Is there hope for my brother?
July 23, 2011 6:14 AM   Subscribe

Mentally ill brother is getting worse...and worse...and worse. What are our options?

Can my parents help my mentally-ill brother? Is there any hope in this situation?

Background: I'll try to be short and sweet, but give as many details as possible.

The brother: Just turned 21. Has suffered from mental illness his entire life (working diagnosis: "extremely bipolar," though it has changed multiple times over the years). From the age of approximately 10 through 17, he was hospitalized and lived in a group home due to violent outbursts and ongoing mental health struggles. He then moved home and partially transitioned into regular life, work, etc., but went off his medication, became a huge pothead, and got into serious conflict with my parents. He is terrifying when enraged (over 6 feet and 200 pounds) and quite charming and charismatic when he needs to be. He's also a great person beneath all of the bullshit -- caring, sensitive, artistic, and funny.

The parents: Former rageaholic father who has since gone through anger management. Codependent, depressed mother. They were abusive, terrible people in the past but have gotten their shit together in recent years and are genuinely broken-hearted about their seeming inability to help him and guilty about the years he spent in treatment already.

In April, following my brother being fired from my dad's company and my parents' attempt to kick him out of the house, my brother broke into my parents' house and threatened to kill my mother. She called the police and he was involuntarily committed. He moved home after roughly one week of treatment, immediately quit his meds and began drinking and smoking weed again, and recently got in a violent altercation with my father that involved threatening with a baseball bat and punching holes through a wall.

On Wednesday he was arrested for a felony vandalism charge after violently defacing a car. My parents have decided not to bail him out so he is sitting in San Diego County jail awaiting trial. In the past he has been able to hold it together for relatively long periods of time, so I am unsure whether the authorities will realize he needs significant mental health care.

My question is: short of conservatorship (which they don't want to pursue for fear of his violent retribution), what can be done if and when he is released from jail? I am starting to have trouble sleeping at night for the fear of my brother committing suicide or killing my parents in their beds, and at the same time my heart breaks for his seeming inability to seek or accept treatment. Is this just a lost cause? Are we missing some kind of service or avenue for help? Should I just be taking care of myself and keeping out of this?

Email responses
posted by anonymous to Human Relations (12 answers total) 6 users marked this as a favorite
First of all, contact NAMI. They have been an invaluable resource to both my parents and my brother in coping with his severe mental illness. They can help your family figure out California state law as it relates to involuntary treatment for mentally ill people, voluntary programs for mentally people, disability, medicaid, etc. They can help you sort through the medication maze. They can present your family with options.

My brother was diagnosed 15 years ago. He recently went through a particularly hellish two-year period during which he was arrested numerous times, violent with my parents, in and out of state hospitals, jails and different programs, and finally found a medication regimen involving very powerful anti-psychotics coupled with mood stabilizers that brought him back from abject insanity. Most importantly, he was finally able to find the personal insight to accept that he is seriously mentally ill and that he has no other choice but to submit to treatment lest he spend the rest of his life in a waking nightmare of hallucinations, voices in his head, and constant terror.

All of this came about because my brother's case got so bad that the police and courts became involved. That is why, though scary and awful, your brother being in jail is not a bad thing. Frankly, it's where he needs to be at this moment because he's a danger to society at large and specifically your parents. They need to tell the court that they fear for their own safety. It might be possible for the court to either order him into a state hospital for a period of time or recommend a restraining order or some other combination of remedies. I can't really tell you; NAMI can help you figure out your options. Call them right now.

Best of luck to you. I'm truly very sorry and my heart goes out to all of you.
posted by TryTheTilapia at 7:25 AM on July 23, 2011 [13 favorites]

How heartbreaking for all of you -- I'm so sorry.

A good friend of mine recently went through something similar with her own brother. Long history of serious mental illness, less violent than your brother sounds, but with lots of delusional thinking that wound him up in jail on a federal stalking charge. He was refusing all help and wanted nothing to do with his family.

What helped them (at the the time, though I know it's an ongoing battle) was to find an attorney for her brother very experienced with psychiatric issues. They can help with the immediate criminal stuff, and help coordinate other referrals to counselors and advise you on commitment/custodial issues. Also that way, it's the attorney dealing with your brother, and it may feel less to him than you or your parents "interfering" with his life. The downside is that this can be expensive.

But absolutely take care of yourself. No one would fault you for keeping out of this entirely, but I would imagine that would be near impossible to do.
posted by pantarei70 at 7:28 AM on July 23, 2011 [1 favorite]

Ultimatum - "Take your prescribed meds and quit the non-prescribed ones, or GTFO."

No one has the time or energy or emotional reserves to badger a noncompliant adult into behaving as a more-than-full-time job. Especially if your folks already have their own issues to deal with, they don't need an additional stressor continually setting them back.
posted by pla at 8:16 AM on July 23, 2011 [2 favorites]

You may want to give these people a call; they're the San Diego Mental Health Services people. This, by the way, is NAMI of San Diego, if that's where your parents are (you want to talk to the NAMI organization where your parents live, not where your brother is in jail, because they're going to want local support.) NAMI also suggests looking at the Sheriff's website for information on medical (and mental health) services in jail. Note this line:
If release is unlikely to occur soon, and you are concerned about important information reaching Medical/Mental Health staff, you may call the facility’s Information line and ask to speak to a member of the medical staff.
Since it's a felony charge and he has no chance of getting bailed out, this is probably worth pursuing. Here are the facility numbers for each of the jails, and here are "local" information line numbers in each of the three area codes for the San Diego community.

(And there is hope. It may be a long time before it happens, but lots of people do well on meds, with counseling, etc., once they start trying to get better.)
posted by SMPA at 8:33 AM on July 23, 2011 [2 favorites]

Was your brother on probation prior to this most recent charge? It's always appropriate IMHO for you to call his PO, his defense attorney, or even the prosecutor to express your strong feelings about what your brother most needs. A PO can mandate that he stays clean and takes his meds, for instance, or doesn't live with your folks.

I am so sorry. This must be incredibly hard.
posted by purenitrous at 8:53 AM on July 23, 2011 [3 favorites]

are you in your own therapy?
posted by sweetkid at 9:07 AM on July 23, 2011

Ultimatum - "Take your prescribed meds and quit the non-prescribed ones, or GTFO."
It's not that simple with a mentally ill person. My boss' son was schizophrenic and behaved similarly to the OP's brother when off his meds. He was functional enough to hold down a job and live on his own when he was on his meds. But it was a Catch-22 - when he got back to "normal" he'd always say he was fine and didn't need medicine. Plus they "destroyed" his creativity (?). So he'd throw them away.

OP, I also urge you to contact the Alliance for the Mentally Ill - they were invaluable when it came to helping my boss with resources for his son, as well as moral support, etc. (It was like AA for the mentally ill - he could call then any time of the day or night for help.) Best of luck to your family.
posted by Oriole Adams at 10:05 AM on July 23, 2011 [2 favorites]

I think the decision not to bail him out was right, though your family probably feels terrible. If he can't stay on his meds and control his behavior, he has to be some place where he can't harm anyone. Get him a lawyer who know mental health legal issues. If he's covered by insurance, maybe he can be committed to a good hospital.
posted by theora55 at 10:39 AM on July 23, 2011

I'm so sorry for what you're family is going through.

I'm also going to strongly encourage you to contact NAMI San Diego (linked to previously) and your (or your parents') local NAMI (find them at the NAMI National site). NAMI San Diego is one of the best in the nation, and they have specific info on their site about relatives with mental illness being in jail. They may not have someone answering on the weekend, but I'd advise calling now and leaving a message, then calling again Monday a.m. if you haven't heard back.

I work at a NAMI affiliate. The people who work for NAMI are there because they want to help other people who have family members with mental illnesses. I know that we get lots of calls from people with situations similar to yours and we are able to help them with resource information.
posted by la petite marie at 10:48 AM on July 23, 2011 [1 favorite]

Agreeing with everyone on NAMI. If your brother is to ever move back in, it needs to be on the contingency that he is taking his meds, daily, while someone watches. Is there hope? There's always hope, but I cannot imagine the pain your family is enduring. I'm so sorry.
posted by namesarehard at 10:53 AM on July 23, 2011

Contact his attorney (likely the SD Public Defender - (619) 338-4700 - I know many of them and most are excellent), the others are more than competent up to good) and inform them of his mental health issues, particularly if you believe his mental health will keep him from really understanding what's happening in court or if he won't be able to help his attorney. They may need to consider declaring a doubt about his competence to stand trial (or make plea agreements) under California Penal Code 1368 (actually sections 1367-1370 but we call it "1368" generally). For the record, I'm not your lawyer, his lawyer, or offering/able to be. This is general information, not legal advise.

Certainly not a doctor, but it's common for schizophrenia symptoms to start or increase in the early 20's. That's something any mental health professional will be aware of and consider when evaluating your brother.

His attorney may also want to consider Mental Health Court, though I'm not familiar with San Diego's program it's often a good option in lieu of a substantial jail sentence (which would be unlikely if this is his first criminal charge as an adult). I'd guess they'll offer to reduce it to a misdemeanor, give him credit time served in the jail (i.e., no more jail if he takes the plea agreement), 3 years formal probation with standard terms like search and seizure plus a requirement that he stay on meds and stay away from the person who owned the car.

However, many with mental health issues struggle with formal probation's restrictive terms. It's a very complex and individualized decision that he may not be in a great position to make.

San Diego County likely has a mental health division within the Health And Human Serviced department, they may be a valuable resource.

NAMI is a great place to start. I disagree with some of the other posts re: ultimatums or lines in the sand, but agree that a plan that gets him on meds and in contact with doctors / professionals is the best path. It's not an easy path. Take care of your family mefite.
posted by unclezeb at 9:24 PM on July 23, 2011 [1 favorite]

Family history says that as soon as he's allowed back into the house, he becomes non-compliant with the meds. Ergo, he needs to not be allowed back into the house. If you can find and access it, a half-way release house, supervised communal house, assisted living, etc seems more suitable.
posted by DarlingBri at 3:39 PM on July 24, 2011 [1 favorite]

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