i’m 20, in maryland on medicaid, and i’m trying to figure out if i need inpatient or residential psychiatric care but i feel really stuck and overwhelmed and i’m not sure if i even qualify.

i have formal diagnoses from childhood (adhd, depression, ocd, ptsd, trichotillomania, pica) from about 5 years of psych treatment as a minor, but my treatment was heavily interfered with by an abusive parent. they actively sabotaged care, prevented certain evaluations, and repeatedly framed me as “lying/dramatic,” which affected how I was treated clinically. i also lost trust in the system because i was trying to protect myself and my sibling from being placed in foster care, and i ended up withholding and minimizing information just to get through required sessions and stay safe.

i recently restarted psychiatric care after about 3 years without treatment. i was seen today by a psychiatric nurse practitioner and started on risperidone, lamotrigine, and hydroxyzine, with a follow-up in 2 weeks before any referrals for additional evaluation or higher levels of care.

my main issue right now is severe, persistent dissociation and functional impairment. i have a short window in the morning where i can function somewhat normally, and then i rapidly drop into a dissociated state where my ability to process my surroundings breaks down. i struggle with vision clarity, reading, understanding speech, communicating, and basic thinking. i become disoriented and unable to function for any task including ones i desperately want to do.

i also have significant memory loss and periods where i don’t feel in control of my actions or decisions. this has led to things like quitting jobs without knowing until afterward, and getting pulled into or escalating unsafe situations at home and having to deal with the outcome without understanding why it’s happening.
the psychiatrist i saw is a psychiatric nurse practitioner, so her ability to do more in-depth diagnostic evaluation and specialty assessment is limited compared to higher-level psychiatric care. dissociation has been acknowledged as part of my presentation, but the current plan is to trial medication first and rule out mood-related causes before any referral for more specialized evaluation.

i understand why mood disorders are being considered, but my concern is that my symptoms don’t feel episodic or mood-driven. the functional impairment (dissociation and depersonalization, disorientation, inability to process speech/reading/visual input, and loss of continuity in memory and actions) is present daily and follows a consistent pattern rather than clear mood cycles or distinct high/low episodes. because of that, i’m worried that focusing primarily on mood stabilization first may not fully address what seems to be a more persistent dissociative-level impairment, and may delay appropriate evaluation and care.

i also don’t think outpatient care is realistically going to be enough right now because my home situation is actively escalating. getting help itself has made things worse at home, and i’m now in a position where it is extremely difficult to focus on anything to do with this because i am constantly focused on navigating interactions with my abuser safely. this takes up most of my mental bandwidth every day and leaves me unable to consistently work on anything. it is significantly harder now that they are home all the time due to disability, so i cannot avoid or separate from the situation.

outpatient care also feels very limited for me right now. i’m on maryland medicaid (carefirst community health plan) and there are very few in-network providers in my area that are actually accessible. getting psychiatric care already took a long time and required a referral to even find someone available, and i’m not confident there is enough local outpatient support to properly evaluate or manage what’s going on beyond medication follow-ups and hour long telehealth therapy sessions. i need help getting back on my feet after 20 years of physical, sexual, emotional, financial, and medical abuse and i have so many overlapping mental and physical issues that i just feel are too complex for this.

on top of this, i am financially dependent, have no income, and no other support system. i cannot work or function independently at this time.

i’m looking into places like sheppard pratt because i feel like i may need a higher level of care than outpatient psychiatry. i feel i need structured inpatient or residential treatment, trauma-informed care, and case management/social work support.

but i’m also scared of inpatient/residential options. i’ve seen reports of inconsistent care, high turnover, and sudden discharge, and my biggest fear is being placed somewhere and then discharged without a safe place to go. if that happens, i would likely end up homeless, since my current home is the only housing i have even though it is abusive. if i leave, i will not be welcome anymore.

i also worry about not being taken seriously or being misunderstood in psychiatric settings as a black patient.

i feel stuck between staying in an unsafe environment i cannot function in vs risking losing the only housing i currently have if higher level care doesn’t work out. i don’t have anything or anyone to fall back on and i’m terrified.

i also don’t know how much my past medical documentation will even “count” for getting help with how bad it is. because of that, i’m unsure whether i even have enough reliable records to qualify for certain levels of care or government assistance programs, or how much that will affect my ability to access residential or inpatient treatment now as an adult.

anyways, in making this post i am mainly trying to understand:

– how people realistically get into higher levels of care especially in a situation like mine
– whether there are programs that provide treatment + case management + discharge planning so people are not left without housing after stabilization
– what steps i should take first given i currently have a psychiatrist but feel outpatient care may not be enough
– and if anyone has experience transitioning from severe dissociation/unsafe housing into stable treatment and support systems
– and whether lack of consistent and accurate records significantly impacts access to higher levels of care or disability/support service
- adult rtc recommendations near me

thank you for reading! any and all advice is greatly appreciated! ❤️

Hello everyone! I am extremely interested in Gentoo but aside from a previous short stint with Arch, I don’t know much about linux or computers for that matter (learning as I go though). I love love lovedddd the steep learning curve with Arch and being able to customize my system to my liking was an endeavor I throughly enjoyed. I stopped using Arch though in favor for the convenience that Windows gave me but I haven’t forgotten that feeling. I have heard about Gentoo but I didn’t know much about it except for the compilation time memes. I have since come to learn a lot about it and I’ve now decided that I want it on every single device that I own. Only thing is I need a little guidance on how to not bite off more than I can reasonably chew and to understand exactly what it is that I’m doing.

I have been lurking on discussions about Gentoo for quite a bit and it seems the consensus is that using it for general use or daily driving isn’t recommended and that it should only really be used for weird setups that you otherwise wouldn’t be able to easily get away with on other distributions. The thing is, my use case IS a little weird. Aside from enjoying the tinkering, I started my linux journey with Arch because I have OCD and a lot of my obsessions have to do with not having complete control or an understanding of what’s going on in my computer. I not only got enjoyment out of the customization but it alleviated a lot of my anxiety. I got to freely use my computer without feeling like there was something malicious going on in the background 24/7. It gave me the opportunity to learn about all the different technologies that operating systems comprise of and that allowed me to understand a lot of what was going on under the hood and I appreciated that. Thing is, it wasn’t perfect.

The more and more that I learned about linux and computers in general, the more I understood that Arch was making certain decisions for me that I would much rather make myself. Learning about the difference between binary packages and compiling from source is what I attribute this discovery to. As well as learning about different initialization systems. After that, I went back to Windows because not only did I feel like it was a waste of time to customize if I didn’t have complete control, I felt like it was starting to get unhealthy to obsess over it and I had to back away and distance myself from communities and discussions about mass surveillance and the more “elitist” side of the linux community.

Using windows wasn’t the answer though as it just made using my computer feel “unsafe.” I tried everything from completely debloating it to installing a bite sized version of windows. The issue is that the upkeep is too much and it just causes more issues and anxiety. It prevents me from actually getting anything done.

Discovering Gentoo and its community completely nipped this obsession from the source. Everytime I spiral, the handbook and this subreddit help me immensely. They do not try to tell you what to do rather they explain everything you need to know to make an informed decision. Gentoo and it’s community don’t force systemd or posture it as a net good or bad, they explain what it is and why you may or may not want/need it. This has helped me realize that the only way to alleviate this is not to blindly follow somebody’s advice on “escaping big tech” or even to sit with the discomfort of thinking my computer is spying on me, but rather to learn about computers and understand how it works. I want to be able to make informed decisions on my install and take certain “risks” as long as I fully understand what I’m getting into.

But this is precisely what I need help with. I want to use Gentoo for the way it streamlines compilation (which is how I want to install most of my packages going forward), and for the choice that it gives. I have a lot of computers because of my role in the family as the designated e-waste landfill and I am always trying to find ways to fit abandoned tech into my ecosystem. The thing is I am still learning so much and my foundation is rocky. I’m still trying to gather enough confidence to just install Gentoo on my devices and work from there but I find that for certain devices, there is a significant amount of learning and planning needed before I do anything. I don’t like consulting the internet though and a lot of the resources that have been recommended to me do not explain things like the Gentoo wiki does… It just kind of tells you what to do and doesn’t go fully in depth like I wish it would.

To give a few examples, I want to start my own home server with an old pc I have laying around but a lot of the guides out there just kind of tell you what distribution, components, and applications to use and have you go on your merry way but none really help me fully understand the technology and concepts that make up a home server so that I can make a server out of what I currently have and do what I want with it without having to consult the internet 24/7. Same thing with gaming. I don’t want a tutorial on how best to optimize my PC for gaming, I want to understand my computer enough so that I can figure out how to do so on my own if that makes sense. There’s just so many factors that go into something like that I don’t believe it would be wise of me to just blindly follow what they’re telling me. I also don’t like doing and adding things to my computer that I don’t fully understand.

I guess what I want is guidance on how to proceed with this and tested and true resources/guides to help point me in the right direction. Wikipedia and the handbook have been my best friend but I find that there’s just so much to learn that It’s all so overwhelming and I struggle to understand and actually apply the information to what I want to do. I don’t want to have to use another os or distro.

What helped you guys get to the point where you can just do things on your computer without significant hand holding? Did you just take a chance and learned as you went or did you have a more structured way of learning? I prefer structure because I find when I learn without it, I’m stuck with a shitty foundation that I’ll have to rectify by relearning everything later. But I feel like I’ll just have to bite the bullet for this situation. Anyway, thank you so so much for reading this far… I know the post is long and a little rambly. But yeah any advice is greatly appreciated!!! :-)

TL;DR:

I have OCD and most of my obsessions have to do with not having complete control over my computers. Gentoo alleviates this in more ways than one. I want to use Gentoo on everything including a home server I’m planning on building in the future but I am still a complete beginner on everything to do with computers so I’m finding it a little hard to get started. I’m looking for advice and any resources.