When I accepted my first nursing position, I truly had no idea what I was getting myself into. It was a residential facility for kids. For those who aren’t familiar with what this mean, I will explain. A residential facility is a long-term treatment center for kids with mental health issues, often with no where else to go. Most of the time when a kid gets to a residential facility, it is because they have exhausted all other options. Inpatient care, group homes, foster care, detention centers. It’s often a last resort.
Within my years of experience, I’ve cared for hundreds of children while working in residential care. Who knows how real this statistic truly is, but if I had to make an educated guess, I’d say maybe 10% of these kids had a caring family involved in their life. I can count on one hand the number of families that maintained custody of their child during their residential stay. And probably less than that for the amount of parents who were true role models and loving families for these kids. The majority of the time, these kids had awful traumatic histories, multiple foster care homes and group home placements, often no where else to go. Many of the children who came to residential treatment had families who had given up on them, lost hope in the future, and did not want to re-obtain custody of their child after discharging from residential.
I’d be lying if I said that this was a bad thing.
Considering the majority of the families of these children are, as already mentioned, often are part of the problem, I’ve never been a huge fan of the whole family reunification concept. Don’t get me wrong, I do believe people can change. If I didn’t, I wouldn’t be in this line of work. However, I will never agree with adults who have already ruined a child’s life thinking that they deserve to have the child back. Maybe you disagree and that’s okay. Maybe after you read the rest of these stories, you’ll have a better understanding for my reasoning. I’ve seen and heard awful things and after working with this population for so long, one of my favorite lines to tell my pediatric patients is this, “you don’t need people in your life who’ve hurt you. You don’t need to let toxic people back into your world if you don’t want to. You can forgive them and still not want them in your life. And that is okay. It’s okay to be selfish. It’s okay to focus on yourself. It’s fine to love yourself more than those who have hurt you.”
If you’ve ever been hurt by someone as a child, then you get it. You know what it’s like to want the approval of those who have hurt you. Constantly seeing children seeking the care and approval from those who have hurt them is nothing short of heartbreaking and if you think family reunification is always the answer, I’m telling you right now, you’re wrong.
Now, you can’t believe everything you hear. Talking with my patients and their families especially during first interactions has taught me that you have to take everything they say with a grain of salt. I’m not saying that I’m not empathetic. In fact, I’m overly empathetic. I care too much. I put all of myself into the care of every patient I see every single time. Maybe that’s how I started to lose myself. It became so normal to hear heartbreaking stories, to restrain aggressive kids, to watch kids cry. I didn’t realize that it was affecting my own mental health until I started to have panic attacks; we can talk about this more later. Let me give you a few stories of what I mean. And no, I’m not calling my patients liars. But you have to remember when you’re coming in with a mental health diagnosis…or any diagnosis, we have to get to know you before we can trust your words.
Let me start with a story of one of my favorite patients. Yes, I know. We aren’t supposed to have favorites. But if a nurse tells you they’ve never had a favorite, they’re lying.
I’d been working as a nurse for probably four years at this point when a sweet little boy, nine-years-old, came into the residential facility for admission. His anxiety was high. His hands were shaking. His short blonde hair was dyed blue at the front and he had stick-on tattoos on both of his arms. Behind him as he entered the nursing station for admission was his dad, stepmom, and caseworker.
Those who know me know that I love nearly every person I meet. I’m one of the least judgmental people in the world, if I do say so myself. But the minute that you, an adult, start doing something that negatively impacts a child’s life, my respect for you will be nonexistent.
Let me stop here and answer another question that you might be asking yourself and one I’ve been asked before. People have asked me why I don’t like to work with adults with mental health disorders. I’ll clear that up by saying that is not true. I do like providing care to adults across the mental health disorder diagnosis spectrum. I know that just because you turn eighteen doesn’t mean that your mental health diagnosis disappears. In fact, sometimes it gets worse. I’ll never stop advocating for mental health for all ages. If you take the time to tell me your story, no matter how bad it is, no matter what awful things you’ve done, I can promise you that I will listen and be a soft, nonjudgmental place for you to land. I will say that although I will always be that for someone who needs me, I will never be able to fully understand those who hurt children. I lose respect there. Adult providers could argue with me that it is not their fault, but in which case I will respond, if you’re already addicted to drugs and unable to care for yourself, don’t have children!
So this sweet little boy with blue hair in the front, covering his left eye, sat at the table in the nursing station looking down at the floor. His dad, stepmom, and caseworker sat around the table with him as I started my assessment and admission process. After about ten minutes, the kid finally stopped looking down at the floor and was willing to start answering questions. However, every time he would start to talk, the dad would quickly interrupt. Sign number one that something was going on that dad didn’t want us to know about. Not only that, but dad wouldn’t let mom talk much and he cut her off every time she wanted to say something. Sign number two that dad was the issue.
As the days went on, the little boy's dad and stepmom came to visit a few times a week. After each visit, the kid would go into crisis and end up in a restraint.
For those unfamiliar with what a mental health crisis is, I could talk for hours about what they could look like. It’s different for every patient and for every diagnosis. For lack of better terms, a mental health crisis can look like a tantrum in the pediatric population. Kicking and screaming, yelling, crying. It can also be aggression; hurting people they love. It can also be hurting themselves; cutting, headbanging. And the worst, it can be suicidal ideation or an attempt.
Little things would set him into a crisis following his dad leaving from his visit. A few people thought it was because he just missed his dad. At this point in my career, I knew that wasn’t the case.
I had seen kids who did have families, biological or foster, come to visit and they genuinely missed them. This was different.
He would ask when he dad was coming back and no matter the answer you gave, his face would fill with fear. He would throw chairs, punch staff, cuss and try to fight with kids, have panic attacks. He was truly fearful.
After a few weeks of this same routine, people were finally starting to take notice that something was wrong with the family dynamic. I had multiple times told them that I had a bad feeling. I was right.
The next day when the dad came to visit the kid, they were visiting in the room next to the nursing office. A few moments after the visit had started, I heard yelling. A lot of yelling. Then I heard screaming. A call for assistance was made over our intercom system and before anyone arrived, I heard a thud.
As everyone ran into the room to see what was happening, the poor boy was crouched down in the corner of the room, crying. The dad was standing over the boy, his face red and hands clenched tight into fists. They were quickly separated and taken into separate rooms and the police were called. After this incident, the boy finally started talking. He said, “I can’t take it anymore. He’s a liar. He hurts me. Bad.” After further assessment, he said that during this visit that dad grabbed him by the neck and threw him into the wall.
The big thud I had heard.
After this incident, he started talking, finally, about the truth of what was going on at home. The reason that his dad wouldn’t let him or stepmom talk during the admission. The reason why he gave me a bad vibe. The reason that the sweet little boy would go into crisis every time his dad would leave: because he knew that he would come back.
If you’ve never worked in the social work field, court system, CPS, etc, then I’ll fill you in really quick: it’s awful. There are not enough employees. Not enough support. Not enough time. Not enough money. And ultimately the children get hurt in the long run. I’m not saying that it’s the workers fault, because it’s not. I’ve worked with some absolutely incredible social workers and caseworkers. I’ve worked with people who have given every second of their time to help these children and their families. Unfortunately, no matter how much time and effort you put into trying to change these lives, you can’t fix them all.
The term unsubstantiated is one we hear in this field all too often. The physical abuse “allegations” made by the boy, including this incident, were “unsubstantiated.” So after all of this, the dad clearly being the problem and obviously hurting this child, the dad was still allowed to visit with his son. It had to be supervised visits, but nevertheless, he was still allowed to visit. Every time I would see him walk through the door, my heart would drop. Back to the term family reunification, this is exactly what they wanted for this kid. They sent dad to some therapy classes and then ta-da! He’s cured and will never hit his child again! (Insert eye-roll here.) If he was comfortable hurting his child while at the residential facility, imagine what he does to him at home.
The day we discharged this kid, I cried. To this day I wonder if he is okay. That’s the worst part about this field; we’ll never know unless we see him on the news one day or back in the facilities.
Both of which are dreaded outcomes.
I find myself wondering often if my patients are okay. If all the hard work and time I’ve put in with these kids was actually worth something. I like to think so, but truth is I’ll never really know.