We're worried about a friend who's having a mental health crisis.
July 10, 2013 10:09 PM Subscribe
A friend of mine, "X," has recently started to display worrying mental health symptoms. I'm a recent friend of his, and I've been discussing the situation with "F," who has known him much longer. F has also been in contact with X's grandfather, who is his most stable source of familial support.
What is our best move, as friends, to get him help? Details below.
X a 19-year-old male, who's always been the level-headed one in this circle of friends. Within the last week, he's been showing several worrying symptoms that have concerned his friends and family (mostly his grandfather, who has been having recent health issues).
He's talking constantly about nonsense philosophy-- things that just don't make sense and don't parse as meaningful ideas, as though he were on LSD. He's emotionally volatile, loud, and has gone on a few crying jags. He also has developed a tendency to lash out at people who disagree with his notions, though he recognizes that he's doing it and apologizes afterwards.
At first, we thought it was sleep deprivation, then possibly psychedelic drugs, but it's been going on for 4-5 days and hasn't relented. He is a regular marijuana user and has done psychedelics before with mixed results.
He has health insurance, and his family has a relationship with a trusted mental health professional. My friend F is planning on taking him to see that professional tomorrow, an idea that X is okay with, though he insists that he's talking perfect sense.
What steps should we be taking here, beyond setting up an appointment and driving him there? Beyond that, what strategies are valuable for a group of young adults dealing with a mental health crisis within our group? What responsibilities is it reasonable for his close friends to take on?
X a 19-year-old male, who's always been the level-headed one in this circle of friends. Within the last week, he's been showing several worrying symptoms that have concerned his friends and family (mostly his grandfather, who has been having recent health issues).
He's talking constantly about nonsense philosophy-- things that just don't make sense and don't parse as meaningful ideas, as though he were on LSD. He's emotionally volatile, loud, and has gone on a few crying jags. He also has developed a tendency to lash out at people who disagree with his notions, though he recognizes that he's doing it and apologizes afterwards.
At first, we thought it was sleep deprivation, then possibly psychedelic drugs, but it's been going on for 4-5 days and hasn't relented. He is a regular marijuana user and has done psychedelics before with mixed results.
He has health insurance, and his family has a relationship with a trusted mental health professional. My friend F is planning on taking him to see that professional tomorrow, an idea that X is okay with, though he insists that he's talking perfect sense.
What steps should we be taking here, beyond setting up an appointment and driving him there? Beyond that, what strategies are valuable for a group of young adults dealing with a mental health crisis within our group? What responsibilities is it reasonable for his close friends to take on?
And not to worry you, or get ahead of any actual evaluation by a medical professional, but X is exactly in the age range when schizophrenia can start presenting in men. Which is why, given the symptoms you list, it's imperative he gets to a psychiatrist for an evaluation.
posted by jaguar at 10:41 PM on July 10, 2013 [10 favorites]
posted by jaguar at 10:41 PM on July 10, 2013 [10 favorites]
It might be useful for someone other than X to communicate to the mental health professional (in advance of the appointment) what you have observed about his recent behavior and his drug usage, both because X might not be the most reliable narrator about what's been happening to him, and because even people who are quite disturbed can sometimes fake being pretty normal for a while. This would be especially helpful if the professional does not have previous experience with X, and thus does not know what a drastic change his current behavior is from his usual self.
This could happen through someone leaving a voicemail message for the professional, or dropping off a note with the office staff. They may not be able to respond in any way (including to confirm that X is a patient with an appointment) due to privacy rules, but the more information the mental health professional has, the better he or she can do his/her job.
posted by unsub at 11:12 PM on July 10, 2013 [3 favorites]
This could happen through someone leaving a voicemail message for the professional, or dropping off a note with the office staff. They may not be able to respond in any way (including to confirm that X is a patient with an appointment) due to privacy rules, but the more information the mental health professional has, the better he or she can do his/her job.
posted by unsub at 11:12 PM on July 10, 2013 [3 favorites]
If push comes to shove you can always call the cops and ask them to enforce a Baker Act, 72 hour commitment so he can be professionally evaluated. (Baker Act is specific to Florida, but most states will have something like this.)
You would do this if you were alone with him, and he started acting in such a way that you believe him to be a danger to himself or others. What you describe sounds like a textbook use of this.
The best way to do this is to have him go from his 'trusted mental health professional' directly to the hospital for a hold and evaluation. I'd be very surprised if this DIDN'T happen.
But yes, if you want, write out something that your friend can give the mental health professional, outlining the behavior you've witnessed.
posted by Ruthless Bunny at 6:19 AM on July 11, 2013
You would do this if you were alone with him, and he started acting in such a way that you believe him to be a danger to himself or others. What you describe sounds like a textbook use of this.
The best way to do this is to have him go from his 'trusted mental health professional' directly to the hospital for a hold and evaluation. I'd be very surprised if this DIDN'T happen.
But yes, if you want, write out something that your friend can give the mental health professional, outlining the behavior you've witnessed.
posted by Ruthless Bunny at 6:19 AM on July 11, 2013
"Danger to self or others" is usually much more concrete than what the OP has posted here -- in most states, it's going to be active suicidality or direct, immediate threats against an identifiable person -- and the other condition that could qualify for a temporary psych hold would be something along the lines of "gravely disabled," which tends to be more like "hallucinating homeless person walking in traffic." I'm in a state that has fairly strict laws to protect the freedom of people with psychiatric disorders, so other states may be more liberal in how they're defining what constitutes a psychiatric crisis (which means, OP, it might be helpful to Google "involuntary temporary psych hold" and your state's names to get the relevant laws).
Anyway, all that is to say that you or a therapist might not be able to have him involuntarily committed. Most people, though, can voluntarily walk into an ER or emergency psychiatric clinic and ask for help. I'd therefore try to take advantage of your friend's willingness to talk to professionals right now and get him in to see a psychiatrist ASAP; your friend could easily change his mind and be against the idea, and then he and you would have a much harder time getting anything accomplished.
posted by jaguar at 11:56 AM on July 11, 2013
Anyway, all that is to say that you or a therapist might not be able to have him involuntarily committed. Most people, though, can voluntarily walk into an ER or emergency psychiatric clinic and ask for help. I'd therefore try to take advantage of your friend's willingness to talk to professionals right now and get him in to see a psychiatrist ASAP; your friend could easily change his mind and be against the idea, and then he and you would have a much harder time getting anything accomplished.
posted by jaguar at 11:56 AM on July 11, 2013
Response by poster: Funny you should say that, jaguar: X's grandfather made an appointment with their guy (who is, in fact, a psychiatrist) for this afternoon, but X swore at him and left.
We obviously can't make him do anything (and I will not be calling the police on any friend of mine under any but the very most dire of circumstances).
What's the next move? X is out somewhere (driving, presumably), and he claims to have found the path to enlightenment. Should we be looking into the best emergency mental health facility nearby and trying to get him there? Would it be better to try to make and keep an appointment somewhere?
As far as I know, F is the only person who's got a car, is free today, and can probably get X somewhere if he puts in the effort.
BTW, we're in Virginia.
posted by 4th number at 12:29 PM on July 11, 2013
We obviously can't make him do anything (and I will not be calling the police on any friend of mine under any but the very most dire of circumstances).
What's the next move? X is out somewhere (driving, presumably), and he claims to have found the path to enlightenment. Should we be looking into the best emergency mental health facility nearby and trying to get him there? Would it be better to try to make and keep an appointment somewhere?
As far as I know, F is the only person who's got a car, is free today, and can probably get X somewhere if he puts in the effort.
BTW, we're in Virginia.
posted by 4th number at 12:29 PM on July 11, 2013
Should we be looking into the best emergency mental health facility nearby and trying to get him there? Would it be better to try to make and keep an appointment somewhere?
Those are both completely reasonable things to do for a person exhibiting the symptoms your friend is exhibiting. Going to a plain old emergency room is also completely reasonable (they'll likely have a psychiatrist on call). The thing that friends in that situation should do is whatever the the ailing person will agree to.
I don't mean to be flip, I just mean that in situations like this, don't let the perfect be the enemy of the good. Someone who seems to be hallucinating and/or experiencing a manic episode (and/or on psychedelic drugs) should be seen by a health professional as soon as possible. Whatever way one can get such a person in to a health professional is the right thing to do.
posted by jaguar at 1:56 PM on July 11, 2013
Those are both completely reasonable things to do for a person exhibiting the symptoms your friend is exhibiting. Going to a plain old emergency room is also completely reasonable (they'll likely have a psychiatrist on call). The thing that friends in that situation should do is whatever the the ailing person will agree to.
I don't mean to be flip, I just mean that in situations like this, don't let the perfect be the enemy of the good. Someone who seems to be hallucinating and/or experiencing a manic episode (and/or on psychedelic drugs) should be seen by a health professional as soon as possible. Whatever way one can get such a person in to a health professional is the right thing to do.
posted by jaguar at 1:56 PM on July 11, 2013
Virginia's got kind of a crappy website, but you can find contact information for the state's publicly-funded mental health centers here.
Given that he has insurance, however, my inclination would be emergency room or private psychiatrist. Publicly-funded mental health is often ... lacking.
posted by jaguar at 2:03 PM on July 11, 2013
Given that he has insurance, however, my inclination would be emergency room or private psychiatrist. Publicly-funded mental health is often ... lacking.
posted by jaguar at 2:03 PM on July 11, 2013
Wait, did your friend swear at his grandfather, or at the psychiatrist? If he swore at and stormed out from the psychiatrist, then I would consider that hospitals are slightly better equipped with security and procedures that might make it more cumbersome (though not impossible) for a difficult patient to just leave, whereas normal offices and clinics are not, and so a difficult and reluctant patient might be better served in an emergency room of a hospital.
posted by jaguar at 2:31 PM on July 11, 2013
posted by jaguar at 2:31 PM on July 11, 2013
Also keep in mind that it's possible your friend will crash in a couple of days, and so even if he's refusing treatment now, he may change his mind (again).
Please don't think that you and your friends are failing if you can't get him help today, or tomorrow, or even if you can't get him help ever; there is only so much you can do to help another adult, and it sounds like you've done everything you can (talking to him about getting help, getting his family involved, reaching out for referrals and suggestions, keeping an eye on him) for now.
A helpful resource for you might be NAMI Virginia. I don't always agree with the theory-side of their organization, but they tend to be really knowledgeable about local resources both for people with mental illnesses and for their friends and family.
posted by jaguar at 2:38 PM on July 11, 2013
Please don't think that you and your friends are failing if you can't get him help today, or tomorrow, or even if you can't get him help ever; there is only so much you can do to help another adult, and it sounds like you've done everything you can (talking to him about getting help, getting his family involved, reaching out for referrals and suggestions, keeping an eye on him) for now.
A helpful resource for you might be NAMI Virginia. I don't always agree with the theory-side of their organization, but they tend to be really knowledgeable about local resources both for people with mental illnesses and for their friends and family.
posted by jaguar at 2:38 PM on July 11, 2013
This thread is closed to new comments.
If the "trusted mental health professional" is not a psychiatrist, then the support system can research psychiatrists on X's insurance. If X is open to talking to health professionals, then I hope that someone can get him into a psychiatrist's office.
A psychiatrist is the only one who can both reasonably diagnose this situation (that is, separate out drug effects from mental health issues) as well as prescribe any needed medication. Someone who may be hallucinating needs a psychiatrist, not just a therapist. (And any ethical non-psychiatrist therapist will immediately refer someone who is possibly hallucinating to a psychiatrist.)
I realize that the "trusted mental health professional" may be a psychiatrist. If so, y'all have probably done all you can do right now. If not, however, you can certainly help set that up as a next (ASAP) step.
posted by jaguar at 10:32 PM on July 10, 2013 [3 favorites]