Help me to help my ill brother

July 12, 2009 12:35 AM

My introverted 19 year old little brother just confessed to me that he "hears voices" (telling him to hurt and kill people) and that he "sees things that aren't there". Help me find some resources to help him.

You can read more about my brother here. This all started with an argument we were having about alcohol. He's been drinking heavily lately and we got in a fight over it. He ended up telling me that he "feels good when he drinks" because it helps to silence the voices and keeps him from feeling uncontrollable rage at the rest of humanity. This is totally new to me. I've never even heard a hint of this from him before. He says it's new to him too, only showing up in the past year or so.

So, he needs help. The problem is that he's 19 years old, works odd jobs for 10 hours a week (making around $8 an hour), has no health insurance and otherwise has no resources. I'm looking around for local psychiatrists but it's obvious that without health insurance our family will be unable to afford more than a single doctor visit or two.

I live in Harris county, Texas. There is a Harris County Mental Health office but they seem to only serve people who have already been diagnosed with schizophrenia or major depression. Barring them, it seems that (ironically) his only other option to get affordable care is to commit a crime and get to see the jail psychiatrist.

Does anyone have an inkling of where I can even start with this? Help!


PS- we can't buy private health insurance for him because he has a major pre-existing condition (harrington-rod spinal fusion). Thx insurance co's!

posted by Avenger to health & fitness (42 answers total)

This is a list of mental health resources that the University of Texas has put together. It seems that the University of Texas doesn't accept those without medical insurance, but that list looks like a fantastic starting point.

Even if you don't find any clinics with a psychiatrist on board, a few of these places on the list will very likely be able to provide referrals to places that will be able to help.

My advice is to keep at it and don't get discouraged - this is something that can be treated. I hope someone else on here is able to provide a better link!
posted by neewom at 12:58 AM on July 12, 2009 [1 favorite]

Avenger, I think (I hope) that you might have misunderstood the services. On this page, second paragraph under adult services, it seems like anyone who is eligible (based on county residence, etc.) will be seen for an assessment where they will be diagnosed with a mental problem if they have one. With that diagnosis, they will then be able to be treated. I hope this interpretation is correct, please, please call them first thing on monday.

If he does have a legitimate mental disability that is as significant as you suggest (and it seems like it is preventing him from working), he should be able to qualify for state-funded insurance and possibly other assistance.
posted by necessitas at 1:22 AM on July 12, 2009 [3 favorites]

(Not saying either of these are much of a good idea, just to mention options.)

When I was briefly facing not having health insurance I looked into Teladoc. When I was reading about it a few years ago it had a variety of restrictions because it was strictly supposed to be a secondary supplement to having a primary care physician.

On getting health insurance - it should be possible for either you and him together, or possibly even just him by himself depending on what the laws are in Texas, to form a company and get a small group insurance plan for him which would have the HIPAA protections that private insurance plans do not. For me, in my state, this allowed me to get around pre-existing condition restrictions.

In my state registering an LLC (Limited Liability Company) is easy, no more complicated than registering a car, and requires only a single yearly form to be filled out with a $150 fee. (We don't have state income tax, that might make things more complicated.) I wrote a bit more about getting insurance this way here. One caveat is that I think you'd usually have to commit to an entire year of insurance.
posted by XMLicious at 1:35 AM on July 12, 2009 [2 favorites]

Avenger - check MeMail
posted by necessitas at 1:52 AM on July 12, 2009

He doesn't need to wait until Monday. Find the MHMR emergency clinic -- I don't know who/what/where in Houston but I'd bet dollars to dimes it's close to the setup in Austin -- he can walk in and see a social worker and maybe a shrink, if one is on duty, can surely get setup to see one.

I can't stress this enough -- he's got to tell them what is going on. Not embellish it -- he's got plenty going on -- but a natural tendency is to not allow others to see the real deal, to minimize so as to not feel weird in the presence of anyone, much less someone you don't know and it's 4:37am Sunday morning in an emergency room psych ward; it's somewhat easy to get defensive there. Don't. If he goes light on this at all, they'll give him an appointment sometime in September. All the money's gone; public mental health services are just stripped to the bone, they save money, they keep the doors open by turning people away, which is just so harsh but there it is.

Alcohol is a powerful anti-psychotic, not elegant but it gets the job down. Soothes what ails. One reason why so many people with schizophrenia and manic depression become alcoholics is that they use alcohol to quiet things down but then, over time, they end up both mentally ill and alcoholic, a nice one-two punch there, two for the price of one. Deadly stuff.

You're going to have to come on like a one-armed paper hanger. They will do what they can to put you (him) off, to shove him out the door, to pretend you don't exist. A horror show: You've got to be sick enough to need public mental health care, yet well enough to jump through all the hoops they throw down to keep you away. Nightmare. Arizona is even worse, but not by much; they're both gruesome. You can help him in a huge way by staying on top of it all, taking notes, who you spoke with, what they said, when to come back, on and on and on. He's probably too sick to deal with that right now. I'm glad he's got you there to help him.

One thing he'll probably have to do is apply for SSDI disability, or the city/county/state won't pay for his medications. They'll help you do this but you've got to keep awake or it'll slip past and then -- no meds. If he doesn't keep all his appts, not only with shrinks and psych nurses but also with case managers, meeting with them quarterly, he'll get tossed out of the system. It's a zoo.

That said, if you successfully work through the mazes upon mazes they throw down in front of you, you can get high quality psychiatric care. There are great shrinks and great psych nurses, psych nurses in MHMR know just one hell of a lot, they are on the front lines, often as knowledgeable as any shrink or moreso. There are compassionate social workers also. There are butchers, of course, heartless, careless, thoughtless shrinks and nurses and whatever else, but no more than in the general populace of shrinks psych nurses etc. The problem is that even the good ones are just buried and they're burned out. If you can catch the right doc on the right day and get his/her attention and get them to see that your brother is a live human being and not just part of the flood of humanity that runs through every day, you'll get really good care.

Get ready to rock and roll. I'll help you as I can, I'll tell you what I know, which is a lot -- I know the system here in Texas pretty dang well, the realities of it, the good and the bad. I can't imagine it's that much difference in Harris county than Travis county, probably more over-run is all, different addresses but I bet if I walked in the door it'd feel exactly the same, and the people would be just about the same, the paperwork identical. Send me memail or whatever it's called or an email [e-mail] if you want.
posted by dancestoblue at 2:40 AM on July 12, 2009 [26 favorites]

Go with him to your nearest county assistance office and help him fill out an application for Medicaid. Then call the Harris County Mental Health office with your brother there and explain to them that your brother is currently completing the application process for Medicaid, but you would like to get him set up with an intake appointment in the meantime. Places that accept Medicaid will usually start the intake process as long as the application has been submitted. If he needs food stamps, put that application in, also, but don't apply for cash yet benefits if he needs Medicaid right away, it bogs the application down and makes the process take longer. If he needs some income and he can't work, help him start an SSI application (you can start it by phone or go to your local social security office). Applying for SSI can be complicated, if you do this contact me later and I'll fill you in on what to expect.

If in the meantime he threatens to hurt himself or someone else, take him to the emergency room, or more preferably a psychiatric emergency room, sometimes called a crisis response center. Find out where they are in advance.
posted by The Straightener at 5:49 AM on July 12, 2009 [5 favorites]

I think you need to treat this as a psychiatric emergency and get to a crisis center or psychiatric ER as soon as possible. If he's hearing command hallucinations telling him to hurt himself and others, that needs to be assessed now. Yes, it may be a good sign that he hasn't complied (as far a you seem to know, have you asked?) in the "year or so" that he's been having hallucinations, but a professional needs to make this decision. Yes, you need to worry about money and insurance and all that, but if this was any other potentially life threatening emergency would you wait?
posted by brevator at 5:53 AM on July 12, 2009 [1 favorite]

Also, the Community Mental Health Centers Act of 1963 mandated that communities make necessary provisions for psychiatric emergency care. There has to be an emergency clinic or Psych ER somewhere in your area.
posted by brevator at 6:00 AM on July 12, 2009

If in the meantime he threatens to hurt himself or someone else, take him to the emergency room, or more preferably a psychiatric emergency room, sometimes called a crisis response center.

I don't think you should wait for him to threaten violence. He already has hallucinations commanding violence, and I don't think anyone here can determine if and when he might choose to act on these commands.
posted by brevator at 6:07 AM on July 12, 2009

Seconding brevator. Take him to a hospital or urgent care clinic now, and you have a much better chance of "stopping it before it starts." Best of luck to you both.
posted by scratch at 7:07 AM on July 12, 2009

Thanks to everyone who has posted so far. Things are quiet now. I'm waiting for my mom to get home so I can get her involved in this process.

I'm kinda wondering how this could go unnoticed for so long. Yet, I also remember him telling me a few months ago that he hates it when we have house guests over, because, as he puts it, "they are trying to kill mom, and all I can think about his how to kill them in retaliation." I can't believe I thought he was joking.
posted by Avenger at 7:33 AM on July 12, 2009

I don't think you should wait for him to threaten violence. He already has hallucinations commanding violence, and I don't think anyone here can determine if and when he might choose to act on these commands.

I am afraid that this isn't really the way psychiatric emergency care works. Unless he willingly wants to enter an inpatient facility, taking someone who is symptomatic for a mental illness but not in a state of emergency isn't going to wind up getting admitted anywhere from an emergency room, nor would they be provided with treatment in an emergency room. Treatment happens either inpatient or outpatient, you get admitted to the former because you are in a state of emergency and need observation and stabilization, you receive the latter in the community to prevent the former from happening. If you're not in a state of crisis, you need to connect with outpatient treatment. However, if he's in a state of crisis, he needs a crisis center.
posted by The Straightener at 7:44 AM on July 12, 2009

This may not be helpful if the answer for him is to get him on SSDI, but Texans who have been refused private health insurance can buy insurance from the Texas Health Insurance Risk Pool. Unfortunately, there is a waiting period of a year for it to pay for preexisting conditions (except when the gap in coverage is less than 63 days).
posted by Ery at 8:08 AM on July 12, 2009

Okay, well the psych-hospital route is out. I talked to my mom and she said that she'll never cooperate with sending him for even an evaluation at a mental health center. She says "those doctors and nurses are crazier than the patients", etc. I can't really do anything without her cooperation or at least her acquiescence. So back to square one...
posted by Avenger at 8:32 AM on July 12, 2009

If he's threatening to hurt himself or someone else you can have him involuntarily committed, but honestly this is an awful way for someone to engage in mental health treatment and you could probably expect it to damage your relationship with him. However, if he's in a true state of crisis that's a hard decision you may have to make.

You don't need your mother's permission to get him connected to outpatient mental health treatment. Dude's 19, he's an adult, if he wants outpatient mental health treatment he can go get it himself.

Also, just a nitpick, but SSDI is based on work history and if you don't have one you need to apply for SSI.
posted by The Straightener at 8:37 AM on July 12, 2009 [4 favorites]

His spinal condition could qualify him for SSDI if it's severe enough. Once he's on SSDI, he has to have his condition for 2 years before they will give him Medicare, but if he's already had it for longer than that, he may get on Medicare sooner. He might be able to get Medicaid if your family is low-income (I'm pretty sure if he's a dependent, they will include your parents' income when assessing his eligibility, but IANA case worker).

Also, was he ever on your parents' insurance (if they have insurance)? He would have been able to on almost any plan until he was 18, and then usually until an age between usually 21 and 25 depending on plan if he is enrolled full time in school. Could he enroll in community college (if he's poor, he may get grants/scholarships/loans) and get back on your parents' insurance? He probably wouldn't be able to until open enrollment, usually at the end of the year, but if your parents have insurance, they should talk to their HR department.

Texas State Risk Pool would probably be the next thing to try if he can't get public aid of any sort, and he can't get on your parents' insurance.
posted by ishotjr at 8:38 AM on July 12, 2009

*Good point by The Straightener about SSDI vs. SSI. I'm used to talking to older people who have worked for many years, so yeah, SSI would be more likely in his case if he didn't hasn't worked much.
posted by ishotjr at 8:39 AM on July 12, 2009

Your brother still recognises that his hallucinations have no objective reality. That's a very good thing.

There might be a back-door way you can get an assessment done without your mother's co-operation. Many providers of social services have a duty of care which requires them to take action in regard to mental health issues which could put their clients at risk of harm (homicidal ideation ups the ante considerably).

If you can hook your brother up with some kind of social service agency regarding another issue (his drinking, maybe), you may be able to use that appointment to trigger a cascade of mental health intervention. At this point, your mother's preferences are secondary to your brother's well-being.

Even an appointment with whichever doctor monitors your brother's general, day to day physical health will be useful at this point if he's willing to be honest with them about the hallucinations. You need someone on your side who has both a duty of care and the ability to pull in and co-ordinate appropriate services.
posted by Lolie at 8:59 AM on July 12, 2009 [1 favorite]

I talked to my mom and she said that she'll never cooperate with sending him for even an evaluation at a mental health center.

Your brother is 19 and does not need consent from your mother to seek medical treatment.

Unless he willingly wants to enter an inpatient facility, taking someone who is symptomatic for a mental illness but not in a state of emergency isn't going to wind up getting admitted anywhere from an emergency room,

Command hallucinations telling him to hurt himself or others constitutes a potential state of emergency. It may be that a mental health professional will decide that it is unlikely that he will comply with the voices, but that needs to be assessed in person by a mental health professional.

Here is an article that you may find useful. Again, these questions need to be asked by a professional, but you may want to know the answers to these questions if he doesn't want to talk to someone else.
posted by brevator at 9:02 AM on July 12, 2009 [1 favorite]

Also, you still haven't mentioned if you've asked if he has hurt himself or others. Obviously you don't need to post that here if you don't want, but you need to ask.
posted by brevator at 9:08 AM on July 12, 2009

Check your MeMail for more information about SSI/SSDI. Sorry I don't have more useful information about how to get medical help right now.
posted by dilettante at 9:23 AM on July 12, 2009

Oh, and since the onset of the condition is before age 22, your brother may be able to get SSDI on your parents' earnings records if they're deceased, disabled, or retired. Just mentioning in response to some of the comments above.
posted by dilettante at 9:29 AM on July 12, 2009

Dude, your mother is the least of your problems. If you're going to be serious about getting your brother the professional help he needs, you're going to have to start with convincing her that this is necessary and worth trying.

It sounds like a long and difficult process, but it could also go a long way towards improving your brother's life- for starters it sounds like if you can get him the meds/treatment he needs, you may be able to get him to stop drinking.

Now is also the best time to get things started: while he's still young and can change, before the heavy drinking sets in permanently. Especially now since he just inadvertently confided in you- he admitted he has a problem and trusted you enough to say it- he may be willing to follow your lead and cooperate with the health care professionals + bureaucrats.

Don't miss this chance.
posted by tachikoma_robot at 9:30 AM on July 12, 2009

Your brother still recognises that his hallucinations have no objective reality.

This doesn't sound like he has a lock on reality:

I also remember him telling me a few months ago that he hates it when we have house guests over, because, as he puts it, "they are trying to kill mom, and all I can think about his how to kill them in retaliation."
posted by brevator at 9:38 AM on July 12, 2009

get your mom to read this thread. print it out if she's got "issues" with the internet.
posted by philip-random at 9:49 AM on July 12, 2009 [1 favorite]

19 is about the age when schizophrenia manifests, and this sounds like a probable case of schizophrenia. (Disclaimer: I am a neurobiology student. I am not a mental health professional. I know about some of the symptoms and I know and have access to information about biological occurrences in schizophrenic brains; I cannot diagnose and don't have any clinical experience whatsoever.)
posted by kldickson at 10:31 AM on July 12, 2009 [1 favorite]

Which means you not only need to find low-cost therapy, you need to find meds.
posted by kldickson at 10:33 AM on July 12, 2009

You should really explain to your mother that there's a very good chance that your brother will end up dead or incapable of living outside an institution if you don't get some treatment for him as soon as possible - and that there's a good chance he's going to hurt or even kill some innocent person, which will be on her conscience for the rest of her life.

I am not a shrink, but as kldickson said, "voices in your head" is the #1 symptom of schizophrenia, a mental illness that's hard enough to treat if you catch it early, and almost impossible to fix if the victim has had it for enough time that these abnormal thought patterns have completely forced out rationality.

I'd also add that if you take action yourself, now, you have a pretty good chance of getting some sort of reasonable treatment; however, if you wait till your brother commits some crime or gets himself involuntarily committed, there's a much better chance you're going get the precisely the terrible treatment that your mother expects.

I had a good friend go into schizophrenia - it was appalling - I remember the moment he held up his five fingers to me and said, "There are five CIA agents in your house" and I looked at him and knew he'd gone mad. He came very very close to machine gunning two perfectly innocent health care professionals who came to pick him up at the National Guard (where he served at the time) and it's only "good luck" that avoided his death or the deaths of other people. (He told me in a rational moment that he'd have killed himself many years before if it wasn't for the effect on his mother.)

You need to act decisively and quickly. The very best of luck. Let us know if we can help.
posted by lupus_yonderboy at 10:57 AM on July 12, 2009 [1 favorite]

As someone who has been in a similar situation recently, don't bother too much with what your mother wants and be on guard against her.

Parents, though they want us to be well, by and large seem to just 'protect' - they will commit you for your own good, but try to bust you out the minute they think you are endangered or not being treated correctly.
posted by Acer_saccharum at 12:06 PM on July 12, 2009

19 is about the age when schizophrenia manifests, and this sounds like a probable case of schizophrenia.

Many different disorders can come with a psychotic component, including Bipolar Disorder and Depression. I would lay off the S-word until your brother is engaged in treatment and has the opportunity to discuss his diagnosis both his doctor and a qualified therapist or social worker.

Listen to dilettante on your brother's SSI/SSDI application and discard other input on this issue. Not to be a dick, but she's the most qualified person in this thread with respect to that particular question set.
posted by The Straightener at 1:03 PM on July 12, 2009 [2 favorites]

Huge thanks to everybody who has posted so far. I've been fighting with my mom about this all day. Long story short: my mom has basically threatened to kick me out/cut me off if I attempt to admit my brother into any kind of mental health facility. She says that she's not as concerned as I am about this, that it's "normal", and that I need to relax.

So now, as you can see, I'm really dealing with two delusional people. I am considering my options but they are looking few and far between at the moment. I really appreciate everyone's concern and especially the law/SSI advice. For now I'm going to see if I can get him in to see a psychiatrist this week (paying cash out of my savings, I guess) behind mom's back.

What really bothers me is that my brother is very private and introverted -- he rarely speaks to strangers, in fact, he says that speaking to strangers makes him physically sick -- so that any interview with a psych. is going to end with him muttering a few things and then claiming to feel fine. As someone pointed out above, yes, he is an adult but that also means that he has the legal right to change his story or refuse treatment all together.

I'll keep everyone updated. Thanks all so much for your help. And please don't worry about us, we'll get this sorted out one way or the other.
posted by Avenger at 1:32 PM on July 12, 2009

Your Mom is in a tough place, but your brother's mental health is critical. The sooner he gets help, the better. It's worth it even if Mom kicks you out. If he has schizophrenia, he has an illness that is difficult to treat, and has severe consequences. The good news is that there is treatment, and it is vastly better then it used to be.

Tell your Mom that if he doesn't have a disorder, they'll just send him home. If he seems fine, and won't tell them what's going on, that could happen anyway. If he does have a disorder, then not treating it is unconscionable.

He's very lucky to have you looking out for him.
posted by theora55 at 2:01 PM on July 12, 2009

Your brother could be a danger to himself and everyone around him - including strangers. He needs to be in a mental health facililty and in treatment for the sake of public safety. He's having psychotic episodes telling him to do violence; he could hurt someone without being able to help himself.

Ask your mother to read about this tragic story if she doesn't believe you:

a man suffering from schizophrenia cut off a stranger's head on a bus; he later pleaded to be executed because he could not live with what he had done when he was not in control of himself.

I also wanted to link to an even sadder story I heard on the radio a few months back, but I can't find a link. In that case, another man heard voices telling him that his wife and child were possessed by demons, and sought help; he was not put in care. He then killed his family, only to come out of his psychotic episode and realise what he had done - his illness had destroyed his life.

Does your mother ever want your brother to do something which he can't control and have to live with it? this is so serious - this isn't the time to discuss whether to put him in a hospital. Mentally, your brother is on the floor bleeding - you must call the authorities and get him help immediately.
posted by jb at 3:00 PM on July 12, 2009

He then killed his family, only to come out of his psychotic episode and realise what he had done - his illness had destroyed his life.

This may or may not be referring to my cousin Michael Laudor. I don't have any perspective on this sort of issue any more, but I'd like to say that

1. there's a good liklihood that if your brother goes to see a shrink and just mumbles, that will be okay for an initial assessment and don't let that dissuade you
2. knowing what I know now, if I were in your position, I'd have my Mom kick me out of the house to get your brother some help

I am so sorry you are going through this, feel free to MeMail me privately if you need someone to talk to.
posted by jessamyn at 3:16 PM on July 12, 2009

She says that she's not as concerned as I am about this, that it's "normal", and that I need to relax.

This suggests that your mother might have been aware of the problem for a while but is stuck in some kind of denial about its seriousness.

If you have no luck with accessing mental health services quickly, even your primary care provider should be able to help. It's not ideal, but it's a starting point for getting professional health-care providers involved - and occasionally hallucinations are caused by physical problems so it's also a pretext for seeking care which both your brother and your mother may find a bit less threatening.

It took over two years for our family to get adequate assessment and treatment for my daughter's bi-polar disorder. I hope your path is an easier one and that you can find the strength to hang in there if you don't have any luck on your first attempt.
posted by Lolie at 3:34 PM on July 12, 2009

Your brother still recognises that his hallucinations have no objective reality. That's a very good thing.

Agreed. If you can do nothing else, continue to remind him that the voices are all in his mind, and try to convince him that getting treatment will be better for him. That the voices are a symptom of an illness just like a runny nose or an achy knee. But the illness is in the brain, and that the sooner he decides that treatment is good for him, the better he is going to be. The longer he suffers untreated, the more normal the voices will seem, and the harder it will be to return to reality.
posted by gjc at 3:35 PM on July 12, 2009

Maybe this is against all the rules, but right now your brother seems to trust you. Maybe you can go with him to the psychiatrist and sort of be a reality check for him. You will be there to help him be honest, to ask the doctor about what he is ethically bound to tell and not to tell, and to assist your brother in whatever compliance issues he might have. And, if the doctor is being a jerk, you'll know it. And it won't be your brother's word against yours.
posted by gjc at 3:41 PM on July 12, 2009

My brother developed schizophrenia as a young man, while serving in the Army in Germany, sometime between the ages of 22 and 23, as best I can understand his life story. In 1975, he left the Army under clouded circumstances, and spent 3+ years thereafter living with my parents, working at a few dead end jobs, moving out to crummy apartments, and then moving back with my parents when he lost some job or other, or a roommate that made his circumstances economic. Generally, as my parents might have put it, he was just "failing to launch." My parents did not recognize he had a mental disorder, and did not understand why he'd left the Army.

He finally came to live with me and my wife for a "change of luck." His demeanor on arrival in our sphere wasn't particularly dramatic, but he was unkempt, with long hair, a scraggly beard, and an overall poor level of personal hygiene. I took him for a haircut, bought him some new clothes, and set him up a few job interviews, none of which he kept or seemed much interested in pursuing. After several weeks, we found he was getting up and sneaking out of our home at 3:00 a.m. to listen at the doors of our neighbors, who he thought were being tortured, in their own home, and then coming back in at daybreak, before we normally woke. We discovered this when the police brought him back to us about 5:00 a.m., after responding to the terrified complaint of one of our neighbors, who found him lurking outside her door at 4:00 a.m., and called the cops.

At the strong suggestion of the police, who were professional enough to have kept him from harm, when it could have gone the other way in so many different scenarios, I took him to the local hospital ER. There, he got a psychiatric consult, and his first formal diagnosis as a schizophrenic. He was admitted for a 72 hour hold evaluation, and started on a course of anti-psychotic medications. I called in a personal day to my work, and went home to call my parents, and explain what had happened to my brother.

They refused to believe me, and I was 31 years old at the time. They told me, flat out, that I had caused this problem by putting too much pressure on my brother to find work, and that they expected me to put him on a plane home to them, immediately as I could get him released from hospitalization. At the end of his 72 hour hold, I picked my brother up at the hospital, and found he'd talked with my parents by phone, and wanted to go straight to the airport, where they'd left him a ticket for pickup. He never read his discharge instructions, and refused to fill his prescriptions.

Over the next 2 years, he continued his pattern with my parents, living with them for few months, taking minimum wage jobs in restaurants and gas stations, which he lost regularly, and occasionally moving out to flea bag apartments with shady roommates, who often scammed him for whatever money my parents gave him. Eventually, he came to police attention again in his own community, when he broke an 8' by 11' plate glass window in a Christian bookstore, to get into their Easter display window, and help Jesus down off His Cross...

He spent the next 6 months, under court order, at the Osawatomie State Hospital, where he was again diagnosed with schizophrenia, and stabilized on traditional anti-psychotic medicines of that era (late '70s). Think "One Flew Over the Cuckoo's Nest" minus Jack Nicholson and all the humor and movie magic. A very tough time for both my brother and my parents, who all had to finally come to grips with his condition.

It was nearly 20 more years, however, before my mother admitted to me, that she was adopted, because her mother had been committed to a psychiatric hospital in the 1930's, and had died there. After my mother died, while going through her papers, I discovered her adoption papers, and her birth name, and some of the story of our biological grandmother, and came to understand some of the feelings my mother must have been dealing with the day she got my call concerning my brother's initial psychiatric hospitalization.

I relate all this simply to let you know, Avenger, that your mother's initial reaction is not atypical. Parents of persons with mental illness have many reasons to deny that their children are affected, and, often, tremendous guilt, if they have any reason to believe that they may have "passed on" an illness which many believe may have genetic pre-disposition. Unfortunately, if your mother cannot come to terms with this situation at the present time, and continues to shield your brother, she can actually expose him to greater risks, including the potential for seriously harming himself or others.

IANAD, and even a doctor couldn't diagnose your brother from Internet descriptions of him or his symptoms that you provide. Yet some of what you relate must resonate deeply with any family member of a schizophrenic. Your brother needs professional help and diagnosis, and your willingness to fund the initial contact is commendable, but perhaps misplaced.

If your brother does have any of the disorders related to schizophrenia, you need to understand that this is a very serious, long term condition, with the potential to kick the ass of whole families, over several generations, in ways that make even other serious diseases seem relatively paltry. It can not only suck up decades of its primary sufferer's life, but place the most intense demands on all family members, over decades. You cannot rely entirely on the public dole for your brother's treatment, but in America, you cannot, practically, get insurance that will cover his problems in the private sector, once he is diagnosed and started treatment. If your brother is to have any kind of life at all, it will come from your families willingness to fight alongside him, and to provide for him, in concert with whatever benefits you can extract from public health resources.

If your brother is otherwise in good health, you will be fighting this disease, daily, as my family has, for 30+ years. My brother receives the maximum $674 a monthly SSI benefits, and gets his meds and primary psychiatric care covered, reluctantly, under state Medicaid. If I did not provide him a home, that would be his total income and health benefits in today's society, and I think you can understand what kind of life he would have to live on $22.47+ per day. He has made credible suicide attempts at least 3 times in the last 6 years, and I expect he will do so again. He has benefited from improvements in treatment pharmacology, including the atypical anti-psychotic medications introduced in the late 1990's, but is currently maxed out on dosage on 2 of the 5 principal atypical anti-psychotics, and every day is, for him, a dance with his meds, his voices, and whatever stress or "bad thoughts" he finds in his environment. That is why such a significant portion of long term schizophrenics wind up as street people, sleeping under highway bypasses and bridges, unmedicated, and estranged from their families.

I commend your instincts to help your brother, and I urge you to get in touch with your local chapter of NAMI, as soon as you can. Take your mother along to any NAMI meetings you attend, if she will go. Contact with NAMI volunteers may help you and your mother to recognize that you, as a family, are in a long term support situation to a person who is desperately ill, and may help you understand and marshall whatever local resources may exist to help your brother.

On a more immediate note, I would urge you to take your brother to any major ER in your area, and once there, relate directly to the staff, that your brother has not only revealed that he has thought of harming himself to you, but that he has had homicidal thoughts, as well: 'as he puts it, "they are trying to kill mom, and all I can think about his how to kill them in retaliation." ' I think you will find that if you quote such things to hospital staff, in the presence of your brother, as examples of what brought you to the ER, you will find that 1) your brother will receive much closer scrutiny by ER staff, and 2) the staff will immediately put "schizophenia" into their differential diagnosis, which should include a presumption of alogia for your brother, which is a classic symptom of schizophrenic disorders, meaning that if he is not very verbally responsive to further questions, his negative symptoms will be considered in a tenative admission diagnosis.

And although I've just linked it, and I fully recognize that your brother has not yet been diagnosed as a person suffering from schizophrenia, I recommend you peruse the excellent Web resource schizophrenia.com for practical advice regarding your brother, and your role as a sibling to a person with severe mental illness.

Good luck. God speed. MeMail me for irregular assistance, if you like.
posted by paulsc at 4:09 PM on July 12, 2009 [19 favorites]

The Straightener is right that we can't and shouldn't assume it's schizophrenia, but nevertheless I think it's important for you to know (and to try to explain to your mother, if there's any chance it'd help at all) that the evidence appears to indicate that the longer you wait to treat schizophrenia, the worse the long-term outcomes. (Read more here-- PDF.)

Also, a good psychiatrist will likely view your brother's introversion and behavior patterns in the session as information in itself, not think "Oh, I can't get any information out of him, I don't know what to do." But it will also probably be very helpful for them to hear from you-- about what he told you, his personality and behavior, etc. (Confidentiality means there's a limited amount they can tell you... but doesn't mean there's any limit on what you can tell them.)

There appears to be a lot of detailed information at schizophrenia.com-- if you haven't seen this FAQ you might want to check it out, it includes information on diagnosis and treatment, practicalities like SSI/SSDI, tips for dealing with a family member's symptoms, etc. The website seems to have a wealth of information you might want to poke around (and much of it may be applicable to people with other causes of psychosis besides schizophrenia.)

Please note I am not an expert and only have an interested and educated layman's familiarity with schizophrenia and other mental illnesses.
posted by EmilyClimbs at 4:20 PM on July 12, 2009

Last update for the evening.

I'm kind of disappointed as it seems my mom has got it in my brother's head that doctors and meds won't do him any good. She had a talk with him and convinced him that all he really needs to do is relax and get some more sleep.

Interestingly, I've learned that my mom has had (as others may have alluded to above, thanks paulsc) admitted that she's had previously bad experiences with psychiatrists and mental health authorities, although she didn't elaborate. (and yes, I and my brother have told her about the killing fantasies, the voices, etc. She seems to think, again, that this is normal for a kid his age. I'm less inclined to agree.)

If there is any good news in all of this, it's that I was able to convince my brother to lay off the alcohol, at least for the time being. He agrees that it's not a real solution.

He seems mostly lucid at the moment although that will probably change at some point in the future. Now that he agrees with mom, I really can't get him to go anywhere. I have a feeling that I'll need to wait until something obvious happens. Although I'm not thrilled about that, it seems to be the cards that I (and my brother) have been dealt.

I guess I was a bit naive thinking that a trip to the psyc-doc and a prescription was going to fix this. Alot of the stories on this thread have served to remind me that, if he really is suffering from a mental illness, this is going to be a lifelong struggle. That kind of disheartens me, to tell you the truth.

There isn't much more I can do now except keep an eye out for more episodes and to take action as they happen. Again, I want to thank everyone who took the time to memail and post in this thread. Theres alot of good resources here and I will be looking into all of them.

Thanks so much.
posted by Avenger at 8:10 PM on July 12, 2009 [1 favorite]

IIRC you're a pharmacist, use it: try calling around your professional association and the local doctors and their receptionists for the numbers of mental health care resources. You don't have to tell them it's your brother, and probably shouldn't; just say you're calling on behalf of a customer who has no insurance and is having mental health problems.

Look into peer-group mental health support for him as well. Here and here are some resources (I just googled mental health support houston). Your mother may not want him seeing a psychiatrist but may not object to him joining a support group for people with problems to help each other.
posted by aeschenkarnos at 12:33 AM on July 13, 2009

Well, it's been almost a year since I originally posted this so I figured I would give everybody a bit of an update (in the odd chance that anybody is still reading this).

Since this time, my brother has come out as gay to me, and that is an issue we're still working through (maybe I'll update that thread in a year?).

Since this was posted, my brother hasn't had any "episodes" such as the voices or hallucinations that I'm aware of. He has, however, gotten fired from his dead-end job and is currently unemployed, playing video games 16 hours a day or so.

I feel a slight need to defend myself regarding my relationship with my mother. Many posters in this thread asked why I would need to listen to my mother regarding the care of an adult sibling. I guess the only thing I can say in response to that is that my brother, while being 20 years old, has the mind of a much younger boy (I would say his mind is about 12 or 13, developmentally speaking). She is essentially his caregiver and my family dynamics do not allow me to overrule the decisions that she makes regarding his care.

I don't know where my brother is going to be a year from now (or ten), but at current course, probably obsessing over video games and being unemployed while living in my mom's house. Probably not getting the treatment that he needs (and, truthfully, is not even guaranteed to work).

I wish I could put a happy face on this post but I can't. Hopefully things will work out in the end, somehow.
posted by Avenger at 6:33 PM on June 22, 2010