Available treatment facilities for mental illness

July 10, 2006 3:25 PM

MentalHealthFilter: To try and sum up a fairly long and complicated issue: My brother, 23, is diagnosed as bipolar. It's been an uphill battle ever since he was admitted to the psych hospital at 11/12 years old. Although his diagnosis and medications have switched many times, nothing seems to work.

It's only getting worse and more dangerous. He currently lives with my parents and it's pretty much hell. He is verbally abusive to my mother, horribly so, has physically attacked another brother, damages belongings and the house constantly, his theft now includes family members' credit cards as well as cash, and people who probably shouldn't know where they live, do.

My mother has always been a supermom in the sense of finding resource to keep my brother afloat. I know that the only reason there is any sort of thread from him to hang by, is because of her. But, of course, this is not anything that he is grateful for, because, he constantly reminds her that he never asked to be born in the first place and will never forgive her. There is only so much someone can do for someone else.

Based on research and readings, I know that mental illness and chemical addiction need to be treated together more as one disorder rather than seperate, and that a combination of drug and behvorial therapy are needed for best results. The problem is that most of his treatment has been outpatient day programs, geared only for drug treatment, or only for mental illness, which makes it very difficult for him to get the intense treatment that I think he needs right now.

So, finally, my question: What are (or are there) other treatment options for those without the means to send someone off to the fancy rehab places all the celebs go to? They are in CT and he has Medicaid and SSI for his disability. Is there any way to get payment asssistance for long-term residential treatment, or is this sort of treatment reserved for the rich and crazy only?

posted by unsigned to health (5 comments total)

contact NAMI - there are state chapters that have resources both for the mentally ill and for family and friends.
posted by judith at 4:31 PM on July 10, 2006

the advice to contact NAMI is excellent as would a contact to the state chapter of DBSA (Depressive Bipolar Support Association). Realistically, I think your odds of finding a specialized treatment facility for persons with co-occuring disorders is very slim--while not exclusively for the rich and famous they are for the self pay, insured or maybe Medicaid/SSI in the State in which you live--and I doubt if even some of them will accept Medicaid--the cost for these programs is usually $900-$1200 per day. I just spent weeks researching facilities for my daughter (alcoholism/eating disorder--fortunately she has excellent insurance)-- there are many programs but few that are really designed for truly integrated treatment and I did not see one that said "medicaid" welcome. If there are ones that accept medicaid as payment in full I would guess they would be associated with large hospital systems which depend on medicaid and medicare for a significant part of their income . You might check out any teaching hospitals in the area in which your brother lives. I run a large community mental health center and know full well how needed and unavailable they are. If you want to e mail me feel free my addresss is in my profile. I deal with this on an ongoing basis. I might be able to refer you to some specific resources as I know someone who did a lot of consulting in CT. My Best
PS Your mother may benefit greatly from active support and involvement with NAMI--they tend to be a first rate organization.
posted by rmhsinc at 6:25 PM on July 10, 2006

NAMI is a decent start, but it is an all volunteer organization, not a funding source. Drug treatment programs that can handle people who also suffer from severe mental illness are few and far between. Typically, most people in these situations go through some kind of inpatient drug rehab, to get their system "clean" of alcohol and street drugs, and then, optimally, go directly to a mental health inpatient facility, where they are put on meds, have the dosages stabilized, and if they're lucky, get some pre-release social work to set up community based follow up. Making the treatment and facilities transfer in an organized way is key to avoiding the common situation of a dried out bipolar person hitting the street, without medical management of their bipolar disease. But it's not at all easy to make such coordination.

Some illnesses can be managed more successfully than others on a community based regimen. My brother is a schizophrenic, and does OK on this type program, living in my home, and also receives SSI and Medicaid benefits that make this financially possible, at a total cost to the federal government of about $26 a day. But I am a single man, without children or other day to day family pressures, and my brother is medication compliant, on stable meds, and has no problems with alcohol or street drugs, or other major health problems. I take my brother to his monthly appointments with his psychiatrist and for med management blood work, and I set up his meds and verify he is taking them daily, which helps him remain med compliant. And I can provide a reasonable home for him, and help him with his motivational problems, personal hygiene, and other living issues. He's quite capable of caring for himself, and can do some household chores, but frequently needs reminders, and suggestions for how to do things. To you, this probably sounds like a nearly ideal circumstance, and one you'd hope your brother could reach, and I relate it simply to hold out hope to you, at this dark time in your family's situation.

Yet I don't mean to minimize the problems your brother is having. Bi-polar folks are notably less medication compliant than people with other drug treatable mental illness, and, as you well know, frequently prone to involvement with street drugs and alcohol, often in combination. Generally, if they manifest symptoms in their late teens or 20's, they will go through a number of cycles of treatment and medication failure, as your brother has, and will frequently run afoul of the legal system as a result. Partly, this is due to the very nature of the disease, and partly, I think, due to further impairment of judgement brought on by drugs and alcohol, and drug seeking behaviors. Unless your brother can get off street drugs, and stay sober for at least 6 months, while remaining medication compliant, his ability to succeed with community based treatment programs is pretty minimal.

Let me suggest that, after you contact NAMI and follow up with whatever recommendations and referrals they may offer, that you contact the district attorney's office in the jurisdiction where your brother resides, and see if they have any recommendations for treatment diversions of mentally ill offenders. I say this because, increasingly, the legal system does not want to see seriously disturbed folks go to prison, because prisons are ill equipped to deal with them. As a result, more prosecutor's offices are becoming clearinghouses for diversionary treatment information that would give you reasonable insight into area professionals who deal with seriously disturbed people.

My brother happened to meet his current psychiatrist through just such a program. My brother had been the victim of an armed robbery at a grocery store where he worked nights as a stock clerk. As a result of the stress of the robbery, he had a major psychotic break, and wound up hospitalized at his area's major regional psychiatric hospital facility. While there, his case came to the attention of a psychiatrist who is also a licensed attorney, and who runs hospital and private practice programs aimed at making seriously ill people functional in community based care settings. A significant percentage of his patients come to him on referral from various prosecutor's offices in the area, after running afoul of the legal system in one way or another, and he acts as a valuable diversionary bridge and an on-going medical manager for hundreds of the most ill people in the city where I live. Not every prosecutor's office will have recommendations for a man of the caliber of my brother's doctor (and we're incredibly lucky and grateful to have him), but they may well have resource recommendations, if you are patient and persist.

Believe me, the right doctor, at the right time, is key to helping your brother. The problem with finding a long term residential solution such as you seek is that, basically, they don't exist, because under the current model of mental health treatment, mental health patients must generally consent and participate in their treatment, and can only be held in a treatment facility involuntarily if they are an obvious and immediate danger to themselves or others. So, because there is a high rate of voluntary drop out for bi-polar treatment, long term residential facilities are rarely financially or medically feasible. Certainly, you should seek appropriate treatment for your brother, and his history and current problems may dictate some weeks in a inpatient facility, which can be covered by Medicaid. But the period involved is, at most, going to be weeks, and is going to be targeted at achieving specific treatment goals, not all of which may be handled at one facility, as I've described above. And unless he is committed involuntarily by the legal system, he may well walk away from the best available programs that you can cobble together. Such setbacks are par for the course, and when they happen, you grit your teeth, cuss at the disease, not the person, and watchfully wait to help again.

Finally, I understand completely your comments about the relationship between your mother and your brother. My brother lived with my parents for nearly 25 years after he was first diagnosed, on a visit he made to my home, where he had his first psychotic break that caused me to have him committed for diagnosis and treatment. My parents initially thought I had somehow put too much pressure on my brother to find work and get himself settled down on that visit, and it took many years for them to fully understand the scope of my brother's illness, and to realize that he had been trying to deal with it internally for some time before it became evident while staying with me. My mother, like yours, always felt more responsible for my brother's condition than she should have, and insisted that as long as she lived, he live with her and my father. So your family's circumstance is also a common one, and the fact is, you or one of your siblings will probably be your brother's support in the future, as I have become for my brother, in the last year, since our parents died.

You'll be most successful helping your brother, if you can come to act willingly, and in concert, as a family. Your mother may be ready to share the load, but not know how, or she may not feel your increased interest in accepting care responsibilities in your brother's life are genuine. Such inter-family role assignments are a big and on-going discussion, and one that every family handles in a unique way. Maybe your role for the time being is to research treatment alternatives, and build consensus within your family. Not everyone may see the issues in the same way you do, but with effort and changes in your brother's condition, they eventually may. Your bi-polar brother has to be involved, as well, sick and irrational as he may be, much of the time.

Let me close by saying that, good can come from difficult circumstances. You and your mother may well benefit from sharing stories at NAMI support groups, and learning from others what has worked, and how they have coped. And in helping your brother, you and your family may build some self-knowledge and perhaps some quiet pride and resourcefulness, that people with lesser challenges never need discover...
posted by paulsc at 7:38 PM on July 10, 2006

Thanks for the responses so far, they are very much appreciated and there is a lot of info that I will follow up on and look into more.

As far as the NAMI suggestion, my mother and I both went to NAMI meetings when this whole debacle first began years ago, and they were definitely great for getting a grasp on everything that is out there, they seem to be very oriented towards education and advocacy, which is important, it's just that we've been through a lot of the more obvious steps. My mom has been great at tracking down resources and fighting with the bureaucracy on the other end of the phone of state resources - and now often gives advice to people in similar situations just getting started. It just feels like we've hit a brick wall.

At one point my brother was living on his own via section 8, but he phases in and out of what he wants to do, and soon up and left for a Christian mission (geared towards drug/alcohol treatment) for about 6 months before deciding he didn't want to do that any more either, and back and forth.

I do think that if he were presented with the opportunity to go into rehab/treatment that he would do it. He often talks about wanting to go, and will make an effort, such as the mission he went to, it's just that although he did spend 6 months at that place, they aren't a mental health treatment facility, it seemed to be more like an extended AA meeting (of which he also attends, although I am not sure to the current frequency). It's like he'll go to AA or NA and come home and drink/smoke.

I pretty much figured treatment programs were few and far between with expensive price tags, but I thought I'd ask.

Thanks again for sharing.
posted by unsigned at 9:24 PM on July 10, 2006

paulsc--what a thoughtful and wonderful post--you are exactly right about the issues you raised and your commitmnet to your brother is something we do not see as often as would like--
posted by rmhsinc at 9:13 AM on July 11, 2006