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The psychology community didn't seem to take trauma into account back then, or understand it well, or have any idea how to treat it effectively. CBT can get certain results, but it doesn't address deeper issues, and doesn't seem to believe that's needed. I think it has its uses, but it's not a panacea.
Each "flavor" of mental health intervention can be biased against others. My son was diagnosed with Schizoid Personality Disorder by a qualified psychiatrist, but the doctor he was assigned to at his county mental health department regarded that as useless woo and believed everything could be treated with meds. That was HIS hammer. Of course working for an under-funded mental health organization, the emphasis was on "managing" patients rather than treating them or, god forbid, curing them. Also, Schizoid Personality Disorder has a terrible prognosis and no recognized, effective treatment, so in a twisted sort of way, he was right -- what could he do except medicate my son for symptoms?
It didn't end well. He tried various meds, none really worked for any length of time, and one day he prescribed an old tricyclic antidepressant with a very narrow therapeutic range. My son apparently got confused about whether he had dosed one morning, took a double dose, and his heart stopped at work later that night -- fatal arrhythmia at the age of 30. I could have sued I suppose but it would have been blamed on my son not "complying" or something. In the end there was plenty of blame to go around. The system failed and had very little to offer anyway.
Each "flavor" of mental health intervention can be biased against others. My son was diagnosed with Schizoid Personality Disorder by a qualified psychiatrist, but the doctor he was assigned to at his county mental health department regarded that as useless woo and believed everything could be treated with meds. That was HIS hammer. Of course working for an under-funded mental health organization, the emphasis was on "managing" patients rather than treating them or, god forbid, curing them. Also, Schizoid Personality Disorder has a terrible prognosis and no recognized, effective treatment, so in a twisted sort of way, he was right -- what could he do except medicate my son for symptoms?
It didn't end well. He tried various meds, none really worked for any length of time, and one day he prescribed an old tricyclic antidepressant with a very narrow therapeutic range. My son apparently got confused about whether he had dosed one morning, took a double dose, and his heart stopped at work later that night -- fatal arrhythmia at the age of 30. I could have sued I suppose but it would have been blamed on my son not "complying" or something. In the end there was plenty of blame to go around. The system failed and had very little to offer anyway.
Oh my god, I am so sorry.
I worry a great deal about my son. We have, through a long process of trial and error, found that seroquel helps him. But the psychiatrist that he was seeing (telemed) has these really strict policies that if a person is late or misses an appointment 3 times they are kicked from that clinic's services and he's had two strikes. He's got to get a new prescription each and every time. And it's not as though this place is some kind of free service, we (and our insurance) are paying for it, and we also paid two steep fees for the appointments he missed in the past.
He is only 20 years old and he's just not responsible enough to be counted on to be consistent with his meds, never abuse them or stay on them regularly, and this expectation that he be 100% reliable and never forget an appointment (or even have, say, an internet issue that prevents him being able to connect) is pretty brutally unforgiving. Meanwhile the counselor/therapist person he was doing talk therapy with moved and left the practice that he was able to walk to, and he has yet to find another.
I really don't know what the ultimate outcome is going to be for him. If we had the money I would have looked into some kind of a group home a long time ago. But the ones I found were so expensive and didn't take insurance, I figure that's just what rich people do with mentally ill family members.
This forum, and others like it, are itself a form of therapy. No, I’m not being glib or facetious. The act of writing, of congealing one’s thoughts in organized written form, is not only therapeutic in itself, but gives one a waypoint, something archival, something over which to mull later. Obviously there will be shrill and hurtful responses, and lots of anodyne dumb ones too. But there may also be the occasional gem. Even if there is none – even if it’s total silence – the mere fact that you’ve written something for public consumption and record, to have recorded your thoughts, is itself of considerable value, is it not?
I agree. I write to understand as much as to be understood. I've kept a journal as a draft email for almost 4 years and it's about 75,000 words now. That's too much to review but I bullet point summaries every so often and I highlight entries I expect to return to.
Regarding writing here or on any public forum, an audience changes the process a bit, or perhaps changes me as I participate. I'm more vulnerable. I believe that has value.
What makes a good therapist? Obvious things like being a good listener, validating people's feelings, general people skills really. A therapist can also serve well by holding clients accountable. If you see a therapist once per week for an hour, that's about 1% of most people's wakeful hours. Almost everything that benefits a person in therapy happens in the other 99% of their time. There's no magic in that hour, and real epiphanies happen most often on the road to Damascus. So getting an understanding of what therapy can and can't do, and then structuring treatment so there's a regular accounting for what the client does during that 99% to implement the plans made during the 1%.
I worry a great deal about my son. We have, through a long process of trial and error, found that seroquel helps him. But the psychiatrist that he was seeing (telemed) has these really strict policies that if a person is late or misses an appointment 3 times they are kicked from that clinic's services and he's had two strikes. He's got to get a new prescription each and every time. And it's not as though this place is some kind of free service, we (and our insurance) are paying for it, and we also paid two steep fees for the appointments he missed in the past.
He is only 20 years old and he's just not responsible enough to be counted on to be consistent with his meds, never abuse them or stay on them regularly, and this expectation that he be 100% reliable and never forget an appointment (or even have, say, an internet issue that prevents him being able to connect) is pretty brutally unforgiving. Meanwhile the counselor/therapist person he was doing talk therapy with moved and left the practice that he was able to walk to, and he has yet to find another.
I really don't know what the ultimate outcome is going to be for him. If we had the money I would have looked into some kind of a group home a long time ago. But the ones I found were so expensive and didn't take insurance, I figure that's just what rich people do with mentally ill family members.
Sorry about your situation and I understand the worry. The best advice I can give is try to be an advocate for him and keep him from falling through the many cracks in the system. My son was profoundly limited and his prognosis was awful, but he was not dangerous or violent or acting out in some obvious way, so the sort of group home / supervised living he needed never "kicked in". We could have in theory afforded private care but he'd have to voluntarily submit to it or do something sufficiently out-of-band that he could be "committed" involuntarily. He didn't want that for himself and he behaved himself and that, ironically, led to the outcome we had.
Another problem you've doubtless encountered is HIPPA regulations that keep you from having any insight into his care unless he allows it. We never wanted to know what my son was discussing privately with therapists or something, just diagnosis and prognosis, and we couldn't even get that at times. With my stepson we had him sign privacy waivers when he turned 18 and keep them current, plus he has generally been cooperative in that regard ... and we've been careful not to infantilize him. But he simply isn't able to make good decisions or remember stuff always and has needed help (thankfully, gradually less of it, which is a good sign).
It's not easy being the parent of an adult child with mental health issues ... I salute you. Do the best that you can, it's all anyone can do.
This forum, and others like it, are itself a form of therapy. No, I’m not being glib or facetious. The act of writing, of congealing one’s thoughts in organized written form, is not only therapeutic in itself, but gives one a waypoint, something archival, something over which to mull later. Obviously there will be shrill and hurtful responses, and lots of anodyne dumb ones too. But there may also be the occasional gem. Even if there is none – even if it’s total silence – the mere fact that you’ve written something for public consumption and record, to have recorded your thoughts, is itself of considerable value, is it not?
I agree. It has been very therapeutic being able to come here and write when I've felt confused, frustrated, angry, etc.
I'm actually considering group therapy instead. I did it in grad school and found it more helpful to be around a group of people who could relate. It also helped with speaking in a group since I naturally get anxiety when I'm in front of a group of people.
I worry a great deal about my son. We have, through a long process of trial and error, found that seroquel helps him. But the psychiatrist that he was seeing (telemed) has these really strict policies that if a person is late or misses an appointment 3 times they are kicked from that clinic's services and he's had two strikes. He's got to get a new prescription each and every time. And it's not as though this place is some kind of free service, we (and our insurance) are paying for it, and we also paid two steep fees for the appointments he missed in the past.
He is only 20 years old and he's just not responsible enough to be counted on to be consistent with his meds, never abuse them or stay on them regularly, and this expectation that he be 100% reliable and never forget an appointment (or even have, say, an internet issue that prevents him being able to connect) is pretty brutally unforgiving. Meanwhile the counselor/therapist person he was doing talk therapy with moved and left the practice that he was able to walk to, and he has yet to find another.
I really don't know what the ultimate outcome is going to be for him. If we had the money I would have looked into some kind of a group home a long time ago. But the ones I found were so expensive and didn't take insurance, I figure that's just what rich people do with mentally ill family members.
I suspect that you recognize those strict protocols are less for the benefit of the practice and more for the client. Recidivism and failure to comply account for huge amounts of pain and suffering. Excuses are dime-a-dozen, and sympathetic ears can be easy to find. There is a reason for medication times at in-patient facilities. The real brutality happens when protocols are abandoned and the routine goes belly up. I have seen it happen with both patients and friends.
Confidentiality prevents me from bringing up an example that strengthens my point.
I suspect that you recognize those strict protocols are less for the benefit of the practice and more for the client. Recidivism and failure to comply account for huge amounts of pain and suffering. Excuses are dime-a-dozen, and sympathetic ears can be easy to find. There is a reason for medication times at in-patient facilities. The real brutality happens when protocols are abandoned and the routine goes belly up. I have seen it happen with both patients and friends.
Confidentiality prevents me from bringing up an example that strengthens my point.
Honestly it feels like he is set up to fail.
Because there are gonna be times where he misses his appointments. I get charging a fee, after all, the practitioner made themselves available and all. What I don't get is booting him from the practice entirely after a 3 strikes rule, no matter how much time goes by between incidents.
Because if that happens, then he's got to try and find another psychiatrist, which is actually VERY hard to do as most in that area are booked up for ages, have waiting lists, or aren't taking new patients. So even if he's trying to be as on top of things as a (relatively mildly) schizophrenic 20 year old kid can, he is then likely to have lapses in his meds when he can't find anybody to help him get them refilled.
The only alternative is for him to have a parent manage all of his appointments and such. Which I did for some time after he moved out on his own, but then I gradually started trying to transition responsibility into his hands. I am hoping that he can make it without being a full on dependent to me...but to be honest, the jury is still out on that.
The problem I have with these "strict protocols" are that if a person does not have a caregiver, like a family member, dedicated to managing everything, then a patient with anosognosia (a not quite accurate perception of their own mental illness) for instance...well, it's pretty hopeless. No one will follow up with them, in fact, they are eager to cut them loose to spin in the wind if they don't perfectly follow the rules...and pardon me for saying so, but that seems to be a lot to ask of a kid who is struggling with these issues AND the harsh realities of early adulthood. If he was good at perfectly following rules without anyone standing over him reminding him what he needed to do, and in touch with reality enough to track appointments meticulously and such, then he wouldn't NEED the services and meds so much in the first place.
Also? The place where he had his talk therapy is able to charge a $50 fee for a missed appointment yet one day we showed up for his appt and the therapist had not made it in to work because of the weather, and nobody bothered to call us or let us know. Which frankly is inconsiderate as hell at the least.
Frankly it's a terrible time...the whole Covid situation is putting so much extra demand on the mental and physical health care industries and there was a hell of a lot of room for improvement in them to begin with.
Because there are gonna be times where he misses his appointments. I get charging a fee, after all, the practitioner made themselves available and all. What I don't get is booting him from the practice entirely after a 3 strikes rule, no matter how much time goes by between incidents.
Because if that happens, then he's got to try and find another psychiatrist, which is actually VERY hard to do as most in that area are booked up for ages, have waiting lists, or aren't taking new patients. So even if he's trying to be as on top of things as a (relatively mildly) schizophrenic 20 year old kid can, he is then likely to have lapses in his meds when he can't find anybody to help him get them refilled.
The only alternative is for him to have a parent manage all of his appointments and such. Which I did for some time after he moved out on his own, but then I gradually started trying to transition responsibility into his hands. I am hoping that he can make it without being a full on dependent to me...but to be honest, the jury is still out on that.
The problem I have with these "strict protocols" are that if a person does not have a caregiver, like a family member, dedicated to managing everything, then a patient with anosognosia (a not quite accurate perception of their own mental illness) for instance...well, it's pretty hopeless. No one will follow up with them, in fact, they are eager to cut them loose to spin in the wind if they don't perfectly follow the rules...and pardon me for saying so, but that seems to be a lot to ask of a kid who is struggling with these issues AND the harsh realities of early adulthood. If he was good at perfectly following rules without anyone standing over him reminding him what he needed to do, and in touch with reality enough to track appointments meticulously and such, then he wouldn't NEED the services and meds so much in the first place.
Also? The place where he had his talk therapy is able to charge a $50 fee for a missed appointment yet one day we showed up for his appt and the therapist had not made it in to work because of the weather, and nobody bothered to call us or let us know. Which frankly is inconsiderate as hell at the least.
Frankly it's a terrible time...the whole Covid situation is putting so much extra demand on the mental and physical health care industries and there was a hell of a lot of room for improvement in them to begin with.
First, the therapist who "didn't make it in" needs to be held accountable in such an environment. I would be taking it right to the top, demanding equity in responsibilities and pointing out that NOT doing so was a violation of patient therapist contract. That lapse would be infuriating to me and NOT be allowed to stand, even if it meant taking it to the licensing body and filing formal complaint. There would be kick-back, and I would leverage that to push for a sliding scale of missed appointment offenses over time, both with client and therapist.
There are major issues involved here. I can see them at a glance. Let's clarify:
1. Top down doesn't work long term
2. Patient compliance is vital to success
3. Spotty cognition and schedules can be incompatible
4. A record of positive success of complaint patients is important financially to a practice.
5. Fees are a double edged issue
6. Long term success is the goal
1. Top down doesn't work long term:
My wife was a practicing psychologist and psychotherapist. She was adamant that healing came from within the client and was never fully successful in a top-down, power-over, therapist/client dynamic.
Having myself worked in a state hospital and having been around, I have to say that she was completely correct. Strict protocol, in a best case scenario, is to stop the BS and excuses that many clients will have ... until a point when they recognize those behaviors as self-destructive and take on the responsibility on their own.
2. Patient compliance is vital to success:
These are the days when you can program phones to give multiple reminders that, once programmed, require no further intervention to keep going. Excuses are... excuses. Don't fall into the trap. You are responsible for you. To deny a person personal responsibility is to cripple them in many ways. It might hurt to see them suffer, but learning is not always joyful.
3. Spotty cognition and schedules can be incompatible:
Even with reminders, there has to be enough organization where lapses generate immediate feedback. Example: a push reminder on a phone to take a med might have an "I have taken my med at (whatever time)" response that gets logged. If the response is not forthcoming, further action happens automatically, including outside intervention.
4. A record of positive success of complaint patients is important financially to a practice.
Bluntly, if a practice can produce an exemplary success rate, they get used more and get to charge accordingly. If that is what you are running up against with the strict protocol, it needs to be called out to the licensing board for further review and action. A setup to fail is completely contrary to the ethics of the profession, and needs to be halted by the authorities in charge. You will need to be clear in your presentation of the complaint, preferably in writing and certified, cc all involved.
5. Fees are a double edged issue
The cost of getting into the profession is positively staggering, and insurance payments don't cover it. What might seem like high fees are not going to cover the cost of the degrees and other costs for years. Fees also separate out time-wasters from real clients willing to work. Regrettably, that can be a severe burden on those not able to work in jobs that pay well. I have no answer or advice, just telling it like it is.
6. Long term success is the goal
In a therapeutic relationship, the competent therapist wants to get the client to a point of self-actualization and reasonable functionality in a manner that is fast but more importantly effective and long-lasting. Extending the therapy time for gain is not a consideration.
One last point that should drive you more than anything - You will not be around forever, and if the issues are not stabilized now to where life can go on, worse things can happen after you are gone.
I have a fairly good idea of what you are going through. It is a rough road. I wish you the best.
First, the therapist who "didn't make it in" needs to be held accountable in such an environment. I would be taking it right to the top, demanding equity in responsibilities and pointing out that NOT doing so was a violation of patient therapist contract. That lapse would be infuriating to me and NOT be allowed to stand, even if it meant taking it to the licensing body and filing formal complaint. There would be kick-back, and I would leverage that to push for a sliding scale of missed appointment offenses over time, both with client and therapist.
There are major issues involved here. I can see them at a glance. Let's clarify:
1. Top down doesn't work long term
2. Patient compliance is vital to success
3. Spotty cognition and schedules can be incompatible
4. A record of positive success of complaint patients is important financially to a practice.
5. Fees are a double edged issue
6. Long term success is the goal
1. Top down doesn't work long term:
My wife was a practicing psychologist and psychotherapist. She was adamant that healing came from within the client and was never fully successful in a top-down, power-over, therapist/client dynamic.
Having myself worked in a state hospital and having been around, I have to say that she was completely correct. Strict protocol, in a best case scenario, is to stop the BS and excuses that many clients will have ... until a point when they recognize those behaviors as self-destructive and take on the responsibility on their own.
2. Patient compliance is vital to success:
These are the days when you can program phones to give multiple reminders that, once programmed, require no further intervention to keep going. Excuses are... excuses. Don't fall into the trap. You are responsible for you. To deny a person personal responsibility is to cripple them in many ways. It might hurt to see them suffer, but learning is not always joyful.
3. Spotty cognition and schedules can be incompatible:
Even with reminders, there has to be enough organization where lapses generate immediate feedback. Example: a push reminder on a phone to take a med might have an "I have taken my med at (whatever time)" response that gets logged. If the response is not forthcoming, further action happens automatically, including outside intervention.
4. A record of positive success of complaint patients is important financially to a practice.
Bluntly, if a practice can produce an exemplary success rate, they get used more and get to charge accordingly. If that is what you are running up against with the strict protocol, it needs to be called out to the licensing board for further review and action. A setup to fail is completely contrary to the ethics of the profession, and needs to be halted by the authorities in charge. You will need to be clear in your presentation of the complaint, preferably in writing and certified, cc all involved.
5. Fees are a double edged issue
The cost of getting into the profession is positively staggering, and insurance payments don't cover it. What might seem like high fees are not going to cover the cost of the degrees and other costs for years. Fees also separate out time-wasters from real clients willing to work. Regrettably, that can be a severe burden on those not able to work in jobs that pay well. I have no answer or advice, just telling it like it is.
6. Long term success is the goal
In a therapeutic relationship, the competent therapist wants to get the client to a point of self-actualization and reasonable functionality in a manner that is fast but more importantly effective and long-lasting. Extending the therapy time for gain is not a consideration.
One last point that should drive you more than anything - You will not be around forever, and if the issues are not stabilized now to where life can go on, worse things can happen after you are gone.
I have a fairly good idea of what you are going through. It is a rough road. I wish you the best.
Thank you.
I actually (personally, I know that others will struggle more with this) don't mind one bit paying for his therapy, meds, even missed appointment fees etc if he is actually getting help that HELPS him. It is far better than letting it all lapse and having him end up in the ER following a suicide attempt, followed by a costly hold in a psychiatric hospital, which has happened. I walk a delicate balance between taking my hands off and letting him be responsible for himself and letting him experience consequences...and trying to intervene if it makes the difference before he hits a place that is incredibly hard to climb out of.
I'm willing to let him be poor, but I have not been willing to let him be homeless. I moved to another state some months ago and before I left, we got him moved into the cheapest housing that we could find and I have paid his rent when he could not. It's still a strain on my budget, but I just know I can't let him be on the street, and his father is only willing to help so much...not to house him. He has some support network where he is, just none of them are as involved as I used to be.
But I have met, over the years, people who ended up chronically homeless because they basically "flunked out" of the system because they felt better, quit taking their meds, descended into irrationality and could no longer provide for themselves. Healing may come from within, but if someone is seriously delusional and reality impaired, it's not like they can just have a few conversations about their childhood, "heal" and voila! Responsible adult! I do not feel that the appropriate solution to that kind of impairment is to cut them loose because they won't be an easy "success story" for your profitable practice, nor to wait until they commit some crime so that they can go into a state facility. I feel that someone from the community should be following up with these individuals...it's nice if they have caring family who will do it voluntarily, but if not, then someone still should.
But that's not very American of me, is it? Where's the profit in that? <-- The flavor of my frustration.
Meanwhile if that person is fortunate enough to have family who cares and wants to try and help, too often the family member has to just accept that their life will revolve around problems with no real solutions until they die, at which point the inevitable collapse of the loved one's life will occur without them there to prevent it. They threw away their own happiness just staving off an inevitable outcome.
That's what I'm afraid of, anyhow. The million dollar question has been whether he is so drastically and permanently impaired that he will never be a truly functional adult...or is at least most of his dysfunction now a matter of him just being young and irresponsible along with his mental issues? Like what percentage of his behavior is due to one or the other of these problems? I have asked therapists (when I lived there and often attended his sessions at his invitation) to help answer that question, but none ever have.
Instead it was either a.) Just a lot of ongoing conversation about his life and feelings...for a couple years' worth of therapy with the same provider even, and b.) "Are you eating and sleeping OK? Good, OK I'll call in a refill of your meds." He had 2 providers, the therapist and the psychiatrist, we filled out forms and asked them to talk to each other to coordinate his care, but they never did. Then both left their practices, he got a new psychiatrist but has not found a new counselor/therapist yet.
I think it can be exhausting and discouraging in a case like this...like yeah, I know, the patient has to do the work, but it's hard enough to just persuade them that the neighbors are not FBI agents sent to watch him. So how is he gonna suddenly "heal" himself? And no professional has been willing to declare him disabled enough to get on Social Security...but I'm not sure if that's the answer or not, either.
I'm kinda just in a holding pattern, trying to help him survive and stay housed while he tries and quits all sorts of jobs (sometimes quitting after a panic attack 3 hours into his first shift)...until he reaches, I think, his mid 20s, at which point youth is no reasonable cause for continued failure to adapt to adulthood and we reevaluate. I guess.
I actually (personally, I know that others will struggle more with this) don't mind one bit paying for his therapy, meds, even missed appointment fees etc if he is actually getting help that HELPS him. It is far better than letting it all lapse and having him end up in the ER following a suicide attempt, followed by a costly hold in a psychiatric hospital, which has happened. I walk a delicate balance between taking my hands off and letting him be responsible for himself and letting him experience consequences...and trying to intervene if it makes the difference before he hits a place that is incredibly hard to climb out of.
I'm willing to let him be poor, but I have not been willing to let him be homeless. I moved to another state some months ago and before I left, we got him moved into the cheapest housing that we could find and I have paid his rent when he could not. It's still a strain on my budget, but I just know I can't let him be on the street, and his father is only willing to help so much...not to house him. He has some support network where he is, just none of them are as involved as I used to be.
But I have met, over the years, people who ended up chronically homeless because they basically "flunked out" of the system because they felt better, quit taking their meds, descended into irrationality and could no longer provide for themselves. Healing may come from within, but if someone is seriously delusional and reality impaired, it's not like they can just have a few conversations about their childhood, "heal" and voila! Responsible adult! I do not feel that the appropriate solution to that kind of impairment is to cut them loose because they won't be an easy "success story" for your profitable practice, nor to wait until they commit some crime so that they can go into a state facility. I feel that someone from the community should be following up with these individuals...it's nice if they have caring family who will do it voluntarily, but if not, then someone still should.
But that's not very American of me, is it? Where's the profit in that? <-- The flavor of my frustration.
Meanwhile if that person is fortunate enough to have family who cares and wants to try and help, too often the family member has to just accept that their life will revolve around problems with no real solutions until they die, at which point the inevitable collapse of the loved one's life will occur without them there to prevent it. They threw away their own happiness just staving off an inevitable outcome.
That's what I'm afraid of, anyhow. The million dollar question has been whether he is so drastically and permanently impaired that he will never be a truly functional adult...or is at least most of his dysfunction now a matter of him just being young and irresponsible along with his mental issues? Like what percentage of his behavior is due to one or the other of these problems? I have asked therapists (when I lived there and often attended his sessions at his invitation) to help answer that question, but none ever have.
Instead it was either a.) Just a lot of ongoing conversation about his life and feelings...for a couple years' worth of therapy with the same provider even, and b.) "Are you eating and sleeping OK? Good, OK I'll call in a refill of your meds." He had 2 providers, the therapist and the psychiatrist, we filled out forms and asked them to talk to each other to coordinate his care, but they never did. Then both left their practices, he got a new psychiatrist but has not found a new counselor/therapist yet.
I think it can be exhausting and discouraging in a case like this...like yeah, I know, the patient has to do the work, but it's hard enough to just persuade them that the neighbors are not FBI agents sent to watch him. So how is he gonna suddenly "heal" himself? And no professional has been willing to declare him disabled enough to get on Social Security...but I'm not sure if that's the answer or not, either.
I'm kinda just in a holding pattern, trying to help him survive and stay housed while he tries and quits all sorts of jobs (sometimes quitting after a panic attack 3 hours into his first shift)...until he reaches, I think, his mid 20s, at which point youth is no reasonable cause for continued failure to adapt to adulthood and we reevaluate. I guess.
Trust me, I know of the issues you address, and have had somewhat similar experiences - again, confidentiality keeps me from discussing them -
By mid-twenties or a little later, sometimes the worst of schizophrenia mixing with hormonal issues is over. At a certain point, many intellectually recognize that the breaks they are having with reality are NOT real, and don't have to be acted upon. With others, the volume somehow gets turned down. How or why, I do not know. If you come toward thinking that failure may happen regardless, consider that some states handle such things better than others, and a move in advance to establish residency may be prudent.
The housing mixing of criminally insane and those with non-threatening issues happens, especially when budgets are tight. Such a case, where a murderer was mixed in with the organically damages pts. on a ward where I worked was the last straw for me. His attorney got him committed instead of a strong sentence, and he only was loose on the ward in restraints and with multiple aides around, because everyone recognized the danger to staff and patients alike. He was a smug evil b. and gave snakes a bad name. Most of the employees didn't even get basic health insurance as part of the job. I digress. Just be aware that there can be more dangers than homelessness.
The "success" stories I know of generally involve rigid adherence to medication, a low cost and low stress life, with some outlet for fantasy that is socially acceptable, such as music, painting, society for creative anachronism, etc.. If there is no outlet for fantasy that can "ground out" reality breaks (and not exacerbate them) those breaks may show up elsewhere.
Mainstreaming works for some, but not all. In the town where I grew up, some patients walked the streets freely and manned a crafts shop that sold patient art. Others needed the structure of partly closed wards, and populations shifted as needed. The community entry houses don't have a terribly good record, as far as I am concerned. Staff are generally underpaid and overworked and sometimes not qualified. Again, profit motive trumps care and competence.
You do seem to have some protective barriers in place for your own well being. Keep remembering that airlines tell you to put the oxygen mask on yourself and secure it before trying to fit one to a child. If you don't honor yourself and burn out, that helps no one.
FWIW, a therapist is not going to be willing to make an off-the-cuff assessment of functionality and percentages. At best, there will be a referral to one who specializes in certain areas, or a request for some sort of standardized test and evaluation.
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