Quandary involving a not-well friend
April 23, 2015 12:28 AM   Subscribe

Am in a bit of a situation involving a friend with a mental illness. Long details inside.

I have a friend. Let's call her Hope. We were casual friends at grad school. She was young, outgoing, interested in being considered cool. Had a special affinity for me (a hetero male, completely non-sexual) even if we didn't always find time for each other.

At some point I noticed that she tended to "disappear" for weeks at a time. Thought it odd but never really questioned it nor probed. She'd reappear, looking slightly gaunt, but more or less the same. I considered that she might have an eating disorder, nothing more.

Then during the third year of our friendship, I kind of received a crash course in Hope's other life, which she did well to keep hidden from most of her friends. To this day I am not sure exactly what she's diagnosed with, but it's a rather serious mental illness that apparently comes and goes. We happened to be living in the same building at the time (though not the same unit), and one evening I found her basically in my apartment, tip-toeing and "sliding" against the wall, claiming that she's hearing voices and looking very gaunt, jittery, jumpy. Then one of her roommates (also a good friend) finally came down to find her, and explained to me that she had not slept nor eaten for the past FIVE DAYS.

Things got worse from there, up to and including her getting physically violent against her friends, we who were trying to help. That's when we called the medics, and she was carted away, ultimately being committed for 6 weeks. That was one horrible night at E/R, I can tell you.

Flash forward a couple of years. I had only maintained online contact with her since, Facebook and IM, and all seemed well (as far as I could tell). Then she announced that she was coming to visit my city. Having more or less forgotten about the incident (perhaps to my great detriment), I naturally offered to put her up for a part of her stay.

We're now in Day 2 of me hosting her, and... yeah. It's starting. She's getting the darty look in her eyes. She keeps asking me if I've said something when I haven't uttered a thing. She's not sleeping or eating, only drinking bottle after bottle of water. I can see her mind racing, trying to hold on to the bit of sanity that got her here, and even understanding on some level what is happening to her and feeling sad about it.

I don't know the history. I don't know how self-aware she is. I don't know if she's on meds, if she deliberately chose to not take them, if she knew she was going to be sick. I don't know any of these things. All I know is, she's going to be with me for the next 6 days (then she flies back home), and I'm fairly terrified.

Apart from me, she has one other friend in town, but I think they've already had a falling out (if that's what you'd call it). Otherwise, she has no one. She's just going to get worse by the day, and I don't know what to do. I have a job, like everyone else, and can't keep an eye on her 24/7, but I'm afraid of what she might do left alone.

As far as I know, she doesn't have travel insurance, so calling 911 on her and getting her committed to some psychiatric ward might cost in the tens of thousands, and I'm not willing to risk that, certainly not for me, but not for her either. The best thing would be for her to go back home, but, to make matters much worse, there's no one at home either who can take her in; both of her parents recently passed away (separately, for different reasons), and she has a very strained relationship with her siblings. To top it all off, she actually moved to a different city recently, where she's basically all alone with just her dog. (I suspect it was her illness which prompted this move - when sick, she eschews all company and "just wants to be left alone.")

I don't know what to do. Just "let her be" for the remaining days and cross fingers that she won't turn violent/self-harm/wander the streets? Try to cut her trip short and send her home? Call 911? Try to get her to seek help here during the short time she's here? I don't know what to do, and am dreading what's to come.

Anyone with any similar experience or knowledge of any help centers/helpful people in NYC, please talk to me. I want to do the right thing here, but I don't know what that is.
posted by anonymous to Health & Fitness (10 answers total) 5 users marked this as a favorite
 
Find out if she's being treated by a particular person, and then get that person's contact details and let them know what's going on. Failing that, is there some kind of nurse line that you can call for advice?

If she's at the point where she's becoming a danger to herself or others, then I think that the only right thing to do is to call in the professionals.
posted by Solomon at 1:05 AM on April 23, 2015 [7 favorites]


Solomon is right: see if she has a therapist already, or even a former therapist. If anybody has treated her for this, they need to be involved now. It may even be worth contacting the place where she was committed before, just to get you started.

Is she capable of talking about this rationally? I'd ask your friend what this condition is, and (assuming she's capable of recognizing and admitting just how bad this can get) find out what she wants to happen before she really goes off the rails. I recognize she may be dangerous and I'm not encouraging you to press beyond the point where you feel comfortable. But if she has some rationality now, try to access it while it's still there.

Are there drugs she should be taking, and can she be persuaded to take them? What were her plans for how to deal with this, if it happened when she was alone at home? Even if she's already pretty far gone, what she says now could at least give you some clues about how to proceed.

It may be worthwhile to contact her siblings. Even if their relationship is strained, they (hopefully) don't want her to get hurt or to hurt somebody else. They may also have some info about her history.

This sounds like a really rough situation. Best of luck to you both.
posted by Ursula Hitler at 2:40 AM on April 23, 2015 [1 favorite]


It sounds like you have never had a straight-out conversation with her about her illness? So yes, time to talk to her frankly. It is perfectly okay to tell someone that you are not able to care for them while severely ill and they need to get professional help. If she refuses help or conversation it is okay for you to say you cannot host her any longer and she needs to make alternate arrangements. It really, really sucks, and I feel for her, but you are describing an acquaintance, not a close friend, who does have a history of violence against friends. Her health has to be her own responsibilty.
posted by saucysault at 2:55 AM on April 23, 2015 [8 favorites]


You mention she doesn't have travel insurance, but does she have regular insurance? Because if she's not coming from abroad, she shouldn't have any problem using her US insurance in NYC. I realize some health insurance is more regional in nature and she may have more of an issue finding someone in network, but there are generally provisions in health insurance policies that make that less of an issue during emergencies and when you are traveling. I'm not an expert in this, so I don't want to get into too much detail and steer you the wrong way, but if she health insurance I think there is a very high probability that there is a hospital in NYC that will take her insurance.
posted by whoaali at 4:31 AM on April 23, 2015 [13 favorites]


I second Saucysault's suggestion that you need to directly address this issue with your friend. Maybe it would help to write out a script for yourself beforehand, and think about the support you're willing to offer, and what you are not willing to offer.

You could also call a mental health crisis line in your area beforehand (a quick Google reveals Lifenet in NYC) to feel out what services are available, so you're a bit more informed before you have this conversation.

The script could be something like (GIANT CAVEAT I AM NOT A MENTAL HEALTH PROFESSIONAL): '[Friend], I really care about you, but I've noticed that your behaviour has been a bit [erratic/off/agitated] lately. I feel like you're experiencing some kind of crisis, and it reminds me of [previous crisis]. I want to support you in finding the help you need, but I can't [have you stay here if you're violent/have you stay here if you don't seek help]. Have you been seeing a care provider? Do you need medication? Why don't we [go to ER together/consult with a mental health crisis team/go to an urgent clinic etc].'

Again, I am not a mental health professional, which is why I suggest calling a mental health crisis line to prepare for this discussion before you have it.
posted by nerdfish at 5:00 AM on April 23, 2015 [3 favorites]


Given her history and her current behavior a rational conversation with her about her state of mind seems unlikely. I am not a therapist but had family members with severe mental illness, including my mother who used to travel a lot and impose herself on both family members and random friends, some of whom she hadn't seen in decades.

There really isn't anything you can do to help her illness, she needs a psychiatrist, a therapist, and some psych meds. If you can get through to her enough to tell her that and she's willing to go to the hospital be sure you know the closest one with a psych ward. She's had this illness for years so she's probably on disability and has insurance through that.

Does she have any money? Could you ask her to move to a hotel? Do you have an unemployed friend who would be willing to come to your place while you're at work to make sure she doesn't start trashing it?

Good luck.
posted by mareli at 5:36 AM on April 23, 2015


Yes, talk to her immediately (even if you have to leave work), but don't mention fears of violence or psychosis, as putting her on the defensive is not a great plan.

Instead, tell her you're extremely concerned about the fact that she's not sleeping or eating, and that if she doesn't have a doctor she can call and/or medication she can take, you will have no choice but to call for emergency help. This does not mean you can't call 911 anyway if it comes to that, so don't make it an either/or kind of deal.

It's very kind of you to be concerned about medical expenses, but please consider this: it may come down to a choice between financial debt (a burden), or physical harm to herself or you (a danger). Choose the burden, not the danger.

Be prepared to call at the time you talk with her, in case she flips out, and if possible have a friend in the next room in case things escalate quickly. Also, do not attempt to drive her to an ER or clinic unless you have a third party in the vehicle. If she's determined enough to not go, she could yank the steering wheel or something similar out of desperation.

I'm sorry. This is an extremely difficult situation.
posted by whoiam at 7:27 AM on April 23, 2015 [2 favorites]


As far as I know, she doesn't have travel insurance, so calling 911 on her and getting her committed to some psychiatric ward might cost in the tens of thousands, and I'm not willing to risk that, certainly not for me, but not for her either.

It wouldn't cost you anything. And, you don't have a lot of options. Your friend sounds very sick. If she were unable to eat or sleep for 2 days due to some stomach problem, for example, wouldn't you take her to the hospital? I'd speak to her gently to see if she can give you any information about how she's feeling, and if she'd be open to getting checked out by a doctor. If so, call a cab and take her to the ER. But, honestly, she has a history of violence against friends, so if that doesn't work, I'd ask her to leave or, if it gets worse, call 911. I would also ask some of your own local friends to help you out. Ask some people to be on call near your place while you talk to her, or at least so they can check in on (or even also stay) with you to make sure you're both ok while she's there.
posted by bluefly at 7:32 AM on April 23, 2015 [2 favorites]


she needs to go to the hospital. you will feel horrible and guilty and sad and scared about it, but that's where she needs to be. she's obviously dealing with a completely uncontrolled psych issue, and it sounds like she's a danger to both you and herself. your responsibility is not to care for her through this (you can't - you don't know what's going on, it doesn't sound like she can tell you what's going on, and you just don't have the resources). rather, your responsibility is to get her to someone who *can* care for her.

good luck, feel free to memail me if you want. i have some experience with this.
posted by megan_magnolia at 8:14 AM on April 23, 2015


Agreeing: a hospital is where she needs to be right now. Yes there may be a cost, and the cost of her not being in a hospital when having this kind of episode can be much, much higher.
posted by feckless fecal fear mongering at 12:03 AM on April 24, 2015


« Older How do I find and buy affordable original artwork?   |   Why are there colors? Explain like I'm six. Newer »
This thread is closed to new comments.