Is It Useful To Ground A Twenty-Year-Old?


“Is it useful to ground a twenty-year-old?”

This is the question that came up while talking with a Dad this week. He has a now twenty-year-old daughter living in his house, and she doesn’t do anything he asks of her.

We’re not talking about your average defiant kid, though. In fact, she is respectful and sweet. She just doesn’t get things done. The problem is chronic overwhelm, not laziness or disregard for the rules. Whether it’s filling out paperwork, or washing laundry, tasks aren’t completed when they need to be.

She stopped functioning due to legitimate symptoms of depression and anxiety that hit during formative years. But there’s no getting up and getting moving now that symptoms have leveled off. She doesn’t even know how to get moving. She never learned the basics of how to make herself take care of daily responsibilities when she was unmotivated or uninterested. Being sick got in the way of important life lessons. For a while, it was a true crisis and everything was on hold.

“Now that she’s an adult, I’m not sure what to do,” he said. “I was thinking I should take her phone and teach her a lesson about acting like a grown up.”

I asked him if he heard the incongruence between his intent (to have her behave like an adult) and his planned intervention (to punish her like a child).

“Well what else can I do?” he asked.

Suddenly he finds himself trying to “ground” his adult daughter, and it is immediately clear that this isn’t going to work.

The problem with grounding a twenty-year-old is that it communicates that the parent is the adult, and the twenty is expected to be a good child. Grounding fails because being a submissive child isn’t working anymore. She needs to own up to her responsibilities like an adult.

So what’s the answer if grounding isn’t going to work?

The world around won’t her ground her and won’t try to teach her a lesson, but the lessons will come. Those who don’t follow the rules face the consequences.

“Can you imagine this situation with someone other than your daughter? A family friend moves in, and he’s lying in bed in a dirty bedroom, not doing his laundry. What do you do then?” I ask.

He says, “I send him back to his parents, because I’m not going to put up with that. But it’s different. This is my kid. I’m stuck with her.”

“Are you stuck with her?” I ask. “Maybe she needs to be the one who is left holding the responsibility for herself. Maybe it shouldn’t be you who is stuck with the responsibility, but her.”

He has a long way to go still, but this got him thinking. I don’t think he’ll ground her after all.

Posted on April 23, 2018 .

The Questions Everybody Wants To Ask About My Urgent Care Clinic


A few days ago, I attended a mental health care conference along with a crowd of other mental health care professionals. Having come from another event, I was wearing a T-shirt with the logo for Sigma Mental Health Urgent Care on the front. I got a few funny looks. I wondered if I had a piece of broccoli stuck between my teeth. Then people started asking me about Sigma, and I realized what the funny looks were about: they were just trying to get their minds around the idea of mental health urgent care. Even my mental health colleagues don’t quite grasp it at first.

Mental health urgent care clinic? Yes. We provide walk in mental health services.

So is it emergency room? Is it a hospital? No it’s not hospital, and no it’s not an emergency room. Just like a medical urgent care is not a hospital and not emergency room, neither are we. An emergency room is designed to take care of people with life-threatening emergencies. A medical example of life-threatening emergency is a heart attack. An urgent care clinic is for minor immediate care needs. A medical example of an urgent care level problem is a possible broken bone.

In the same way, a psychiatric emergency is usually a crisis situation that might even be dangerous to the safety of someone. An example would be an immediate urge to attempt suicide, while an urgent care level problem in mental health is usually the inability to wait 2 to 6 months to get help because of the backlog in the middle healthcare system.

Emergency versus urgent can be confusing. The funny thing is that the patients who need our services understand what we do intuitively. They are never confused about what we do.

I see all the stuff online about how you like to treat teenagers and young adults. Are those the only people you treat at this urgent care clinic? I do enjoy seeing teenagers and young adults, and that’s what I often write about on my blog and in my book STUCK in the Sick Role. But at Sigma, we see people of all ages. My writing centers around mental health care topics that I think require more discussion. Specifically, I think the education people receive about their mental health condition at the time of their first diagnosis can alter the course of their illness and even the course of their lives.

Oh, so do you have somebody there who treats high blood pressure and broken bones? Nope. We only do mental health. It’s right there in the name.

How can you be an urgent care if you only do mental health? Urgent care means walk in clinic. The mental health part indicates that that’s all we do.

Are people only allowed to come one time? What do they do after that? Many patients come to Sigma for a period of time. It may be one month for short-term stabilization, or sometimes it’s a six-month period while waiting to get in with a psychiatrist in the community.

I bet you hand out a lot of Xanax, right? No again. We don’t hand out addictive medications at Sigma.

So when people come to your clinic, do they just see a therapist, or what? When people come to Sigma, they are evaluated from a psychological perspective and medical perspective. That means everyone is assessed by a prescribing medical professional who specializes in mental health. Often our therapists participate in the assessment process, but patients don’t “just see a therapist.“

Don’t people have to bond with you for a long time to be your psychiatric patient? How can that be a temporary thing? A trusting long-term treatment relationship is often an important part of mental health care. However, people who come to see us are often desperate for any help. Many simply want to refill of their antidepressant and can’t find a clinic to renew it.

Are the patients violent? Are you scared of them? Goodness no. We have never had anyone in our clinic that was violent or scary. I think that this idea comes from discrimination against people with mental health conditions, and maybe also from the idea that we operate like a mental health emergency room.

Are they brought to you by police? No, we don’t accept patients from police. If someone is taken into police custody and then transported for mental health evaluation, that care takes place in a mental health emergency room. Our patients are help-seeking people who come to us by choice. No handcuffs involved.

Have other burning questions? Post them in the comments.


Posted on April 16, 2018 .