You're in a really tough spot. It seems that your son is refusing all treatment other than the hospital-homebound status. (I'm not sure what that means. If he never leaves the house, what's the "hospital" part of it?)

Since the state requires self-referral for residential placement and you're pretty sure your son won't agree, the only other option is for you to commit him against his will, which is very hard emotionally for everyone, and just about impossible unless you have good insurance and a doctor's support. And if it's against his will, he might need a placement that he could not easily just walk away from. .

At nearly 17, your son is past the age when you can just boss him around, so I think you'll need to approach him more as the young adult-to-be. I hope you have a good relationship with him, at least some of the time, because if you can hold meaningful conversations, you might have a chance at helping him. It seems to me there are at least two things you need to start talking about:

1. What does he find unpleasant about his current treatment (pdoc, therapist, med side-effects (physical & mental), just having to take meds, etc.? YLook at it from his point of view so that he believes you are listening, that you care, that you are on HIS team, even if that means agreeing to more of what he wants. Would he be willinig to try a new pdoc and/or therapist? Would Or would the current pdoc and/or therapist be OK if there were some changes? The point of this discussion is not to defend the status quo or to argue about whether or not he needs treatment, but to understand and demonstrate to your son that you take his concerns seriously.

As an adult, he will have to choose his own doctors/therapists, and when these folks on imposed on him by parents, there's no buy-in. If I were in your shoes, I would let him switch care providers, even if they are out of your insurance network and you have to go into debt or drive 90 minutes to meet them — but I'd also let him know that you are willing to go into hock only as long as he holds up his end of things — in other words, giving new providers a chance at success, which might take a few months getting acquainted, feeling lousy during med changes, etc. And you might even have to switch more than once to find a good match. There is nothing worse than seeking treatment from someone you don't feel comfortable with, and that goes double or triple for psychiatric care.

Does your son know he's depressed right now (or is that your observation)? He must be aware that his life is not very satisfactory right now, which should lead to conversations about what he would change if he could wave a magic wand. Online friendships are OK, but it's a lonely existence. Would he like to hang out with friends (old or new) more? What would make his life more interesting? How does he propose to shake his depression if he refuses treatment?

2. Talk about his impending adulthood. What does he want to do with his life (big questions!)? What happens when he graduates from high school and turns 18? Does he realize that adult freedoms and rights come with responsibilities, and that in the eyes of the law, parents no longer owe him even a roof over his head? Not that you plan to abandon him! It's time to start setting expectations.

When my oldest was your son's age, we started talking about this, and the bottom line was: If you go on to college, we parents will support your education, but there's no more allowance. You have to earn money for your entertainment, cosmetics, clothes, and general spending money. If you decide not to continue your education, then you'll need to get a job; you can still live at home, but you'll have to pay room & board. Either way, we'll keep you on our health insurance and pay your medical expenses.

Expectation-setting can be done in a perfectly friendly, you're-growing-up-and-will-be-an-adult-soon" kind of way. This kind of dialog assumes your child will make his own life decisions (college vs employment after high school; taking a gap year or two could be an option). You and he have probably thought more about college, but if he's not ready for college, he needs to come up with a plan for the next couple of years while he finds himself, and you need to help him understand that he has to assume new responsibilities as a young adult.

For your own sake, start thinking about how long you are willing to let your adult son live in his bedroom with only online friends, what house rules you may impose (and enforce) on an adult child who is resisting, etc. No need to come up with answers yet.

I suggest you do an internet search on several terms (bipolar, child, refuse treatment) to see what you can find. The two articles below describe what you are/will be facing in the years to come and may help you think about small ways in which you might be able to help your son (or yourself).

http://www.healthcentral.com/bipolar/c/question/61845/28392 (substitute "son" for "spouse")
http://www.healthieryou.com/helpdep.html (see "Depressed Young Adult")

Finally, you may find it helpful to join some kind of support group. You'll also be able to find other people who have had to deal with sticky situations of their adult children with bipolar, schizophrenia or other serious mental illnesses by checking out your local NAMI affiliate. NAMI's support groups and educational programs are all free.

Daunna Minnich
Moderator, JBRF Education Forum