How do I help my father get help for mental illness?

July 6, 2008 7:44 PM

I'm pretty sure my father is mentally ill and I need to get him into some sort of public assistance living situation. Does anyone have experience with something like that? What do I do?

My father is 57, divorced, unemployed. He has a long history of not being able to hold down a job and he is in a deep depression period right now--he doesn't leave the apartment except to go to the bar. One of my brothers just moved in with him, but realized asap that he couldn't live with an unemployed, depressed, alcoholic (who also steals the rent money). The consensus among the family members still willing to listen to him is that he is also bipolar or psychotic--and he has never sought or received any sort of counseling or treatment. The situation now is untenable. My brother is going to move out and my father will be homeless this time next month. I truly believe that he could benefit from either medication or therapy or both. I know he won't seek it himself. I'm not OK with him "choosing" to be homeless without him first getting a shot at treatment. Is there any sort of public assistance that I can take him to? I don't know where to begin to get him diagnosed or to get him into some sort of treatment facility. He also told my other brother that he was diagnosed with Hepatitis B this week and my brother sent him money. I don't know if it's true or not, but if it is, he'll need treatment for that, too.

I'm afraid you'll want to debate his mental well being, but I know him better than anyone and he's in terrible shape. I need advice on how to get him into welfare or medicaid and get him into a living situation where he can receive some sort of treatment for free. He lives in northern Colorado. Thank you.

posted by anonymous to human relations (9 answers total)

Call Social Services.
posted by greta simone at 7:59 PM on July 6, 2008

You could talk to him about applying for SSI. In order to qualify, he'll need a psychiatric and physical assessment. Which might connect him to some system of treatment. If he eventually qualifies for SSI (assume some months, could be longer than one year), the payment can help against homelessness.
posted by ClaudiaCenter at 8:15 PM on July 6, 2008

If you know who his doctor is (the doctor that diagnosed him with hepatitis - assuming his story is true), you can call and tell the doctor your concerns. Because of privacy restrictions, the doctor won't be able to tell you anything about your father's medical or mental health situation, but you can tell the doctor how you perceive things. Perhaps that will be enough to get the ball rolling in the right direction, but that's only if your father sees the doctor on a regular basis.

Unfortunately, you can't force medical or mental health care on him if he's unwilling (unless he does something drastic that makes him an imminent danger to himself or others, which would get the courts involved for a possible committal, but even that is very iffy).

Your best bet is to encourage him to be willing to seek help for himself, either through his doctor or through social services. You can go along with him and help him with the process, but he really has to be a willing participant.

Good luck.
posted by amyms at 8:31 PM on July 6, 2008

There's a couple things going on here at once. There's substance abuse, there's mental illness, there's unemployment and there is a housing issue. This is a lot to take care of, though a competent social worker could walk him through these things if, and it's a big if, he's willing to engage with one.

If your father has a work history he will be eligible for disability benefits which will far, far outweigh the benefits he will get from welfare (80% of his previous income if he fits their guidelines). Definitely get the medical coverage from welfare (contact his county assistance office for instructions), but welfare isn't where he wants to get his income. As a single man, he'll get next to nothing, definitely not enough to get housing with.

He wants SSDI, but his drinking is going to complicate applying for it dramatically. Part of the welfare reforms in the 90s was a clause attached to SSI and SSDI benefits mandating that the applicant's substance abuse be immaterial to the disability. This is to say, even without his drinking problem, your father would still be so mentally ill that he would not be able to work. This can be difficult to prove. Basically, he should apply for disability and appeal what will almost certainly be a denial based on his substance abuse. The appeal process will either require the assistance of an attorney experienced with SSI/SSDI appeals or an extremely ambitious social worker who knows how this extremely complicated procedure works. If your father has no income right now, he will actually be a perfect case for legal aid (probably the first time I've said that in AskMe), and you should contact the local legal aid group and ask about SSDI appeals.

He will have to be diagnosed by a psychiatrist at this point, and also go through a series of doctors appointments; if you are willing to help him with this process you can become his representative, so that his appointment letters will be delivered to you, and you can keep him on point with his appointments. A legal aid attorney can brief you on all this. You can read up on all of this, here. Specifically, look at the SOAR program.

That's one piece of the puzzle. The next piece of the puzzle would be finding a place where your father can live, where he can still drink and be non-compliant with medication since it seems like he has no interest in sobriety or managing his symptoms (don't worry, neither did most of my clients). There are programs like this, housing first is the name of the strategy (Google it for more info), but these programs are still in the minority and I don't know anything about Colorado. I worked for two different housing first programs in Philadelphia, but our clients were mostly coming straight off the street, or from some other institution. The sad fact is that in order to qualify for homeless services, you have to have an established history of homelessness.

Beyond that, your father is going to hit a lot of walls if he won't stop drinking and at least consider medication (assuming that he is in fact bipolar and psychotic and an alcoholic). Most housing programs for the mentally ill do not work on harm reduction frameworks and won't accept someone who is actively using. That's sad, in my opinion, and I think eventually that will change, but that's still sort of the norm.

Here is a list of homeless services agencies in Colorado. I don't know if any of them are near your father, but knowing homeless services, they'll probably be willing to help you and make referrals to appropriate agencies, regardless. Call them and start talking this out with people who know the landscape.
posted by The Straightener at 8:33 PM on July 6, 2008 [7 favorites]

Okay, having recently gone through a similar situation with my mom: You need to get him to a psychiatrist, whether he wants to go or not. Ask for an evaluation. Ask for the records to be released and a letter to be written to the Social Security Administration.

Your father will almost certainly qualify for SSI, which will then qualify him for Medicare and a monthly stipend AND for a senior apartment for like, $70 a month. Here are the problems:

1. SSI applications are routinely denied and must be appealed. The process can take years. It does take at least six months.
2. The waiting lists for senior housing are years long.

So yes, you need to seek out your local department of social services. In some states these departments are run by the county, while in others they are run by individual cities. Do a bit of research and you'll find yours.

If you need to get your father Medicaid, look at your state's Medicaid site and gather all the appropriate documentation you'll need to apply. You can frame this as an "emergency," and they will possibly respond quickly, though it typically takes several weeks to a month or two, at least in New York. My advice on the Medicaid thing is to get there (with your father, of course) very, very early -- like the minute they open in the morning. The lines and waits can be horrendous.

You also need to contact his primary care physician to let her/him know that your father is mentally unwell. The best way to get your dad into the psychiatrist's chair may be to say, "You'll get money out of this, and you'll get better." But first, he'll need a referral from his primary care doctor, unless you've got amazing insurance.

As for a hospital situation, a doctor will only commit your father if he is considered a danger to himself or others. He may well be, especially if he is about to be homeless of his own volition. If all else fails, take him to the emergency room when he is at his worst. There, they can process paperwork for a Medicaid application as well as get him evaluated and into proper care. Some hospitals also have social workers who will sit down with you and guide you through some of the possibilities, and tell you about what options your father has.

Best of luck.
posted by brina at 8:39 PM on July 6, 2008 [1 favorite]

Just to clarify because you're probably not familiar with the terms, SSI does not require that the applicant have a job history and paid into Social Security. However, as a consequence, the maximum benefit is capped at $637 per month. SSDI is a disability payment based on the amount paid into Social Security and is based on a percentage of income (80%, as mentioned). If your father has a recent work history, go for SSDI and try to get the higher benefit. But don't worry, if he hasn't worked in the last five years he's still eligible for SSI and the $637 per month will be plenty to get mental health housing with.
posted by The Straightener at 8:47 PM on July 6, 2008

This is very hard for you; I sympathize.

Your father will get better help if he's in hospital, because then he will be given medication and may cooperate in the application for SSI. If he won't go himself then you can try to get him committed. To have him committed you may need to say that he is about to kill himself -- that's probably the only thing that will make it happen. As pointed out above, it's the danger to himself or others that triggers the committal process: not a long-term descent into homelessness, but imminent danger. You will have to be believable and convincing; laying groundwork could be helpful.
posted by anadem at 8:07 AM on July 7, 2008

To have him committed you may need to say that he is about to kill himself -- that's probably the only thing that will make it happen.

Do not do this. This is the perfect way to permanently ruin your relationship with your father. If you have ever been involved in the process of involuntarily committing someone to a psychiatric facility (I have), you know that it is incredibly traumatizing. If you try to involuntarily commit your father and he resists the police will do whatever they feel necessary to subdue him. If your father is drunk and unreasonable he could get hurt. In every single situation where I or another social worker on the team I was working with involuntarily committed someone (and with actual cause to do so) the relationship with that client was irrevocably damaged. Besides, once he gets to a psych facility he can still refuse treatment if he desires, refuse to take medication and after the 72 hours initial lock down period he'll still be able to tell a judge in mental health court that he feels he doesn't need treatment and was wrongly committed, at which point the judge will probably release him.

I understand that there's a lot of fear involved in potentially watching someone drink themselves onto the streets, but the mental health community doesn't engage in forcible medicating or involuntary stays to try to save someone from themselves because that doesn't work. It sets up an adversarial relationship between the provider and the client that makes things much worse down the line. Trust takes time to build, you need to slow play these things and take it as fast as the client is willing to take it.
posted by The Straightener at 8:43 AM on July 7, 2008 [3 favorites]

I don't have any solutions that haven't already been well explained here already, but I did want to say that I'm sympathetic to your situation, and I wish you the best. Please feel free to metamail me if you ever feel like you need a listening ear.
posted by dejah420 at 5:27 PM on July 7, 2008