Our son has mental illness, he lives with us, he’s 30, we give him his meds everyday, he has no job, no friends, no motivation, sleeps all day and paces all night. What’s the next step for us?

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Such a difficult situation and can really be challenging when we have an adult child who is really struggling to make that launch.

I think that there are a number of things that come up for me on this. The first is that different types of mental illness require different types of interventions. So, the answer to this question would really vary depending on whether your child is schizophrenic or is struggling with some anxiety. In other words, there's a whole spectrum of answers that would be more applicable to certain diagnoses.

I'll just give that as a caveat that we would need to know a little bit more about that specific type of mental illness. But I'll answer this, assuming that it's something in the genre of anxiety, depression, maybe some agoraphobia, those types of things.

You've already got some medication on board. So hopefully that means there's a psychiatrist that's overseeing his care. I would obviously recommend some individual therapy to assist with this. But one of the things we can do when we have an adult child who is struggling to function, provided that they have the capability of doing that, is to allow some consequences to match behavioral choices. In other words, if a child is declining to have a job, maintain a routine schedule, and manage their self-care. Having some consequences that would match that and allowing the person to have a healthy relationship with the consequences of their choices. What that might look like over time would be, together with your spouse or your partner, whoever the we is in this question, setting up a timeframe for this young adult. In other words, " Sweetheart, we love you very deeply. We want the very best for you. We know that the very best for you would include being able to live independently and really flourish in your life. As a result, Mom and I, or Dad and I, have decided that, within the next four months, we will be working with you toward identifying jobs that would be a helpful possibility. In month four, we will begin to charge you rent. Our goal is to empower you to move out, as we increase that rent gradually over time to become self-supporting."

You may wish to have a caveat, "We will be happy to underwrite some therapy for you while you're getting on your feet."

But also declining to over function for someone who is able to function. Again, if this person is able to get their own meals, to manage their own schedule, not doing that for them. If they're not eating, really not continuing to provide that food and intercept the healthy consequences of that person's behavior. Sometimes we really have to feel the pain of our choices before we can grow and learn.

Another thing that comes up for me, as a parent myself of young adults, is that the way that we parent when our children are in distress, often takes us back to some early childhood roles that we learned. So when we have a child who's in distress, that feels frightening for us. If when we were young, we learned how to caretake other people so that our environment would be safe, we tend to do that in our parenting as well. If we're concerned about our child, we might tend to over parent or over-function for them to create a sense of perceived safety. What tends to happen then, is the other individual winds up under functioning and that can become a perpetuating cycle.

One thing that can be very helpful is doing some of our own work on our own early childhood experiences and any roles that we may have inadvertently moved into as a way of creating safety for ourselves that no longer are helpful and effective.

Great thoughts.

The only thing I might add, or as a follow-up, I would really want my child to be in therapy. Just to talk with somebody besides mom and dad.

I would also say sleeping all day, pacing all night. Clearly, we're hearing some anxiety and if there isn't any med management, I would want to make sure that there's med management that's being monitored.

Great, great question and good thoughts, Jenna.

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Dr. Kevin Skinner