Mental health and family

January 9, 2007 9:02 PM

Adult sibling with mental health problems living with parent. How to help from afar?

Trying to maintain anonymity/so details below will sound odd or vague.

I have an adult sibling who has struggled for many years with mental health problems.This sibling has attempted suicide numerous times in the past.

For this reason, this sibling is now living with a parent. This sibling has recently bothered neighbors leading to the parent receiving a legal notice (failure to comply will result in ____).

Sibling has continued hostilities towards neighbors. Parent has tried to convince offspring to stop, but offspring has then become physically aggressive.

Some other problems 1) parent has some money but not a lot 2) if this sibling receives an ultimatum, sibling has acted impulsively in the past (suicide attempts,hitting)

I don't know how much I can help. I've thought of offering the sibling a chance to move with me. However, I live in a very small studio across the country (I know my sibling would not stay here)

Part of the current problem is that once again sibling decided non-compliance with medication is the better route.

My big concern for the moment is that if changes do not happen soon, one of the following will happen: sibling will antagonize neighbors more resulting in police involvement (which will result in an arrest or the sibling will something rash at a later point); legal problems for parent (who cannot afford this); sibling does something rash [towards a neighbor (altercation), parent, or self].

Can anyone suggest any resources? Other forums? Ideas that may have worked for you if you have a similar family?

posted by anonymous to human relations (7 comments total)

The Depression fallout message board helped me a lot when I was dealing with a family member who had gone off the rails. The people there are very supportive - and the author of the book Depression Fallout (which may also be a helpful read) is very active there and helpful. Even just reading through some possibly related threads there may give you some information (even if it's not depression your sibling is suffering from).
posted by gomichild at 10:03 PM on January 9, 2007

I’ve just recently got diagnosed with Cyclothymic Mood Disorder, after years of fearing being “labeled” as a nut job, and therefore avoiding it. I also avoided taking medication because I didn’t trust anyone to prescribe it for me—what if they were trying to suppress the real me, and they were only interested in treating the symptoms but not the disease. I think your brother/sister needs to see a psychiatrist, and the sooner the better, but a good one though.
Maybe the reason why he doesn’t want to take his meds is because they’re not having an effect on him—believe me—if they help him get better, the first person to tell you that he wants to take his medicine will be him. I also think that you should tell him not to worry about the financial costs of his treatment (if you can afford it that is) to assuage any guilt that he might be placing on you and his family.
One last thing: why does he have an altercation with his neighbours?? Have they been rude to him?? Do they antagonize him/her in some way?? I’m not sure the reason for this, but I hope it’s not so serious that he’ll have to get arrested. The thing that your brother sister needs more than ever right now is someone on his or her side, and not the law and everyone against him, which is what he will probably perceive if he does get arrested.

I hope things work out a little better for him, and you.
posted by hadjiboy at 10:09 PM on January 9, 2007

guilt that he might be placing on himself, that is
posted by hadjiboy at 10:11 PM on January 9, 2007

Kendra's law was made for your sibling. It might seem like the nuclear option to compel your sibling to receive treatment, but one of the criteria for AOT under the law is that the person be "unlikely to survive safely in the community without supervision, based on a clinical determination." For example, he could be at high risk of being shot by the police.

That example is the one my ex-husband's parents used on my brother-in-law when the court ordered him to follow his "mental health treatment plan." Did he like it? No. Did he comply? Yes. He did not want to go to jail. Did his condition improve? Immeasurably. It did take a while to get the meds right, but it hadn't even been possible to get the meds right before, when he wasn't taking them consistently.

Your parent undoubtedly doesn't want to take away your sibling's agency, but your sibling's mental health problems, if untreated, will do exactly that. From what you relate, his agency is mixed at best -- he is mostly ruled by his disease. It might be necessary for you or your parent to seem to be the bad guy, to help your sibling take back control of his own brain.
posted by Methylviolet at 10:53 PM on January 9, 2007

If you're willing to tell us, a rough idea of your location (country, state if in the US) may help people to better understand what your options are.
posted by concrete at 12:07 AM on January 10, 2007

I've told enough of my brother's story around here, that I can just link to it now, whether or not you want to read any of that. Suffice it to say, that I have been the family living far away, wishing to help, and that I'm now the primary caretaker for my mentally ill brother, and that it is now I who stay in touch with relatives who live far away, and want us to know they want to help.

With respect to the particulars of your sibling's case, much depends on the specifics of his/her disease, the quality and frequency of care they have received (big differences in outcomes can result from the sophistication of the treatment and case management professionals involved, if any), and the particulars of the drug regimen your sibling should currently be on. Perhaps more importantly, big questions arise regarding the legal status of your sibling, because of their history and residential arrangements with your parent. If the parent has been appointed the legal guardian, conservator, or reciever for your sibling, or holds their legal or medical powers of attorney, or is registered with Social Security or state welfare agencies as a person responsible for the administration of financial benefits for your sibling, they may have leverage with "the system" that could help them steer your sibling into better circumstances. I say this particularly in reference to your comment that "This sibling has recently bothered neighbors leading to the parent receiving a legal notice (failure to comply will result in ____)." which I take to mean that your parent as received a warning, citation, or court order on behalf of your sibling, as opposed to being cited or enjoined him/her self. If your parent is being threatened or enjoined because of your sibling's actions, your parent needs legal help immediately, and should respond to the notices or court orders received, as appopriate.

Whatever the condition, it sounds as if your sibling is not medication compliant, and is acting irrationally. Depending on the jurisdiction, and the specific behavior, the situation may or may not rise to the level of them representing "a danger to themselves or others" which is a near universal standard of judicial discretion in all U.S. jurisdictions. One might wish for the forward thinking of New York state that methylviolet references, but that's not the case in most of the country. But if their altercations with your father or his neighbors can be characterized as threatening in any regard, most courts will act to send a person to a psychiatriac facility for short term evaluation, at least. This sometimes leads to longer terms of involuntary committment, during which medication programs are created, and the patient is stabilized before being released to home environment living situations, and follow up care resources. Could be the best thing to happen to a deranged family member, for their own sakes, and for the benefit of remaining family members. I would try to keep an open mind about all this, based on the particulars of your sibling's continuing actions and effects on your parent and neighbors. It could well be you'll soon welcome the involvement of police in controlling the situation, without harm to either your parent or sibling.

As to whether you should or should not "support" efforts to keep your sibling "out of the system," all I can say is that many people with mental illness initially receive assistance, diagnosis, and treatment as a result of coming to the attention of the legal system because of their irrational or threatening behavior. From what you describe, your sibling is not listening to family members, and is violent enough to be feared by your parent, and certianly by neighbors. It may be the best thing that the police step in, to control the situation, before it escalates. Following on that, in most jurisdictions, your sibling will get a hearing to determine whether they are truly dangerous to themself or others, and if they are determined to be, will be protected, and placed in a diagnostic or treatment facility, involuntarily, until a medical treatment plan can be agreed, and put into action. So, there are far worse things that could happen, if your sibling is as severly disturbed as your post implies.

I don't think it is useful for you to undertake to house or help your sibling directly, by having them move to stay with you. A "clean slate" is not going to be helpful to someone in the grip of a deteriorating mental illness, unless the treatment and social services available in your area are notably better than where your parent lives now. It is probably better for all concerned if you can arrange to travel back to your parent's and sibling's home, at a time you can together, consult medical and legal professioinals regarding your sibling's condition. Nothing beats hearing things from the treatment resources yourself, and being involved in developing on-going living arrangements and care program plans, when illness being treated is severe, or possibly even considered shameful or threatening, to your parent, however irrational that attitude may seem to you at your distant remove.

You can be sounding board, by telephone. You can be a researcher, and a communicator, against the day you'll be called in to help with this directly. You can save money to be used for the help of your parent and sibling in continuing to live independently, if that is possible and desireable. You can work out how to travel back to your parent's home, and share the decision load, if not some of the housekeeping chores of your parent's household. You could find caregivers and cleaning professional to assuage your parent's housekeeping load, if that would be well accepted by your parent and sibling.

But mostly, you can make whatever sacrifices are necessary to achieve some loving face time with your family. It's sometimes difficult for the mentally ill to relate to a voice on the other end of a telephone line, particularly in moments where they experience pain, memory difficulties, or strong emotions like fear or love. But your parent and sibling may welcome your familiar presence, and you may thus promote shared memories and family rituals, that might strengthen your bonds with one another, as they are simultaneously tested by your sibling's behavior.

You could also be in touch with NAMI on behalf of your parent and yourself, for guidelines and local resources in your parent's locale. Be aware though, that NAMI is a strongly local type organization, mainly run by volunteers, and so you may need to be pretty proactive in approaching them for help and suggestions regarding your sibling's situation.
posted by paulsc at 2:34 AM on January 10, 2007 [1 favorite]

Before my mad housemate got forcibly dragged off to psych ward by four burly cops, I used to think that this kind of thing was just a horrible and unnecessary violation of a person's civil rights.

When I saw them belting his fingers with an extensible steel baton to make him let go of the back door of the divvy van so they could chuck him inside and slam the door, I was sure of it.

But he did much, much, much better after he was committed and medicated.

Some years later, I had my own brush with psychosis that resulted in my own arrest and involuntary admission. And I got better after that, too.

If your sibling gets arrested, the cops will physically prevent suicide, and your sibling's illness will then be taken seriously enough to get treated. It's a totally sucky route to treatment, but it's not the end of the world.
posted by flabdablet at 3:40 AM on January 10, 2007