This is the case study of an 18-year-old transgender male client living in South Florida who entered into his first residential stay in treatment immediately upon discharge from a local hospital where he’d admitted himself voluntarily four days prior due to significantly increased depressive symptoms and suicidal ideation over the previous month. Client presented as highly anxious and overwhelmed with the state of his escalating mental health problems upon arrival at DH. From an outside perspective, this client was a gifted high school senior experiencing an increased struggle to function across domains, though this decline was mostly apparent academically.
Client had recently been informed that he was at risk of not being eligible to graduate on schedule, triggering his decline. Internally for this client, the burden of school, work, family, and social stress and responsibilities felt too heavy to bear. Despite being in outpatient therapy with a psychiatrist who specialized in treatment of this client’s complex diagnoses, including depression, anxiety, PTSD, and autism, as well as issues related to identity and frequent dissociation, he could not find relief. Client maintained compliance for years with prescribed medications as part of his outpatient treatment, yet they did not feel effective in improving his symptoms to allow him to function.
Client disclosed a history of self-harm which had been triggered by the intensity of his mental health symptoms and also reported a single previous suicide attempt at age 14 via overdose of his prescribed antidepressants. Client felt that he lacked the ability to identify and express his emotions due to his autism and trauma, which worsened the intensity of depression and anxiety he faced and resulted in behaviors that he later framed as a cry for help to allow his parents and other support to recognize his dire need for intervention. The primary motivation Client identified upon admitting into DH was to learn effective coping skills to live a life free of suicidal ideation, though he admitted his hope was minimal in comparison to his perceived barriers.
Client arrived to DH uncertain of what to expect in residential mental health treatment, specifically in a dual diagnosis facility; he was naturally anxious and apprehensive. Client remained hyperfocused on discharge and external factors throughout his first two weeks in treatment. However, through the process of developing rapport with the DH clinical team via interventions that were trauma-informed, culturally sensitive, and individually targeted for Client’s unique presenting concerns and needs, Client was able to reduce this guarded and unhealthy pattern of behavior by adapting to treatment and becoming receptive to the professional support and help being offered to him. Client received support and accommodations to maintain his academic engagement while in treatment in order to remain on track with goal of graduating high school on time, which served as a primary motivator for his willingness to stay in treatment. Client overcame social anxiety by actively engaging in daily group therapy sessions, which also allowed him to learn and practice a variety of coping skills while increasing awareness of factors contributing to mental health and associated risks. Client was able to make significant progress towards the resolution of his depression and anxiety, achieving a level of stability through the development of healthy, effective coping skills in conjunction with medication management. Client was also able to process and reach a therapeutic breakthrough in family therapy by disclosing the nature of his trauma to his mother. Additionally, Client and his mother remained highly engaged in DH’s amazingly powerful family program even after his transition home, reporting that this has tremendously improved their communication and led them to have a relationship that they’d never had before: one of honesty, understanding, true support and mutual appreciation.
This client was able to successfully complete the Residential and PHP levels of care over the course of 11 weeks, followed by a smooth transition home with his family. Though he was in treatment throughout the majority of his final semester of high school, he was able to resume his Senior year activities, attending prom and graduation within weeks of discharge. Client’s mother provided his DH Therapist with positive updates on their continued progress in the months since he has been home, sharing photos from his graduation along with a report that he has regained part-time employment, and is continuing to make progress with his outpatient therapist, and is enrolled to begin college courses in the fall. Client and his mother have each expressed their appreciation for the role Destination Hope has played in their individual and family success in their mental health journey.
