What ‘Treat and Street’ Means for My Daughter Who Has Bipolar


When my daughter was officially diagnosed with bipolar disorder, I knew the chances she’d be hospitalized were high.

What I didn’t know was that she would be hospitalized five times by the age of 9. I believe at least three of these hospitalizations could have been prevented had she been given the care that she needed.

Her first hospitalization set the bar — my daughter was assigned a case manager who worked as a liaison between the doctor, the school and us. She really went out of her way to ensure my child received the best care possible. During this visit my daughter was inpatient (meaning she stayed overnight in the hospital) and then outpatient (care that doesn’t involved staying overnight) for a total of six weeks. Since the hospital was over 100 miles away, my daughter and I stayed at a motel during the weeks when she was in their day treatment program.

My daughter remained marginally stable for about seven months. Shortly before this time, my husband and I had to put her on government insurance due to some unforeseen circumstances. I knew this insurance would be subpar, but I never expected the standard to be as low as it was.

When her symptoms started getting bad again, it took three different trips to a local hospital’s emergency room before we were finally told by a county appointed evaluator that my child met the criteria for admission to a behavioral health hospital. My child was bound by restraints and sedated because she was so out of control she tried to injure several hospital staff members.

The crisis team member took one look at my child and decided she met the criteria for hospitalization without interviewing her.

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So my daughter had her second hospital stay only 80 miles away from our house. But, it did not include outpatient care. This means she was hospitalized, stabilized and then released with no sort of treatment plan. Without the transition of an outpatient program, we were left on our own.

This hospital stay became the first of four hospitals in a two-month period. It was a perfect example of “treat and street,” a term among the mental health community to describe when a hospital stabilizes the patient and then returns them to society with no real follow-up.

During her previous outpatient care, my daughter was able to work on her coping skills through group and individual sessions and was monitored by hospital staff to see if there were any significant changes in her behavior. Without these extra supports, she returned to our house and quickly returned to her old, unhealthy coping mechanisms. Her behaviors put our family and those in community at risk. On one occasion she was rehospitalized for taking off her seat belt in a moving vehicle in order to attack me.

We felt like we were on a merry-go-round. Each time was more traumatic than the last. On one occasion my child was escorted via ambulance from our house in restraints because she would not go quietly in our family car to the ER. She knew what was coming and wanted no part of it. I believe if my daughter received the level of care that she received at her first hospital stay that summer, that scene could have been prevented.

In my opinion, it’s irresponsible for a behavioral hospital or insurance to allow a patient under their care to be discharged without a comprehensive plan of care. All mental health patients, regardless of their economic status, should be provided the necessary skills and tools to help them function at their best possible level. For my daughter that means if she needs to be hospitalized again, she will also need an intensive day-treatment program preferably at the hospital she was admitted to. This will help her remain stable for longer periods of time.

Returning an unstable individual home without a solid after-care program may seem cost-effective at the time. But in the end it’s not just money that is lost — the patient’s dignity is lost as well.

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