Beacon for FamiliesComplicating Factors
These aren’t being highlighted to avoid or solve, since some may be unavoidable. Having this background knowledge and understanding may help reduce the emotional toll if they occur. Sometimes, advanced planning can take these into account.
Clinical Complexity
Some clinical factors make diagnosis and treatment more challenging
Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD)ADHD and ASD are being increasingly recognized in young adults, and both may complicate regulating emotions and engaging with treatment.
Symptoms may overlap with mental illness, making diagnosis more complex.
Substance UsePsychiatric symptoms and medications may be affected by alcohol, marijuana, stimulants, and other substances.
Sometimes substance use comes before a mental health crisis. Other times, it's a coping mechanism. Mental illness, drugs, and withdrawal may all cause similar symptoms. Since these concerns frequently overlap, they are often assessed together during crisis evaluation.
TraumaPast or ongoing trauma may complicate emotional regulation and make it harder for the young adult to seek help or trust the treatment team.
Trauma responses may overlap with other symptoms, making assessment and treatment more complicated.
Treatment Complexity
Medication ManagementPsychiatric medication is far from an exact science.
Even when the diagnosis seems clear, it often takes trial and error to find the best medications for each person. If the diagnosis is unclear, the process could be even longer. Side effects may hit each person differently. Caregivers may help by showing patience, validating the young adult’s emotions, and encouraging them to stick with the often frustrating process.
Insight and AwarenessThe young adult may have varying amounts of insight into their illness.
- Serious mental illness may impair a person’s ability to recognize that they need treatment. This is called anosognosia, a neurologically based lack of insight. If the young adult refuses to accept care, that could be driven by the illness itself. However, disagreeing with diagnosis or treatment plan can happen for multiple reasons, and does not always mean that the young adult lacks insight.
Delusions Involving People or InstitutionsPeople who were once seen as safe might now be seen as threatening, but trying to disprove delusions may increase mistrust.
Instead, it may help to validate the emotions involved. For example, acknowledge how scary or upsetting the situation feels, but don't debate the delusion itself.
Questions About a DiagnosisSome patients have concerns about a particular diagnosis, and diagnoses may change over time.
It often helps to focus on treating symptoms and finding shared goals rather than debating a diagnosis.
Impact on Daily Life
Mental health crises may destabilize the factors that help you take care of your basic needs.
Daily FunctioningKeeping up with your housing, school, job, and other responsibilities while in a crisis may be difficult.
Evictions, bad grades or academic suspension, bad credit, and other serious consequences are possible, and may make it hard to relaunch after symptoms improve.
Financial and Insurance IssuesExpenses add up quickly during a crisis.
Insurance deductibles, copays, medications, outpatient care, residential programs, housing, tuition, transportation, legal fees, and lost income may lead to debt. Prior authorizations may delay care, claims may be denied, and coverage often depends on whether a provider is in or out of network.
Relationship StrainDuring a mental health crisis, relationships shift, and it's natural to feel strain.
Caregivers may fall back into roles they thought had ended, and young adults may struggle with needing help at a time when they expected more independence.
Reduced contact, or no contact, rarely has a single explanation. Common factors are interpersonal conflict, influence from a partner, family conflict after a divorce, professionals working with limited context, symptoms related to mental illness, or distorted beliefs. Caregivers may replay memories and question themselves. Some self-reflection is valuable, and it can help parents to understand their role in the relationship and how different views of the same situation can be true at the same time. But it is helpful to also recognize when mental illness may be affecting perception.
Transitions in CareAny time the young adult moves between levels of care (for example, from the hospital to a PHP, or from an IOP to an outpatient treatment team) or from one clinician to another, the transition may introduce some complexity.
When transitions don’t go smoothly, caregivers may need to step in and help. Waitlists, transportation, even housing, medications, and safety in general may sometimes fall on the caregiver. Advocate for assistance from their former/new providers and use community resources to help.