Managing BiPolar Relative

November 19, 2009 5:13 PM

Managing Bipolar Manic Episode?

My Mother is bipolar. For the last twelve years, her symptoms have been managed quite well with medication, primarily Depakote. Four months ago her Medicaid Insurance switched her to a generic and she had an allergic reaction. She stopped taking the medication and then had the manic episode. She called me and my brother and my brother took her to her psychiatrist who prescirbed another generic. It's been about two weeks and I haven't seen much improvement in her symptons.

She's highly emotional and screams or cries at the smallest things, and talks constantly, but I guess we can live with that. My biggest concern right now is that she can't manage her own affairs. She gets a disability check and usually she can live on that even if it's tight. But this month she burned through it all on what I would call "manic spending" T.V. shopping network, gifts she can't afford, etc. She bounced her rent check, and I had to come in with a bail out because her account had gone negative and accumulated overdraft fees. She also can't manage to take her psychiatric medication on time and she may be missing pills for other conditions (severe osteoporis - she's 67). Also, I'm worried about things that have happened during previous episodes. With manic episodes in the past she's done things that led to her being evicted (most notably spray painting the apartment walls). She also started drinking during previous manic episodes (she's an alcoholic with twelve years sobriety). On top of all of this, she hurt her back (three vertabrae are out of line), which is making it difficult for her to walk or get out of the apartment.

My brother lives nearby. I live 3,000 miles away. He works two jobs and he's basically burnt out with helping her.

He's talking about having her hospitalized. I know she won't go voluntarily. I'm not sure we'd be able to get her committed (standard is pretty high -- danger to self or others) and I'm not sure we're there yet. I know she would really resent us if we tried. We both have power of attorney over her healthcare and finances.

So I guess my questions are as follows:

(1) Her psychiatrist won't call me or my brother back even though we both have a release. Neither of us think the current generic is working. We'd like to get an insurance override to get the brand. Any suggestions? I've thought about calling a crisis center or emergency hotline?

(2) Using the power of attorney, is there some way to manage her affairs without hospitilization? I'm most concerned about the manic spending. If I can pay her rent and phone bill, she has food stamps so she won't starve. But it's really not taking the meds that is the problem. I don't want her to be evicted or have her phone turned off.

(3) Should I be thinking about having her hospitilized? I've thought about getting some kind of home health aide, but my mother's railed against that too.

Any ideas about how all three of us can manage this?

posted by bananafish to Health & Fitness (7 answers total)

The doctor can, and should go to bat for her to go back on the brand-name med. If he's not, you need to find another one - it's only a matter of filing some paperwork with the insurance company on his part and if he can't be bothered to do it, screw him. If she gets especially agitated you could bring her to a crisis center or a Psychiatric ER for assessment. They would probably hold her for a few hours to observe and you would have an opportunity to possibly find another doctor to manage to her care. They probably wouldn't hospitalize her unless she was an eminent threat to herself or others but at least you could get in front of someone who could, you know, do their job and actually help. You can use power of attorney to manage her care outside of a hospital, but you might want to speak to a social worker about what this entails.
posted by echolalia67 at 6:27 PM on November 19, 2009

(3) Has she been hospitalised before? Because those places aren't nearly as bad as people think - I know plenty of people who've spent time in hospital for mania & other psych conditions.

Then again, I don't know where she lives (USA, presumably?) or what psych wards are like there.
posted by UbuRoivas at 6:39 PM on November 19, 2009

I forgot to add: in terms of resentment...a person going through a manic episode might be expected to resent having their energetic & grandiose plans & projects frustrated, but do you know for sure that she would resent you once she's thinking normally again?

People I know say that it was frustrating to be hospitalised at the time, but in the clearer light of normality, they generally admit that it was the best that could have been done for them.
posted by UbuRoivas at 6:42 PM on November 19, 2009

Can you and your brother pay for the brand-name med out of pocket? Just paying for a month's worth of meds seems like a bargain, if it would prevent a costly spending spree. And it would buy you time to get her doctor to call you back.

I would talk to her pharmacist and see if you can just get her current prescription filled using the brand name drug that was working in the past even if it costs you extra.

If there's a problem, I'd ask the pharmacist to call and see if they can get the switch made. From the perspective of the doctor's office, dealing with the pharmacist is easier, so the pharmacist might be able to get you what you need.
posted by selfmedicating at 7:49 PM on November 19, 2009

I have worked in 2 short-term in-patient psychiatric facilities (both were actually units within a medical hospital), and we frequently had patients admitted under the circumstances you describe. She would probably need to go to the ER voluntarily for an evaluation, but they could probably help your brother make the case to her that she should stay for a med adjustment. Although length of stays varied for people experiencing a manic episode, typically it would take a week to 10 days to get them back to baseline (unless it was very severe, with the patient having no insight at all). Having a hospital stay on record after the med switch should give her doctor a darn compelling case with her insurance company.

There are people that will tell you to avoid psych hospitals at all costs, and no doubt they have an experience that justifies that position. However, I've seen many people helped in a short-term scenario as I describe above. Best of luck.
posted by dreamphone at 10:14 PM on November 19, 2009

"which is making it difficult for her to walk or get out of the apartment"

Well the upside of that is it limits the amount of trouble she can get herself into.

"Using the power of attorney, is there some way to manage her affairs without hospitilization?"

Depending on what rights she signed away, you might be able to take over her finances. You could automate them so that her disability check is deposited and all her bills for the month immediately paid from that, then an allowance of what's left is issued to her in cash. You'd have to set up a new account that she didn't have access to, though.

"But it's really not taking the meds that is the problem."

Call around until you find out whatever local (to her) social service agency is in charge of helping mentally ill people, and see if they have any sort of service that can check in on her daily and make sure that she's OK and taking her meds. That might help bring some stability, routine, and order back to her life.
posted by Jacqueline at 1:15 AM on November 20, 2009

if you both have power of attorney of her health, you probably CAN get her hospitalized -- and in a crisis, that's sometimes the best place to be. once there, the staff will monitor her medical care, find the right meds for her, etc. you should also be able to find her a new doctor. while she's this unstable, she needs to be under close supervision, because what she's going through in her head is tortuous, most likely. take advantage of your power of attorney - find out what you can and cannot do. and try to find about mental health patient advocates in her area - start with the local department of mental health.

you also have power of attorney over her finances -- why don't you see about her handing the bill paying and receipt of disability to you or your brother? then she can't spend. (i've had to do this on occasion myself).

feel free to me-mail me if you want to talk more - i've been hospitalized myself and it saved my life, in many many ways.
posted by unlucky.lisp at 4:21 PM on November 22, 2009