Mental health from states away

July 16, 2009 4:19 PM

What can an adult son do to help his homeless, possibly mentally ill mother states away?

My husband just got a call from his aunt that they have found his mother living homeless by the river in Madison, IN. My husband (27) has not spoken to his mother (55) in two years and the relationship has always been strained. He has long suspected that she is mentally ill and moved out as soon as he could. I have had little experience with her, but here is one example. She came to visit us and her other son 3 years ago. One night of the visit, my husband and I were going to take her out to our favorite restaurant. While we were at work that day, my husband gets a call from her saying that he is "sneaky and deceitful" and that she wasn't going to allow us to take her out to dinner. She then rented a hotel and stayed there the rest of the visit (she had previously been staying with us). Both my husband and his brother asked her what she meant, but she wouldn't tell either of them. I have no idea what it could have been. She didn't call him for a year. Next time they talk, she accuses him of being on drugs and hangs up on him. He has never done drugs in his life. My husband tells these horror stores from his childhood. I don't know what type of illness she may have, but according to family, it's been getting worse.

His aunt (who also has a strained relationship with her sister) wants my husband and his brother to come out and have some sort of intervention. What are their legal options? We live in AZ and don't have much money. We can afford a couple of flights, but not much else. I know it's very difficult (if not impossible) to get someone committed involuntarily. She is apparently very deeply in debt and hasn't been employed in over a year. She has her MA and she used to have a successful career. Would the state of Indiana pay for any sort of help? She's lived there almost her whole life. I saw the other question earlier this week, but I was hoping someone would know something pertinent to Indiana, or about children helping parents. She divorced my husband's father years ago, and he has since passed. She doesn't really have anyone close to her. What about social security? Or state health care?

Any suggestions would be helpful. Thanks for letting me ramble on a bit

posted by lizjohn to health & fitness (18 answers total)

See what you can organise by phone before you go rushing out there. Unless you have a specific plan in place and it's a workable one, you probably won't get far just arriving there with no specific support services lined up.

If you have no idea at all what's available in the region, the police department in that area and the biggest local hospital should have a good idea of where to start - both will be dealing with homeless people with mental health issues on a daily basis and can probably suggest a starting point where you can find someone to co-ordinate getting assistance for her.
posted by Lolie at 4:39 PM on July 16, 2009 [1 favorite]

No advice beyond suggesting a reading of The Glass Castle just for some commiseration; and my hope for only the best for you all.
posted by peagood at 4:40 PM on July 16, 2009 [1 favorite]

This sounds like it may be Schizophrenia. I can't offer any real help, but I wish you the best -- dealing with a mentally ill parent has been one of the most frustrating, sometimes scary, (and ultimately fruitless) ordeals imaginable.
posted by biggity at 4:44 PM on July 16, 2009 [1 favorite]

I'd start with a NAMI chapter in Indiana, preferably in the county your mother-in-law lives in.

Good luck!
posted by magstheaxe at 4:46 PM on July 16, 2009

Seconding NAMI.
posted by desjardins at 4:47 PM on July 16, 2009

Oh, and I forgot. NAMI has an 800 # for assistance; they may be able to get you info and/or referrals. Call 1-800-950-NAMI.
posted by magstheaxe at 4:49 PM on July 16, 2009 [1 favorite]

There is a line in The Glass Castle where the homeless mother asks for a health club membership and the daughter doesn't understand it. It means a place to shower and get warm every day as well as a locker.
posted by mearls at 4:55 PM on July 16, 2009 [1 favorite]

Unless she is threatening harm to herself or to someone else you will not be able to have her committed. Harm in such cases is usually defined as violence. I went through this with my mother several times and with my cousin once. Your mother-in-law might be paranoid schizophrenic, and there is very little you can do. It's unlikely you will be able to reason with her. Don't waste your money flying out there, and don't feel guilty for not going. I know this sounds harsh.

Instead of spending money trying to help her, your husband and his siblings might want to use the money to get counseling to understand how their mother's behavior has affected them. Since there may be a genetic component it would be a really good idea for all of them to avoid using any mind-altering substances, including alcohol. I don't have anything specific to back this up beyond experience, it's what I told my kids.

See if there is any kind of support network where you are. A friend with a mentally ill parent found it helpful to attend Adult Children of Alcoholics (ACOA) meetings. Feel free to contact me.
posted by mareli at 5:00 PM on July 16, 2009 [1 favorite]

It is possible to get someone involuntarily committed without the threat of harm to self or others, it's called a failure to care commitment but the threshold of evidence is high; you really have to show that someone's life is endangered by their inability to care for themselves. At the peak of summer, you're probably not going to get that unless she's severely malnourished or suffering from some untreated disease or injury that could kill her if it's left untreated. In the winter the temperature factors in and failure to care commitments are more common for people living in the streets.

But then what? If she doesn't want treatment, an involuntary commitment will only detain her for 72 hours of observation. She needs to come to the conclusion that she wants mental health treatment in the community in order for an involuntary commitment to be worth much more than three hots and a cot for a couple days. Has she ever expressed interest in receiving mental health treatment? Is she mortally opposed to it?

If she's not willing to forfeit any rights to you or voluntarily engage treatment, likely the most you could do legally would be to petition for a failure to care involuntary commitment, and then go to mental health court as a petitioner on the day that the commonwealth decides if she needs to be involuntarily held any longer than 72 hours. However, if your mother doesn't want to stay inpatient any longer than the initial 72 hour lockdown, the judge is almost certainly going to release her unless a doctor gets on board saying she should be held.

When I used to work in homeless services I got calls from people like you all the time, living at a distance and asking what could be done for their addicted or mentally ill family member who was living on the streets in Philly. Unfortunately, I told them that unless their loved one wanted to engage in and maintain treatment in the community, the options aren't many other than talking with that family member and encouraging them to get help. You will have to be patient if she is resistant, effective longterm treatment simply cannot be forced.

If she is actually interested in engaging in mental health treatment and looking for housing, that's a totally different story. If that is the case please MeMail me and I will try to walk you through the process of getting her connected to these resources in your area.
posted by The Straightener at 7:04 PM on July 16, 2009 [2 favorites]

My family went through something very similar. Unfortunately, authorities informed the relatives heavily involved as the caretakers that unless she committed a crime, there was not much they could do for her in terms of forcing her to take meds, go into the hospital, etc.

The key things that =were at least attempted were:

1. To make sure the local police in her area knew who she was and who to contact in the event of an emergency ---- for them to be aware that she has family and people who care about her can be huge.

2. Trying to send clothes and money via various (very legitmate) resources and either the person in question would not take them or they were unable to legally hand these items over. Many of them came back. It would be a good idea to find out if someone in your area can provide this service if she'll take the items.

3. Knowing where to send her if she did get arrested and the family would then be able to make decisions --- once the person in question was stabilized after getting arrested (for something minor but enough that they could haul the person in question in), (s)he was sent back to the family and has been quite well with regular psychiatric appointments, group and individual therapy, and initially home social work visits/outings, etc. It took about five years for this happen, though. During that time, through a lot of random phone calls, various people in my family were able to maintain contact and at least keep track of where this person was. (This person somehow traveled from upstate NY to the midwest to the southwest and back to the midwest during this time until finally coming home to the east coast.)

4. If the person's location was known and his/her activities known (local police knew the hangouts, etc.), then someone would try to fly out a few times a year to see if anything could be done and to at least try to have this person keep a toe in our world.

It's a difficult situation to be in because it's such a helpless place. I wish you and your husband the fortitude to withstand it and the patience that might be required to wait her out.
posted by zizzle at 7:12 PM on July 16, 2009

To answer your other questions, yes, the State of Indiana will help her if she is willing to get treatment by providing her with Medicaid coverage that will pay for medication and outpatient community mental health treatment. She will probably qualify for SSDI under a mental health disability but the application process is very complicated and difficult for mentally ill people to complete and she will need help with that. She can get help with that by getting case management services that will be part of her community mental health treatment; a social worker can receive letters from Social Security on her behalf, transport her to the doctor appointments that social security will require her to keep and retrieve medical records that social security will demand to see before awarding her benefits. If she is denied these benefits, she will be eligible for legal aid services to appeal that decision. If she had a career her SSDI benefit may be substantial, and will afford her housing either private or subsidized depending on her income. Her social worker will help her with housing applications.

All of this depends on either your mother presenting at a social service agency and asking for help or someone doing outreach with your mother and her agreeing to be helped. Again, this is where it gets into all kinds of details that you can follow up with me about if and when they come up.
posted by The Straightener at 7:22 PM on July 16, 2009 [1 favorite]

The Straightener has given you very good advice in both of his responses. Following it will not be easy. As a social worker, I have little to add. I've been the homeless shelter manager and the mental health case manager he referred to in both of his posts and he's spot on with his advice. I'd like to add that it takes a couple of forays into community mental health treatment before any of this ever begins to take hold. Recovery from mental illness (and recovery is possible) is like recovery from addiction, relapses are part of the process. It can be crazy making for the family.

Good luck. Hang in there and remember that there's only so much you can do. Much, if not all of this, is in her hands.
posted by dchrssyr at 7:39 PM on July 16, 2009

I have been dealing with my paranoid schizophrenic son for several years now, and I have learned a few things, mostly the hard way.

1. As magstheaxe suggests, NAMI would be the first step, to learn more about mental illness and how to deal with it. My husband and I made a lot of mistakes in the beginning, trying to use logic with our son, who sees reality in a different way.

2. The majority of mentally ill patients are eligible for Social Security Disability, but in your case it would be more difficult since there has not been a diagnosis or hospitalization. Try to involve a physician she trusts in her care.

3. County help: most counties have decent mental health program: NAMI can steer you in the right direction. There are group homes, but paranoic schizophrenics are particularly resistant to rules, since they are suspicious of most people. We are thankful that he trust us enough to live with us, but you indicate that your mother-in-law is already suspicious of your husband. Don't feel guilty, it isn't your or your husband fault that she has this sickness.

4. Intervention could works if it is presented as "We are worried about your physical health", but don't try to convince a person suffering from paranoia that their thought patterns are not logical. Try to keep communication going, but realize that she is an adult, and entitled to live her life as she chooses ( this actually was very hard for me to learn, how to respect my son self when I surely knew better)


5. The people who run the homeless shelters are very caring and knowledgeable: your husband could visit one where you live, to explore possibilities.
posted by francesca too at 7:47 PM on July 16, 2009

The Straightener has basically covered all the bases.

To get started connecting her with social services, you should get in touch with the Jefferson County Division of Family Resources, the county-level agency of the Indiana Family and Social Services Administration. They'll be able to talk with you about what steps need to be taken to get her the care she needs.

As has been pointed out, if she really does want to live on the street down by the river, there may not be a lot anyone can do about that, but if she really is that badly off, the state may be able to intervene. Then it may become a question of whether you'd rather have her somewhat miserable but receiving care and under supervision, or subjectively happier but in constant risk of exposure and want.

This just sucks any way you slice it, but getting in touch with county social services really is the place to start.
posted by valkyryn at 7:50 PM on July 16, 2009

First, thanks to everyone for their thoughtful responses. I have warm fuzzies.

Second, my husband wanted to comment, but he's not quite sure what to write. He's the user The Potate. Feel free to MeMail him.

I understand there's much to be done and it's a matter of putting ones nose to the grindstone and just making a lot of calls. I think my husband feels very conflicted about the idea of his mother being truly mentally ill. He usually describes her as insufferable, manipulative and controlling. I think the situation is such that now it's obvious that she needs help. Whether she is receptive to it is another thing. He believes that she may be too proud to get help. She was a caseworker for many years in an obliquely related field and he thinks that she probably knows the correct avenues for receiving help, but is choosing not to seek them.

When I mentioned reading The Glass Castle, or going into therapy, he seemed very receptive. He has read this thread, and is reading over my shoulder now. I just want to thank everyone again.
posted by lizjohn at 8:12 PM on July 16, 2009

Best of luck.
posted by typewriter at 8:19 PM on July 16, 2009

I understand your husband's ambivalence about labeling all of his mother's behaviors as mental illness, not least because it sounds they have caused him a great deal of pain and difficulty.

One perspective that might be useful here is to let go of the tendency to see mental illness as a sort of excuse or catch-all explanation for her behavior. Instead, see it as a framework for addressing the problems posed by her behavior (lashing out, alienating people, not being able to maintain stability in housing, work, etc.). She may be "insufferable, manipulative and controlling" as well as mentally ill. The latter doesn't excuse the former, and it certainly doesn't make what he had to endure as her son ok. Recognizing someone's mental illness doesn't excuse their bahvior or the very real pain it causes. It doesn't make his mom any less manipulative, insufferable, and controlling, or any less responsible for the ways in which she may have hurt your husband. It does, however, offer a useful framework to change her situation and, to some extent, her behavior.

Good luck.
posted by foxy_hedgehog at 3:21 AM on July 17, 2009 [1 favorite]

No suggestions, but thank you for writing. It helps to learn I am not the only one.
posted by humannaire at 7:56 PM on July 19, 2009