Can we avert disaster? (mental-illness-legal-issues filter)

May 26, 2007 2:04 PM

My adult brother with various mental health issues (living at home with my parents in the Chicago area – near north suburbs) keeps going off and doing self-destructive...and illegal stuff. It’s getting worse, and it can’t go on. We’re clueless and scared. Help us, HiveMind! So much

Ah, me…where to begin?

My baby brother (mid-30’s) has always carried a host of developmental disabilities -- learning problems, inability to socialize, etc. Not classically autistic, but possibly Asperger’s-like, and he was diagnosed nearly a decade ago with schizophrenia (of the negative symptom variety). Since then he’s been on a host of meds in an attempt to control a whole soup of this and other mental health problems, including compulsive tendencies, depression, etc.

It is the compulsive behavior that is causing the greatest issues. Over the past several years my bro has engaged in a series of problematic activities that share the features that (1) he clearly lacks both control of and good judgment over them; and (2) they’ve been about trying to get/make money. Highlights of the downward spiral:
- (6-7 yrs ago): obsessive purchase/collection of videos…which at some point, having spent all his money on them, he decided to sell on ebay (probably making back 1/10 of what he spent, but I imagine “feeling” like he was making money)
- (1.5 - 5 years ago): Working in a low-level office job and blowing much of his earned income on impulse purchases. Discovers online gambling, gets into that, blows the rest of his money and more. Starts being a “bad” ebay seller, trying to sell stuff he doesn’t have on hand and then stuff he doesn’t have at all. Discovers the power of the internets to provide just about anyone with a credit card at predatory terms, and blows money he doesn’t have at said terms. Debt racks up.
- (about 1.5 years ago): Brother gets caught after signing a client check over to himself. Police are involved, but no charges are pressed – it’s obvious to all that he’s no criminal mastermind, just a messed up guy and somewhat lost soul. He is fired from job, though.
- Since then, it’s been too much free time to get into trouble, and the obsession with money (and stunted legitimate avenues to get it) remains. Nearly a year ago it was discovered that he’d stolen my mom’s identity (both their names are on a bank account, since she has requested control of his SSI checks) to open other credit and rack up a few thousand dollars in charges there. After some frustrating failed efforts to get the credit card company to negate the charges (which might have been more successful if they’d been willing to send my brother to jail), they decided to just try to gradually pay it off. They got my brother connected to a program where a psychiatric social worker came to the house weekly; no one knows much about what actually was accomplished during these sessions, but a few weeks ago my brother told the SW to stop coming, and he did.

Now, the other day my grandfather mentions offhand that money has been mysteriously flowing out of his own bank account. After some investigation, our fears that my brother is at it again are confirmed. I’m fuzzy on the exact details of what and how, but I understand it involves another fraudulent account using the fact that my grandfather and mom have a joint account together. We’re talking about $10K here. My grandfather is understandably upset but compassionate about the situation. My parents are heartbroken and at their wits’ end.

Prior to this last straw, my parents’ approach has been to figure out how to get things just out of crisis mode, see that things seem calmed down, normalize the new state of affairs, and then hope and pray that the underlying problem has gone away. They’re good, loving folks and intelligent people, but life has thrown one setback after another at them, and so they have tended to tread water, moving from one crisis to the next.

The situation is simply no longer tenable, either from a short-term or long-term standpoint.

Short term: at this rate, the kid will land himself in jail! Believe me, he wouldn’t make it there. In addition, this pattern is clearly only getting worse, my brother has led himself to financial ruin, and he’s taking the family with him. My parents are in their early 60’s, earn only a modest income, and have I’m sure a slew of financial worries that go well beyond this. Perhaps most importantly, it's obvious that he's just not getting the kind of care that he needs. My parents can feed him, clothe him, and house him...but that's clearly not all that's needed here.

Long term: no one’s getting younger, and my parents now acknowledge that the (co)dependent situation they have enabled with my brother is unfair to me and my new family. What will become of him when they are gone? I love my brother and my family very much, but I need to love him from a protected distance, knowing that he’s reasonably well cared for -- I’ve worked hard to escape the chaos of my family of origin, and I don’t want my own life, marriage, etc. to be hijacked by inheriting his unmanaged issues as my responsibility. That might make me seem like an unkind or ungenerous person, but I do know myself and what I am and am not equipped to handle.

At this point, my immediate goals for the situation are to (1) identify any/all options and resources I can that can help my family figure out the best strategies, decisions, etc. for the highest good of all concerned; and (2) find ways to be supportive of my family, given that I do not live near them and am very limited in my ability to get back “home” and help out in person.

I would love to hear any advice or recommendations from anyone who has been or knows someone who has been in a similar family situation, or simply any MeFi social-worker types who can point the way to how one goes about finding a path through this kind of mire. I’ve found paulsc’s wonderful comments on previous posts but wonder if there’s more or more specific advice available for my family’s situation. I’ve referred my parents to get in touch with the local chapter of NAMI for starters. What else?

- short-term – What are the options for handling the immediate fiscal/legal issues created here? What kind of supports should my family be recruiting, and what’s the best way to find them? Are there good practical options for helping to keep my brother out of trouble with this sort of activity while we try to deal with the underlying issues?

- near-to-long-term – What kinds of supervised living arrangements might be available and appropriate for my brother? What would those situations be like? What do we need to do to prepare as a family for that sort of thing?

Chicago-area-specific suggestions, referrals, etc. are most especially welcome.

posted by shelbaroo to human relations (16 comments total)

Sometimes prison IS the answer. Sounds harsh but, how much are you willing to sacrifice?

As an adult who is knowingly committing identity theft related activities maybe its time to treat him like an adult?
posted by Max Power at 3:30 PM on May 26, 2007

I wish I had some good advice to help you help him, but I don't.
It may not be possible for you to fix his life.

What I do recommend is that you step back and make sure you are protecting yourself. He could ruin you. He could ruin your mom, and he could ruin your grandpa. You might be able to recover, but if he's the "baby" at 35, your parents are retired or near retirement and can't allow themselves to be ruined at this late stage in the game.

Keeping him just below crisis for years has probably allowed him to cause more problems for himself. It has certainly caused more problems for others in your family.
posted by putril at 3:31 PM on May 26, 2007

Your family is in a crisis they can no longer manage.

Please encourage your parents to file and ID Theft report with the local police. They will then investigate and this will help your parents begin to remedy their financial problems. Once the police are able to establish who committed the theft, (as you suspect it being your brother) they can present this as proof. At this point your parents MUST be convinced to consider sending your brother to jail or an institution.

Intervention?? Would NAMI be able to facilitate? Would it be possible to have him committed? It sounds like your family has lost control over him as well as their finances. Jail sounds like the place to put someone who has committed ID Theft and elder financial abuse but in this case the jail system (probably after intake and interview with your brother) may also recommend him being institutionalized.

I also wonder if he has a substance abuse problem your family is not aware of. Follow the money, and see where it ends up...
posted by Carnage Asada at 3:56 PM on May 26, 2007

Sounds like substance abuse.

People write off dope and alcohol, but their effects on people with predispositions for manic behavior, schizophrenia, even autism are well-documented and potentially psychosis-inducing.

Also, prescribed meds only work when people commit to sticking with them. Manic states are often desirable to those who suffer from them because the intensities of the range of emotions are often a source of stimulation in and of themselves. So meds bring the high down and the lows up, and in the process the "mediums" can leave the individual feeling self-consciously average or normal.

But be sure this behavior is documented. Sadly, the person you are related to sounds like a loose cannon. Documenting the situation can help to prevent others from becoming victimized should you have to "cut him loose."
posted by humannaire at 4:52 PM on May 26, 2007

I’ve worked hard to escape the chaos of my family of origin, and I don’t want my own life, marriage, etc. to be hijacked by inheriting his unmanaged issues as my responsibility. That might make me seem like an unkind or ungenerous person, but I do know myself and what I am and am not equipped to handle.

No words of advice, per se, but I just wanted to say that I think the fact that you recognize this is wonderful. You want to protect the life you've created, your husband, and know your limits; that is something that many people never achieve. Good for you - and no, it certainly doesn't make you sound unkind or ungenerous! - but like someone who is functional and pragmatic, and who understands that keeping herself sane is the best thing she can do for her family who is otherwise ensnared.

Good luck to you.
posted by AthenaPolias at 4:59 PM on May 26, 2007 [1 favorite]

shelbaroo, I wish you luck in finding a way to "out source" your brother's care, but unless you are willing to spend 5 figures a year to make it happen, I doubt that you'll be successful, in the long run. The kinds of facilities you are looking for don't really exist any more, for middle class and working class families. Statistically, if your brother can't shelter with family for the rest of his life, and can't learn to live independently or in the rare community based group living facilities that have a long term spot, it's very, very likely he is either going to the streets (where many schizophrenics wind up in America), or to jail. Tens of thousands of people with similar mental health issues are out on the streets in America tonight, and thousands more are in our jails and prisons, having run afoul of the law. You are right in thinking that your brother would not do well in such situations; few people could, even without the mental and perceptual problems having mental illness creates and/or exacerbates.

I wonder about your understanding of your brother's diagnosis, and about his treatment. Schizophrenia is sometimes best thought of as being a spectrum of dysfunction, but people that have both classic schizophrenic disorders and autism/Asberger's issues aren't common, in my experience. A lot of schizophrenics have more negative affects (flatten emotional response, difficulty socializing, difficulty with communication, etc.) than positive ones (psychotic symptoms, "voices," hallucinations, paranoia). If there is any good news in the treatment of schizophrenia, it is that new atypical anti-psychotic medications continue to be developed, and although many continue to have serious side effects, they are no where near as debilitating as the conventional anti-psychotic medications of even 20 years ago. Other than the SW you mention making home visits, you don't speak of any psychiatrists or other medical professionals being in charge of your brother's case, insofar as medication management, and prescriptions are concerned. From your description of your family's financial arrangements, it sounds like your parents have your brother set up with Social Security for SSI, which will also normally qualify him to receive certian health benefits, including psychiatric supervision and medications, through Medicaid. Yet, if he does not take his meds, or go to his psychiatric appointments, he will not remain medication compliant, and this is a common problem with schizophrenic people. Step 1 for your family is to be in touch with any persons in charge of your brother's case managment, to alert them to these problems, and perhaps, to inquire as to alternate therapies. Many anti-psychotic drugs quit working for reasons we don't really understand, and if this is happening with your brother, he may need a short term committment for stress reduction and changes to meds, to get his base problems in reasonable control. Until he's essentially medication compliant, on meds that actual control his anxiety, psychosis and other symptoms, he is in danger, in many ways.

Turning to the issues of your responsibility and roles for your brother's future care, if any, let me just say that I understand, because I've been through similar issues with my own brother. There's a fair amount of our history contained in many other AskMe responses I've made to similar questions in the last couple of years, but like your brother, my brother lived with my parents for over 28 years of his adult life, until they died in 2005. He was first diagnosed during a visit to my home after he got out of the Army over 30 years ago, and he returned to live with my parents at their insistence, through a long series of hospitalizations and attempts at independent living, that never worked out. When my parents died, I became my brother's primary caretaker.

It's something I knew all along would come to pass, when our parents died. As a younger person, it was something that I expected to be difficult, but having come to it, let me say that it has been easier than I had hoped, primarily because my brother has accepted my help with managing his disease with a great deal of grace, and because he and I work on keeping him medication compliant, and in good physical and emotional health, as much as we can. Regularity of schedule, including basics such as mealtimes, are important in keeping oral meds working as well as they can. Weight control, physical fitness, stress avoidance, sleep management, and socialization are all important in keeping my brother on his meds. I also go with him to his monthly psychiatric appointments and blood work appointments, which keep him on his anti-psychotic meds dispensing protocols. It's a constant, daily balancing act, which is not particularly onerous, but which is darned near impossible to hire out.

But it wouldn't be fair to simply leave this topic by saying that caring for my brother has turned out not to suck as much as I thought it might, when I was younger. Because, truth be told, his life and his well being have added immeasurably to mine. He has a certian goofy sense of humor that is endearing, and a genuine concern for others I sometimes lack. And his example of quiet courage in bearing for all of his adult life a disease that has cost him any semblance of a normal life, for which he once might have hoped, is down right inspirational.

You say "I don’t want my own life, marriage, etc. to be hijacked by inheriting his unmanaged issues as my responsibility." I understand. Really, I do.

And yet, when it comes to it, that may not be how things play out. It's possible to adapt. Rewards, and understanding often come, unbidden, just as they are needed.

But immediately, your family needs to be in touch with whoever is medically responsible for his psychiatric care. In contrast with other posters to this thread, I can't endorse abandoning him to run-ins with the legal system, if you and your family can reasonably still help him avoid it. The potential for violence is too great, and the possibility for effective case management in the system is nearly nil. In particular, the correctional system itself will work hard to shed responsibility for non-violent mentally ill persons, in nearly every jurisdiction in the U.S., with a vigor that is born from the desperation of correctional officials in trying to manage the portion of their populations with mental illness who are so dangerous and who have extant criminal histories serious enough that they must be segregated from society. You say your brother wouldn't do well in jail, but you make no mention of how little the detention system would be interested in having your brother as an inmate. If you've never visited the lockdown facilities of a major urban jail, or a involuntary commitment facility in a major American city, let me just confirm they are no place for a frightened, confused, non-predatory person to be, even for a matter of hours. And unless your brother becomes threatening delusional, or truly violent, they are going to be little more than very short term way stations for him, until he becomes a victim of someone more predatory than he is.

Get in touch with his treating psychiatrist. Discuss what you know of his symptoms, and his issues with treatment supervision with the SW, and with meds. Take advice regarding personal involvement, so as to use any travel or personal time to best advantage. Be in touch with your parents and grandparents. This is not likely to be a situation with which you can positively assist, at arms length, indefinitely. Since you can't change the disease, and you can't probably change your parents, work on changing what you do have power to change, which is generally your own attitude and thinking about this situation.
posted by paulsc at 5:36 PM on May 26, 2007 [12 favorites]

If there are truly developmental disabilities involved, an alternate residential setting (group home/more restricive type program) may be more appropriate for him than living at home. A group home setting coupled with an appropriate day activity (closely supervised job or a therapy type program) may provide enough of the structure to keep your brother out of truoble, and limit access to those things your brother uses to get out of trouble (internet, cash, too much free time, your folks cash).


Consider hiring a private social worker that is familiar with all the rules and entitlements that may be available to your brother. Once that is determined, they can provide advice on the various programs that may be available for your brother,your folks, and you along with the various financial impacts. I am sure that you could research this yourself, but when I needed to help my folks through the medicaid / nursing home maze, it was just easier to hire someone.

Good luck to you and your family. I know that this is a hard situation. You are doing the right thing.
posted by Raymond Marble at 5:53 PM on May 26, 2007 [1 favorite]

This is really difficult, and I sympathize.

A good place to start is definitely with your brother's psychiatrist and social worker, as paulsc suggested. Check in with them for their understanding of the situation and your options.

If there is really mental retardation or schizophrenia here, a possible way forward is to have your brother declared non compos mentis and to have a competent person acquire power of attorney for his affairs. This would have the benefit, among other things, of eliminating his ability to enter into binding contracts. This would show up on his credit report, making it much harder for him to persist in his practice of opening credit accounts and draining others' bank accounts.

However, it sounds like he might be too capable to be declared non compos, and too antisocial or paranoid to cooperate with signing over his power of attorney. In that case you are really in a bind.

Deinstitutionalization, a term for what happened to mental health care in this country in the 1980's, pretty much eliminated the humane options for mentally ill people who need supervision and are not fortunate enough to have wealthy relations. These people either get by at home with the graceful assistance of their family members, or they wind up in the prison system or the state mental health institutions that do remain. These latter are no better than prisons and may be worse in some ways.

Have you talked to your brother? What changes is he willing to make? What help will he permit on his own behalf?
posted by ikkyu2 at 6:12 PM on May 26, 2007

Thresholds

A good friend of mine in Chicago has worked for this organization for years. They work very closely with schizophrenic patients to help them live independently, take their medication regularly, manage their finances, and generally cope with day to day life.

I am unsure of the role they might play in support for families of the mentally ill, but I would imagine that effective treatment would likely include this sort of support.

Good luck to you. I have a family member who suffers similarly. I wish I could be more helpful about all the financial issues this illness has created. Perhaps someone at Thresholds might be able to offer some options.

Good luck.
posted by TryTheTilapia at 6:32 PM on May 26, 2007

I was also going to recommend Thresholds since you are in Chicago. A good place to start researching your options. Best of luck.
posted by jeanmari at 7:44 PM on May 26, 2007

Get help from a lawyer or financial planner to make sure family accounts are protected.

It may be possible that if the current theft goes to court, a judge could mandate psychiatric care & meds instead of jail.
Good luck.
posted by theora55 at 9:48 PM on May 26, 2007

As far as the financial fallout of all this, you need to make sure everyone (including yourself) is protected from him siphoning more money off. You, your parents, and grandfather need to protect yourselves just as you would if he did not have mental health issues. Google "family identity theft" for information on this.
posted by yohko at 9:09 AM on May 27, 2007

Thank you everyone for the advice and encouragement. I do remember learning about Thresholds from an undergrad psych class but had forgotten about that resource and certainly had no idea how extensive their options were. I am emailing my folks the info. I've also offered to pay for a social worker to sit down with them and help map out the maze.

My brother is, AFAIK, medication-compliant (my folks do keep an eye on that), but it is a good point that his meds may not be the right ones for him at this point.

Obviously, meds aside, a comprehensive plan of attack will be needed. When we figure one out, I'll post an update for future MeFi reference.
posted by shelbaroo at 10:24 AM on May 27, 2007

Other people have addressed the psych treatment aspects, so I just want to point out one money issue. Isolating your brother's funds from everyone else's is also a good idea b/c his SSI cannot be garnished or collected. See 42 USCS § 1383. It's rather shocking how few people know this (including creditors and collection agencies who will lie lie lie about this). It is extremely common for people with serious psych problems who have to get by on the meager amount provided by SSI to get into terrible financial situations.

Make sure his SSI is not co-mingled with other funds, and send letters to all his creditors stating that he cannot pay back the money he owes, his sole source of income is SSI and cannot be attached or garnished, and he does not want to receive any further contact from the creditor. The The Fair Debt Collection Practices Act, 15 U.S.C. § 1692c, requires creditors to honor this request. It can provide some peace of mind to be able to "write off" some of these debts (although he still owes them!). Getting this stuff off your plate means you can focus on other things.

Whether or not the creditors can freeze his bank account is probably a matter of state law, but if they do, you can probably get them to unfreeze it by sending a letter stating the same things as above along with 3 months of bank statments. You should be able to find model letters for this stuff online.

ID theft is a hell of a thing to have to disentangle oneself from, but there are good resources online. The Federal Trade Commission actually has some decent resources, and some state attorney generals do good work in this area. Good luck.
posted by Mavri at 2:31 PM on May 27, 2007

Thanks, Mavri, I had no clue about some of those legal aspects of the situation - this is good info to have. However, once the chain of financial connections is fully mapped out, I'm afraid that the fact that he has acted using shared accounts means that it might be harder to separate out responsibility with creditors. As others have said, though, dealing with the issue as identity theft/fraud may help here, although I am certain that we will only be comfortable doing this if we can be fairly confident that legal tools and treatment to deal with the situation and not incarceration will be the result.

Finally: paulsc, you - and your brother - are an inspiration to me. I can't say now what choices will be right for me or what I will do down the line... but I can only hope that whatever I do reflects the kind of compassion, humility, and grace that your actions - and your understanding of them - demonstrate.
posted by shelbaroo at 9:42 AM on May 28, 2007

This question needs an update!
posted by meehawl at 8:06 PM on November 11, 2007