How do we get her to open the door?

Right.

Well, she finally does open the door. She knows that they're going to take the children. She's in and out of the manic all this time.

Right.

And she says, Well, the the caseworker says, Are you here? Is anyone here? My sister wasn't in town. I wasn't in town. And I knew that they had my grandchildren had to go into foster care. But I will say that that was one of the best things that ever happened. Right. Out of all of it.

So so this so so wait so I just want to just uh because this actually brings up a good point. Because what they will sometimes do is take custody of the children, but then the parent still doesn't get help.

The parent still doesn't get help.

The parent still doesn't get help. And I and I want to just wait, I just because I looked this up as you were talking because I wanted to find out what was going on in Oklahoma. In 2017, Oklahoma had not expanded Medicaid. I don't know if your daughter was so so it Medicaid was not expanded, right? So so if you so that means that she most likely didn't actually meet the criteria for those expanded services under Medicaid. If she was owned her own business, then it'd be whatever health insurance she could actually purchase on the free market. When you actually go to uh states such as Oklahoma, Texas is also another one. I had a family member impacted in Texas. They can buy uh medical care where it is uh they call it um critical care only. Like it only cut covers medical, medical, medical hospitalizations. You can buy very, very cheap insurance, and some people buy it because that's you know, and it doesn't it doesn't cover mental, it doesn't cover mental health. When you expand under Obamacare, you actually then get all access to all of these uh services. And this is a really important discussion for what we have going on now, where we're actually trying to take people off of Medicaid and what can happen with their services. So I just wanted to actually I did look that up while you were talking. So tell us. So after they took the children, um she was still calling out for help and didn't get it?

She's still calling out for help. And so as I'm telling this story and and we're going through what happened in this time, we should we don't know this, Dr. V. Right. The average person doesn't know that. They don't get an extended here. Yeah, so I I again I am grateful for the the insight, but that this average person, our neighbors, you, us, we don't know that this is available or what's not available. Right. All we know is we're in a crisis. Correct. That's what we know.

Correct.

And I need some help. And I need you to tell me what I'm supposed to do. Help lead me where I need to go get some help. Right. And you got a person who is crying out for help, and you can't help me.

Right.

And so they take the children and they and and and so grateful. They were able to keep the children together. They found a beautiful home, a lovely family that took that took the children, and guess what? They left her in the house. And so, I believe probably two days later, she calls again, and they finally keep her in the hospital. They finally admit her.

Okay.

So they admit her, and this at this point, we are now a week before Thanksgiving. Right? And so they kept her for let's I I want to say just a few days.

Okay, in an inpatient in an inpatient psychiatric center or in the inpatient psychiatric center. Gotcha.

Right. And so now they they let her out. So to the caller's question, they they did eventually feel as though her life was in har would be would be in harm or otherwise. The children have been removed, but they allowed her to be admitted.

Right.

And so in that, she gets out, and I tell you what, and within 30 days, my daughter was gone. She was heartbroken. And and you, you know, we talked about, you know, whether it was suicide or not. I tell people, God put her to sleep. And she was heartbroken. She was heartbroken that whatever's happening with me, mama, why didn't you get me some more help when I was younger? Why didn't you see this going on with me when I was younger? She asked me this question. And again, I'm asking your listeners to listen.

Right.

Don't, don't, don't blow it off that oh, he's just crazy. They're not.

So so so let me ask you this. What did you see when she was younger?

When I she was younger, I and I tell people this, you know, in my work, you know, what happened to your child at three, five, seven, and nine? There's traumas that happened. There's breaches that happened, Dr. V. And and at around five, Courtney was showing um just this uncooperative side, that bad kid. I'm not watching her right here. Right.

Was she diagnosed with anything?

She was diagnosed with oppositional defiant disorder.

Okay.

And as a parent, you're like, well, what is that? I know what ADD is, and I know what ADHD is. And they're like, okay, well, you she doesn't fit the boxes for this. So what boxes she does fit is this.

Right. So so let me just actually let me just because a a lot of a lot of a lot of our listeners may not actually know what oppositional defiant disorder is. And so let me just kind of go through that. And it's interesting that you use the word five years old, because five years old is actually the time period where most kids get diagnosed with oppositional defiant disorder. Um and it is an extreme rejection argumentative of authority. So these kids uh they'll lose control of their temper, they're easily annoyed, they're often angry and resentful. What's important is they will deliberately annoy or bully or attack other people, they blame others for anything that happens to them, um, they are extraordinarily vindictive. Right? If they're less than five years old, this happens most of the days over a period of six months. If they're over uh five years old, then this may happen sort of once a week, right? And it impairs their ability to even have um friends at school, um, it impairs their ability um educationally, um, it impairs a lot of areas of functioning, right? And what happens is if the severity is diagnosed based upon how many settings does it occur in. Does this occur only at school? Does this occur at school and at home? Does this occur at three or more settings where this child is like this in almost any setting? So that's the diagnosis and that's some of the criteria. Five years old is a very pivotal age. So tell me what you were seeing with her. And I know we're we're we're kind of coming to the top of the hour, but tell tell me quickly what you were seeing with your daughter at five years old.

I'm seeing if I don't get my way, we call it a tantrum. If I don't get my way, then I'm just gonna fall down and just throw myself into a wall, or I'm going to scream at the top of my youth my lungs.

Right.

And I'll never forget where I I knew that something's going on. Not only did you not just do it with me, and as parents, we have to watch this behavior. Do they do it with others? To your point. They're like, okay, well, they don't discriminate. You know, she she got an attitude with everybody. That's what we call it, right? She got an attitude with everybody. But she's five. How's she got an attitude with everybody?

Right, right.

But now, mind you, she was a sweet girl. Now, don't you don't get me wrong, she's a lovely girl. But when she was at school, and that teacher is saying, Hey, I can't do nothing with her. You gotta come get her. You gotta come get her. She can't stay here. She just threw herself down the stairs. Right. She just threw herself down a flight of stairs.

Right. It will usually, they will usually act out to the point of causing harm to themselves, whether or not they bang their head in the wall, yeah, or throw themselves down the stairs, or hit a wall and break a. Sometimes they hit a wall and they'll break their, they'll literally break their metacarpals, the hands and their bones from breaking a wall. So it's it's a very extreme. So I don't want anybody to think that this is just a bad child. This is an extreme.

There is something going on, and it doesn't happen all the time.

Right.

And again, I I just encourage your listeners to not put their head in the sand and say that, oh, there's nothing wrong, oh, they'll grow out of it. And you may have brilliant children, smart children, creative children. Absolutely. Number one, we can't treat them all the same, right? Right. They're all unique in their own special way. But I just encourage our listeners that when you see it, you know what they say at the airport, right? When you see something, say something. Right. Yes. I just encourage yourself to seek understanding what's what's happening with your child.

Right.

Because oftentimes there's evidence there. For my daughter, even though she would have grown out of that behavior, now I'm going into junior high, now I'm dealing with, you know, adolescence. It it changed into something else. She was a beauty queen. She was a typical teenager. Right. But it it shifted, okay?

Now, now, in it when she when she was younger, from five years old to going into high school, was there any interface with the mental health community or treatment or medications or anything, or you kind of just struggled through it?

Well, I I you know what? I learned how to to manage her personality. Okay. So during that time, Dr. V, there wasn't a medication to put her on.

Correct. So a lot of people don't okay, so wait a second. A lot of people don't realize oppositional defiant disorder, there is no medication. I'm glad to bring it. I'm glad to bring it. I'm glad you I'm glad you brought that up. It does require a lot of cognitive behavioral therapy. It can be very, very tough, even to this day.

Absolutely. I said, Well, honey, I didn't all I could do was what I could do. I I tried to give you coping skills. We tried to learn how to deal with the behavior. We worked through, we worked through how to put a um some patterns and some habits together.

Together, right. And and I want uh I want our listeners to realize that your when your daughter died in 2017, how old was she?

She was 26.

Okay, so this was so this was 30 years ago, right? W if she was five years old, this was 25, 30 years ago. Um we're and we're getting towards the end of our show. Is there any quick, very, very quick uh thing you want to actually tell people?

I want to tell people don't don't fool yourself. And it's okay to be honest with yourself and your family. I want you to if if there's help that needs to be sought after, to seek the help.

All right.

Do not be ashamed. Do not be ashamed.

Awesome. Thank you.

Those who are family members, don't don't shun them.

Absolutely. Embrace them.

Embrace them.

Absolutely. Well, folks, that's a wrap. I I really appreciate uh Andrea you coming and joining us today.