Forcing 25 yr old son to leave home.

[swimming]

Our son was diagnosed 10 years ago with OCD. Since then he has had no quality of life. After reading the previous posts about how important family support is. I would like to ask views on whether we would be helping our son to take responsibility for his own health by renting a small flat nearby. We would furnish it and make it comfortable for him, help him financially and he will always have our support.

I will try and as briefly as possible give some background on his experiences with the medical profession and the state he is in now . He was diagnosed at 15. His psychiatrist said his condition was too severe for CBT and ERP and only offered medication. My son refused to take medicine and at one point the psychiatrist, GP, mental health nurse and a mental Health representative came to the house(at my instigation). They were introducing themselves to each other when my son saw them and ran away.

Since then he has attended some sessions on and off with a psychologist until that broke down. He has never taken medicine and thinks he can beat OCD himself. His OCD is around contamination but perversely he is now dirty although he is always washing his hands. He doesn't eat enough. He will not wash his clothes or bedding and won't allow us to do it either. He sleeps for maybe 2 days and then might stay up all night.He was in such a bad state 8 months ago he was voluntary admitted to a psychiatric hospital but discharged himself after 2 days. While he was in the psychiatrist said he wasn't displaying OCD symptoms. After much pushing from my husband and I we managed to get the local mental health team to take him on. Two nurses came to the house about 4 times and say they can not work with him because he won't talk to them about his problems.

We recently went on holiday and reluctantly left our son on his own, We were hoping he would shop for food and go out of the house or if he didn't manage that, he would realise he needed to take medicine and go and see another psychiatrist. Unfortunately we are back he didn't leave the house and ate what he could find in the cupboards. My Mother was checking up on him and brought him some food in once.

I recently started to claim benefits for him. He will not even sign his sick line and has taken the latest one to his room.

I have told my son if he chooses to live like this that is his right but he can't live like this in our house anymore. I don't see what else we can do but I am frightened he will just waste away in squalor on his own. He looks so ill and old it is heartbreaking for our family.

[ailo]

Hi. Welcome to the forum.

I dont know if i have any advices, but it doesnt sound like a good situation. I have contimination ocd as well. Getting his own place could be the best solution, but he sounds ill, (and im not sure his ready..) The best solution i think, is for him to getting help and gradually ( but pretty soon) be living by himself. ( if thats the goal) it cant go on like you discribe. To seek or improve somehow help must be a condition for not moving out immediatly? To live by himself could be the goal. He should see a gp. I had and still have real problems with talking about some of my issues. I get medication to help me being able to go throgh therapy. But i cant say thats the only solution. But i would consider it. I was skeptical as well to drugs. If he doesnt get help, it doesnt sounds like his getting better. Have he done some progress with ocd on his own? I Wish he would get better. Living with ocd and anxiety isnt easy. Its alot of great knowledge on these sites who can help you understand ocd and maybe get some good advices. I Wish you the best of luck

[Hal]

Hi swimming,

It's a difficult call, providing he still has support........moving out could help your son, my worry would be though that he could become more isolated renting somewhere. I know you'd pop in to keep on eye on him, but there wouldn't be the same level of contact that comes from living under the same roof, he may withdraw more than he already has.

It must feel like you're walking a tightrope knowing what to do for the best to help him......it's possible your son can beat this by himself, some people do, we have quite a few success stories where with the use of self-help books and support forums like those here, people have made headway, but there has to be that motivation and drive there, to make it work.

You've probably already tried this, but would setting some sort of time frame be an option......something like 4 or 5 months for him to demonstrate to you that he's doing something constructive towards tackling the issue - after that time if he's still where he is now the deal's got to be engaging with the treatment provided by his mental health team.

It's interesting his psychiatrist said he didn't have any symptoms while in the unit, that makes me wonder if his problems around contamination might centre only around his home...... if that is the case and he jumps at the idea of moving out, the risk's going to be he may end up avoiding rather than facing and overcoming the irrational fears......and they may then attach to the new flat and maintain the OCD.

It might also help him to check out our support forum......reading other people's experiences, seeing how much we have in common, but also what we can do to get well again might be useful.....there's a huge amount of support here for him and it could help him take that step towards starting the CBT.

It is scary knowing we're going to be asked to do what we're trying so hard to avoid, but if he could find that one therapist he felt he could trust and took things at a rate he felt he could cope with, he would steadily come through this and regain a good quality of life.

I hope something clicks for him and you as a family can get back to a life without OCD causing so much pain.

Hal

[Guest Tricia]

What a truly heartbreaking situation this is.

I've read through your message twice, but I don't think you said what your son's reaction is to moving out.

Many people with contamination fears cope better out of their homes, but a new flat would soon be home and I am not sure your son would cope well.

His condition sounds very severe if he is now not washing. It is not unusal for us to reach that point, but it's when it all becomes too much to deal with. Someone I know went two years without a bath or shower or a change of bed sheets, even though his contamination fear was extreme. He has now made an improvement after moving out of his parents' house. However, it was something he wanted as he felt so afraid of contamination from the rest of the family.

David Veale and Rob Willson discuss how parents should cope with adult children with OCD in their book Overcoming Obsessive Compulsive Disorder.

[swimming]

Hi,

Thank you all, for your replies. My son doesn't want to move out of the family home. In fact he is terrified and the nurses seem to think this is part of the problem. He only discusses how he feels when things are brought to a head, like this weekend when we brought up the subject of him moving out. From what he has been saying this weekend I think he doesn't want to get completely better and lead a full life. He seems to bargain with us e.g. If I am able to go to tennis and go out of the house like I have done in the past is that ok ? Or on Saturday I washed my hair and had a shower. We have encouraged him to read this forum, watch TV programs, read OCD books, join support groups and he does not want to.

When he went into the hospital he spent the whole time finding about his rights and got himself an advocate to find out his rights as he was scared he could be sectioned. He wouldn't use the showers or even the soap in the hospital. He did not give his permission for the staff to speak to us or let them even do normal tests like weight blood pressure or anything. I find it difficult to believe the psychiatrist did not want to see my son again. He said he didn't think it was necessary. I feel this was a missed opportunity as my son trusted him, because he gave him the chance to come home from the hospital at the weekend. Although I didn't agree to that because I thought we would never get him back in again.

I don't think my son will be able to get better without medication and CBT. He has fought so hard with this over the years. His brain seems to be running slowly, almost as if he is burnt out with the constant ruminating, worrying and battling against it.

He has missed so much and has the chance of tennis coaching. Two years ago he obtained his level 1 coaching which was a massive achievement. He still thinks he can turn things around with our help (if he stayed at home.) We feel if he doesn't move out and take some responsibility for himself, he will remain a recluse and we that we are enabling him to live like this. We think we will be in the same situation in ten years time. I wish we had forced him out like his GP advised when he was much younger. At least then he was stronger and healthier than he is now.

I have had problems with depression and OCD in the past. The OCD was not remotely as severe as my son's (I didn't know what it was then) I take medicine every day and manage to lead a full life.)

Sorry this is so long any more feedback is welcome.

[Hal]

If he's terrified of moving out, I'm not sure I'd push it tbh.......but if he's prepared to bargain with you maybe you could use it to bargain with him, perhaps the thought of what will happen if he doesn't try to help himself, might be enough to spur him further forward.

I'm not sure I understand where his psychiatrist was coming from saying he doesn't exhibit OCD symptoms, if he didn't shower/ use the soap in the unit, in all likelihood that's not down to laziness, it points to quite severe contamination issues (even the shower and soap aren't clean) or he's so exhausted mentally and physically from performing the rituals he avoids washing....one of those strange paradoxes with OCD.

As he's raised the idea of going to tennis, could you take him up on that as a start? Perhaps having that focus again will remind him what he's missing out on and help him realise how much OCD's taking from him.

[Caramoole]

He still thinks he can turn things around with our help (if he stayed at home.)

Then there have to be some rules, some goals and an agreement to stick with them, with your help.

[Guest Tricia]

Swimming, I still find it hard to believe, but there are actually psychiatrists who know little about OCD. The doctor your son saw appears to be one of those.

I feel to force your son out could be disastrous. Having said that, you cannot be expected to carry on like this year after year. I'm afraid you'll be in the same situation in ten years' time unless your son agrees to receive help.

I agree with Hal and his idea about tennis, but your son sounds terribly depressed so without medication he may not be interested.

I've been re-reading Dr David Veale's advice. He does say if an adult child's OCD is very severe and the 'child' keeps refusing any help, then parents must look after themselves and contact their local mental health team (and to find separate accommodation if necessary). He also adds that in some cases people with severe OCD can be admitted to a hospital against their will to be given medication. But he also speaks of other things to try first. Would your son agree to speak to a good therapist on the phone, for example? This shouldn't cause him too much stress and he may come to trust the therapist over time.

I would suggest buying the book Life in Rewind. It might give your son hope. Although the young man's symptoms are not the same as your son's, his situation is similar and the book has a happy outcome. He was treated by a top American psychiatrist who truly thought his OCD was too severe to be helped.

Dr Veale does emphasize that no therapy should ever be forced or sprung on someone with OCD. It has to be done willingly. As Caramoole said, there needs to be discussion and some rules put in place for all your sakes.

[Guest nidu]

Hi swimming,am also almost in the same state of your son..unable to manage my daily life...but i request u not to send him..being alone is not good..

[Guest Sally44]

As parents we really do try our best for our children. All I can say is that if it were me that I would bargin with my son about what he would have to do to remain in the house. That would involve agreeing to therapy and medication. But I wouldn't force him out because that would bring things to a head and would probably lead to him being hospitalised against his will. Being hospitalised itself may not be a bad thing, but you need your son in a place that specialises in OCD.

When professionals begin to treat OCD they usually start by making a hierarchy of goals, starting with the simpliest first, so that the person does succeed. They would need to work with your son for him to tell them what those targets would be.

Have you contacted the Maudsley Hospital in London, as they specialise in OCD and they also have a live in unit. If you find out about it, and maybe phone and speak to someone on the unit - then speak with your son about this place and what they could/would do for him. Then seek a referral. But he really needs to be on board about going there.

I am sure your son is exhausted, overwhelmed, extremely fearful and just trying to keep the status quo because he is in such a state at the moment. And I am sure you are too.

What would happen if, for example, you insisted he washed himself, and let someone clean his room? You need to claim the benefits because you could even use it to have a cleaner come into the house and clean up.

My son is nearly 14. He has a diagnosis and I am pushing to get some therapy. We have just started, again, on medication [he had a bad reaction to the other medication he was on]. And like you I do not want him to end up as an adult in a flat unable to leave and having to be completely dependent on others coming into the house to look after him. What kind of a life is that.

Like your son, mine also refuses to bath or change clothes sometimes - this is his way of avoiding the rituals and obsessions. He just seems to accept that he is so contaminated that nothing can add to it. But that means he refuses to go into his bedroom [so as not to contaminate it], and so he sleeps in our bed, fully clothed. He also cannot cope with his room being cleaned, because to him no amount of cleaning kills/removes all the germs. Therefore my actions are just pushing the contamination around the room onto other objects, onto myself, onto everything I touch after that etc etc.

I hope you manage to make a plan together and find a way to move forward. Does your son have times when his OCD is not so bad? Do you think there is depression as well? Could there be any other disorder involved such as autistic spectrum disorder? [although that sounds unlikely if he is interested in a career of tennis coaching as that involves working closely with people].

[grams88]

Hi Swimming

Your son sounds scared, I'm thinking that he sounds scared about the whole scenario and very understandable. I think with contamination ocd it can leave someone in a very fragile state not being able to do the things that they want to do, maybe when it comes to getting help that very prospect can seem extremely scary not that we should discourage it but take the tiny steps towards it.

I agree with Nid, I think being alone could make his condition worse, sometimes it can be that he needs the company. When I'm going out to the shops I tend to go out with my mum as I tend to feel a bit awkward if I'm going out on my own, I don't think I've done that for a long time.

I can be hard to change our mindset about therapy and I've got the feeling that your son sees therapy as maybe a bad thing or something that's going to be hard work. Is that fair to say?

Graeme

[swimming]

Thank you for your replies. We did not take the flat on. However my son will not bargain or set timescales. We asked his GP for him to be assessed by a psychiatrist, because the last time he was diagnosed was when he was 15. The consultant and CPN's seem to think because he is not sectionable, they can't do anything and when we talk about his OCD to the CPN's they said he presents himself differently to them. He doesn't want any help from them. He told the DWP he thinks he is not entitled to benefits because he could work for his Dad or find a job. So he has now been in bed for 36 hours with no food and probably very little water.

We have a son who is in denial about his health and physical condition. Who doesn't want help and the medical profession who thinks he is choosing this lifestyle and we should throw him out of our house.

Tricia I have just begun reading the book you suggested Life in Rewind and it brings it home to me although I have witnessed how badly OCD has affected my son it's not nearly as bad as it must be for him.

Another book I find helpful is Obsessive Compulsive Disorder a survival guide for family and friends by Roy C. I think I found it from a link from a book by Fred Penzel possibly from this web site.

[Hal]

However my son will not bargain or set timescales........He doesn't want any help from them.

You've been more than fair, if he's not prepared to meet you halfway I can't see that you have much option now other than to try another tack......the flat idea does seem too drastic, but would a close family member, maybe your mum or a friend be prepared to put him up for a couple of weeks or could his mental health team find a residential unit for him, I'm sure some don't require someone to be sectioned?

It's far from ideal, but it would give you a break, provide him with some support, but also sends the message that as a family you're not prepared to accept the current situation as it stands........something has to change.

OK he is ill, but at the end of the day he's also an adult who needs to begin taking some level of responsibility for his own health.......he's settled into a way of living that isn't conducive to his physical and mental health....... if he's not willing to accept that himself, you're not really being left with any choice other than to up the ante.

[swimming]

Update - Our son is still at home, now in bed 24 hrs a day, starving himself and not drinking enough fluids, ignoring us when we speak to him. On Sunday we spoke to him for hours and then tried to start clearing his room. He got out of bed and an argument developed and I phoned the police. When they arrived he spoke to the policeman no problem. The police were excellent and could not have been more helpful. They have experience of this and when I explained the mental health nurse wants to put my son into a homeless accommodation unit (not for people with mental health problems they advised against it as they are always getting called out to it.)

A few weeks ago we formally complained to the head of our mental health team as we have repeatedly asked for a psychiatric assessment. Within a day of this complaint, our son had an appointment with a psychiatrist 3 days later. We really hoped he would attend and I think he did try (he travelled 15 miles to get his haircut the day before.) However he did not attend. His Dad and I have an appointment on Friday although if son won't give consent then psychiatrist can't tell us much. Son's GP will not come out to assess him and says psychiatric services are not doing anything. I think because my son can speak when he wants to and is intelligent, they aren't classing him as an emergency,waiting until he is in a coma and will section him then. Our problem is will it be too late? When will we know at what point should we phone an ambulance?

[swimming]

I did not add in April we found a private psychotherapist who specialises in OCD. He is a former sufferer and was excellent. He came to our house for an intensive course for a week and my son wouldn't work with him as a) he wants to get well but not yet or b) he doesn't think he has a problem, depending on what day it is. Any thoughts or advice welcome.

[carolj]

How heartbreaking for you and frustrating at the same time. You say he travelled 15 miles to get his hair cut and you think he tried to get to his appointment, but I think this goes hand in hand with 'he wants to get well but not yet'. I would guess he is living in his own comfort zone and is terrified of challenging his OCD.

I would definitely talk him into giving permission for the psychiatrist to talk to you on Friday. Promise him what you think will make him say yes. Perhaps you will leave him alone for the day and won't try to get him to eat or drink. Make it something he will like rather than a threat (although Im sure you feel like shouting the place down. Ive been there, done that!!!). Even if he won't, go to the appointment and tell the psychiatrist you know he can't tell you much, but you have a lot to tell him!

Would the private psychotherapist give you a report from April so that you have something you can give to the psychiatrist that isn't coming direct from you?

It is notoriously hard to get someone sectioned, but this could be useful for you, especially as they have an advice line. Obviously you can't just let your son starve himself, but Im not sure calling an ambulance will help as they aren't in a position to remove him from home as far as I know, but Im not an expert in this.

http://www.mwcscot.org.uk/the-law/mental-health-act/emergency-detention/

I hope for the sake of all your family someone will do something. Please keep in touch and let us know how you get on.

Carol

[swimming]

Thank you Carol

We gave the mental health team and the psychiatrist a report from the private psychotherapist before the last appointment. He also had a talk with the CPN. Thank goodness we got this, as the psychiatrist is not recognising OCD (because of the few days in hospital). I will have a look at the link you sent. I am also phoning the mental welfare commission and getting advice from them. Will keep you posted.

[carolj]

Good luck. Its so hard dealing with the OCD and having to fight the authorities is just the final straw.

I hope someone listens.

Carol

[swimming]

Hi Carol,

I checked out the link you sent. It is the mental welfare commission where I have phoned for advice. Your link showed there are alternatives to sectioning(our own GP told us this and pointed us in this direction.) I will phone again tomorrow and get more advice prior to an appt with the psychiatrist on Friday. I have asked Mental Welfare Commission advice recently and was told to ask for an assessment under section 228 of the mental health act. I have requested this and not had a reply yet. Tonight my son is lying in bed, he has showered (don't know for how long, bathroom steamed up and flooded as usual) and he is a poor soul, his body looks like a skeleton. When I get him assessed I will request his weight and I will take this further. His own GP blames the psychiatric services but surely he has a duty of care as well. I appreciate your advice and note you have given me the link for Scottish law which differs from English law. I have also paid a membership fee today. I was a member before and unfortunately let it lapse.

[carolj]

My son is a little older than yours, but he too has suffered for what seems like forever. Its just heart breaking isn't it and no matter what you do it still makes you feel useless. We think we should be able to make things right for our children even when they are adults and will never give up trying. I saw on TV a man who described it as grieving for the son he had and I agree with that. That happy little boy who loved life.

I truly hope you find the help he needs, deserves and has a right to and he starts to get his life back and you, yours.

Ashley will very much appreciate you becoming a member and if you need any help with the system (albeit its the Scottish system), he is always willing to try and intervene for you if he can.

[Guest Sally44]

I also found that the charity "Mind" had alot of useful information and advice about how to get services involved.

My son is still classed as a child, so although still hard to get anything it is easier than if he were an adult.

Your Crux is that your son is saying he does not want/need help and they are accepting that because he is 'an adult'.

However there must be some law you can use that will make them responsible IF he did starve himself to death for example due to a mental illness. And putting that in writing may force them into action because the fear of being sued can get them to do something.

Although you are in this catch 22; it must be quite a common problem. Adult with mental health problems not recognising it, or accepting help, therapy, medication etc. So there must be a way around it. A charity like MIND is going to have alot of knowledge about this.

Does your son have a diagnosis of OCD? If not that might be the first thing to work on getting because if he has OCD you can try to find out how you can get your son access to what he needs.

And you do need to try to get your son on board to want to start challenging his OCD. Is there anything he used to do, or loves to do that OCD is stopping him doing?

Also could there be any other condition going on such as Aspergers?

Can you make a daily diary for about a week to show what your son and the family are going through.

Everyone seems to think that Contamination OCD means that the person will be forever cleaning their environment and themselves. Not so. They do what the OCD tells them to do, which might mean refusing letting you wash or clean because you are contaminated, or you will contaminate the things you move about or clean and will introduce that contamination into his bedroom [which is usually the most protected place].

Edited October 9, 2015 by Sally44

[swimming]

Thanks for all your support and suggestions. My son was assessed by a Mental Health Officer and a CPN on Thursday and he still has capability so although he is starving himself nobody can do anything. The mental health team do not know what to do with him, and are now thinking he would be better in his own tenancy with lots of support. They will meet briefly this week and the following week for an hour long meeting on his case. Meanwhile at home my husband, his father has tried to make healthy light meals for him and he hasn't even tried to eat. I have tried to talk to my son and pointed out he will die soon, although he said 2 weeks ago he doesn't want to die. I am "preparing" myself and my family for the prospect that my son will die soon.

[Caramoole]

Can you persuade your Son to somehow log on to the forum?

[snowbear]

Hi swimming,

I normally steer clear of the Friends and Family forum because I'm aware of the heartache I've caused loved ones in the past and feel too embarrassed to offer any advice here. I'm probably better at helping those with OCD than those living with someone who has OCD.

I've also hesitated to reply because the suggestions I have for you may not be approved of by doctors, therapists, OCD-UK admin or anybody at all for that matter. So first and foremost, feel free to ignore everything I say if it doesn't sit well with you. And if admin here want to delete my reply that's fine by me. I'm fully aware I'm sticking my neck out and suggesting something a little unconventional.

I've been where your son is, not eating, not drinking, skeletal, heading for multi-organ failure on the physical side while unable to accept help or change on the mental side. And my fiance watched, helpless, becoming ill himself trying to support me. I convinced the mental health team not to section me and they agreed, probably because I wasn't in a coma yet (though I prefer to think it was my wonderful negotiating skills and the fact I convinced them I had a recovery plan in mind. In truth at the time I hadn't much of a plan but I knew being sectioned would scupper any plan I might come up with.) I remember it well, although it was over a decade ago. Reading your story took me back there and got me thinking about what turned it around for me (us) and whether there was anything in my experience that might help your son (and you).

The first thing I would say is he probably has depression. I'm not making a medical diagnosis here, but it's almost inevitable if he's reached the stage of suffering and acceptance you describe. That means his entire world will have shrunk to a small space around him, everything will be viewed through a negative lens, his thinking will be slow, making even the tiniest decision will be a marathon effort for him and changing anything, anything at all, will feel like inviting in an inevitable catastrophe. Probably in his mind it feels safer to exist on the edge of extinction than risk toppling the lot by introducing the slightest change. It's not that he's not trying or doesn't want to see things fixed. His brain will be working flat out to solve a (to him) unsolvable problem. He just can't see how to fix it himself and nothing suggested by other people so far feels (to him) like it will fix it either.

Don't take any reluctance to talk on his part personally. Inside his head he's spilling the beans to you, his mum, and if only telepathy were possible... but it's not. So you've got to find another way to re-connect and communicate with each other. Spoken words are hard work when you're severely depressed.

Then there's the OCD. As you know, OCD resists change more than anything, even more than depression. So right now he probably feels completely and permanently stuck, his existence balanced on a knife edge with two powerful enemies inside his head telling him nothing can ever change. I doubt anyone has the courage or strength to overcome such an obstacle alone. But it can be done.

If you're preparing for the worst ('the inevitable' unless something changes), then you've little to lose by trying something that flies in the face of the standard OCD treatment advice. It's good that your son said he doesn't want to die. Hold onto that. Believe it, for it's true. What he wants is for the pain to end and life to go on, but right now those two things probably seem like opposing ideas with no possible way to make both happen. Trying to reconcile 'the impossible' is driving him crazy just now. But he wants to live and that's important. So, to live...

1. He needs to eat and drink. To achieve that essential step it may require a little bit of temporary pandering to the OCD.

I can immediately think of 3 reasons I had for not eating/drinking, but there could be more, unique to your son's thinking and beliefs.

i) it's just too much effort to chew, swallow, lift the fork. This is the depression draining every last ounce of energy. Try tempting him to eat soon after he wakes from a longish sleep.

ii) the food/fork/plate may feel contaminated, or the kitchen preparation area may be contaminated in his mind. Ask him if this is how he feels and if it's why he won't eat what you've prepared. Offer food that comes in sealed packets, drinks from sealed bottles. Consider disposable cutlery or sterilizing the cutlery by pouring boiling water over it before he uses it. If he can't touch the wrappers or bottles, ask if he could eat the food if you carefully opened the packet and tipped it onto a sterile plate straight from the dishwasher, or if you haven't got a dishwasher a plate that's been sterilized, again by pouring boiling water over it. Don't be afraid to ask him what would make the food/drink edible and get him to think of a solution he's happy with. Try to make his suggestions work, even if it's crazy, or a lot of effort. If a 'compromise' you make works, introduce something that stretches his comfort zone just a little bit while he's on a relative 'high'. Go for tiny increments, try not to rush the process. It's not unlike weaning your baby all over again; get enough food in to keep him going while mixing some baby-satisfying compromise with some new experiences.

iii) ask him if the bathroom is the problem, particularly using the toilet. Better to starve/suffer dehydration symptoms than have to 'go' with all the hand washing, body cleaning and everything which follows. He may simply be trying to reduce bathroom visits to a minimum. Or maybe the towels don't feel clean, or the toilet paper. Again, something as simple as an unopened packet of toilet roll kept just for his use after opening it might be something to consider. Ask him - he might not have these fears at all, but the fact you're trying to see his world as he sees it and showing willing to 'compromise' will mean a lot.

Remember, you're not going to be 'giving in' to the OCD forever, just long enough to keep him alive and regain the ability to start thinking more clearly. (Dehydration is a major cause for making irrational decisions in healthy people. Just because he has OCD on top doesn't make the dehydration any less important as a contributory factor to confused thinking and the inability to make choices when presented with more than one option.)

2. He needs to have something to plan for. Not just an event that's coming up to look forward to, but something he has to plan. Right now you can make it his funeral if nothing else comes to mind. Doesn't matter what it is, the point is to get him thinking about what he wants.

In severe depression it can be really, really hard to think of anything you want. The world has nothing left to offer you. Life has nothing you want. Being well doesn't offer anything you want because you can't imagine ever being well again, so it's irrelevant. But in his inner despair, in his pain there's something he wants, something he believes would make his present life that tiny bit more bearable. Encourage him to look for it and name it. Then help him devise a plan to make it happen.

3. Just before he achieves that goal, get him to set another goal, make another plan. And so on.

This is taking baby steps, shuffling when you want him to run, but it might be as much as he can muster as a first stage.

It must be incredibly hard to watch, and to suffer alongside him. It must be tempting to hope for big, turn-around changes. I can only imagine the depth of the desire to offload the situation to mental health services by having him hospitalised or moved into his own accommodation. (From what you describe he would last less than a week on his own before a major crisis occurred. I've been through more situation-induced crises than I care to remember, so why the mental health team are even considering this option just now is a bit beyond me. Maybe in a few months when things are more stable?)

Everyone's an individual and what worked for me might not work for your son, but I couldn't leave you preparing for his death without saying something.

Good luck. Keep us posted and if I think of anything else I'll let you know.

[carolj]

I have to say Snowbear you made me feel very emotional reading your post and Im sure Swimming will take comfort and hope from your advice, which had a lot of helpful practical ideas. You are right, getting him eating and drinking has to be top of the priority list right now.