Comments about his lack of deservedness do not require a response - simply carry on with whatever you are planning. The same can be said in general of his statements about killing or hurting himself, though it can be useful some of the time to either (a) make a reflective sort of remark, such as: You must be very unhappy/upset, or (b) express curiosity about his statement (e.g., What would happen if you did that? How come that would help?). In general, though, when children make such remarks in moments or emotional reactivity, it's better not to respond because they cannot 'hear' the response in a rational manner. If he acts unreasonably to his brothers, employ discipline - e.g., give him a 'warning' to stop the rudeness or mistreatment, and if he fails to do so place him in time out. For the most part, you needn't intervene if he hits or scratches himself, beacuse this will promote an unhealthy sort of interaction. Only if he's posing a threat to himself should you restrain him from doing it. You are also doing the sensible thing by planning to talk this over with a clinician.
When you see your therapist ask about books you can buy to help with disipline matters, building self-esteem, etc.
Bipolar Children are often mistaked for ADHD. Or as in my son he is Bipolar, ADHD, ODD(Oppositional) Are you saying that your grandchild "sees" people are does he hear voices? (How long has it been since Grandfather's decease? He may be just missing him.) I'd like to hear from the Good Doctor here if this applies to Bipolar or Schitzophrenia. I do know that "hearing voices" is somewhat common in Bipolar.
Bipolar symptoms in my son included Mental Family History. This is very important. If anyone in family (Parents, cousins, Aunts, Uncles, Grandparents) have any mental issues than this is something to tell a psychiatrist about. Any threats about killing self, desire to go to heaven should be taken seriously. You may want to check out the Library for The Bipolar Child by Demitri Papolas. A very good book. My son goes off in Rages (major TemperTanrums lasting hours) when saying NO or just not giving in.
Second, I forgot to mention that Risperdal is an anti-psychotic medication that is used for schitzophrenia( Though my son is not). It helps with Rages, Nightmares, Hearing Voices.
Kids need love, assurance, attention and even discipline.
There are other ways of dealing with some of these problems that come up. Running to a DR. for quick fix drug is not the answer.
Long walks and talking with the children will do more good than anything else.
Especially if you don't judge and ask the right questions.
Kids are people, not possessions.
I have a 7 year old Granddaughter that just started to wet the bed. I believe she is doing this because she feels her Mom does not love her. Mom has turned custody over to the Day 9 days out of 14. I think I probably would do more than just wet the bed.
I am open for advice and comment.
Chips
Please read Danielle Steele's HIS BRIGHT LIGHT. This is about her son struggling with Bipolar and he HAD lots of love, attention, therapy, disipline, etc. No Label.