HELP! Sister in NYC needs psychiatric treatment but doesn't want it.
May 27, 2014 7:25 PM   Subscribe

My sister is frightening the people who love her by expressing suicidal urges. She isn't sleeping or eating, and even coworkers are worried.

Sister is in her early 30s, living with a roommate in NYC. She's currently seeing a therapist for general counseling, but that hasn't seemed to do much. Here's what's been most alarming in the past few weeks:

- Expresses a wish to die
- Says she has nothing to live for
- Barely eats, and throws up when she does
- Drinks excessively
- Unable to sleep
- Is not receptive to comfort or advice
- Talking about her emotional state worsens her unhappiness
- Doesn't recognize that her behavior scares others

She's had episodes like this many times over the course of her life, and they seem to be getting worse in length and intensity. I and the others who love her are terrified and exhausted. Nothing we say seems to help, and each successive emotional breakdown seems more extreme. One of her friends texted me in a panic because Sister said she wanted to dive under a bus.

As far as I know, she hasn't actually threatened suicide; she's only talked about the desire to do it. All the same, none of us non-professionals are equipped to help her anymore than we've already tried and failed to do. Suggestions to see a psychiatrist are brushed aside out of fear that the doctor might prescribe medication that causes weight gain.

Is there anything at all I can do to encourage/force her to seek treatment? I might not have described the issue well, but this is absolutely NOT just a "bad day" for her. I'm beyond sure that her behavior is not that of someone who's mentally sound, and that she'll never achieve mental soundness on her own. Her history bears this out.
posted by Sullenbode to Health & Fitness (19 answers total) 4 users marked this as a favorite
Can you go and be with her?

If at all possible, I think I'd take a few days to go and see her. Tell her how worried you are. Heck, show her this question, even. If there is someone there to physically make the phone calls for appointments, etc., she might be more amenable to getting help.

Having someone show up and be there for her might make the difference.
posted by Salamander at 7:41 PM on May 27, 2014 [2 favorites]

Can you contact her therapist and relate the things you have heard her say or do personally?
posted by saucysault at 8:01 PM on May 27, 2014 [3 favorites]

Do you know the therapist's name, or will your sister tell you? The therapist can't legally give you any information without a release, but you could certainly contact the therapist and tell them your concerns and what you've seen.

Since she's already seeing the therapist, who is a professional who can help assess for suicide risk, I think leveraging that is your best bet. (This is assuming the therapist is a licensed mental health professional and not a life coach or something.)
posted by jaguar at 8:01 PM on May 27, 2014 [4 favorites]

Do you know your sister's therapist name? You could try calling and telling her this. She won't be able to talk to you about your sister, but she can listen and this is probably helpful info for her to have in treating your sister.
posted by matildatakesovertheworld at 8:02 PM on May 27, 2014 [1 favorite]

Does your sister have a GP? It might be easier for her to go visit them to get a physical workup done on these issues, rather than jumping immediately to the Psychiatrist. There may be an organic cause to part of this that could be treated, and/or they can refer her to other doctors - including Psychiatrists.
posted by spinifex23 at 8:13 PM on May 27, 2014 [1 favorite]

Do you know your sister's therapist name? You could try calling and telling her this. She won't be able to talk to you about your sister, but she can listen and this is probably helpful info for her to have in treating your sister.

Yes, definitely do this. Agreed with everyone that the therapist won't be able to tell you anything specific about your sister, but it will make you feel better and more equipped to handle the situation.
posted by sweetkid at 8:19 PM on May 27, 2014 [1 favorite]

One of her friends texted me in a panic because Sister said she wanted to dive under a bus...
As far as I know, she hasn't actually threatened suicide; she's only talked about the desire to do it.

To me, when you tell a friend you want to dive under a bus, that's a threat of suicide - it seems like an awfully fine line. If a friend or family member did this to me, I would call EMS and get them taken in for a mandatory psychiatric evaluation in the emergency department. I don't know that this is the right thing to do, but I do know that many people who make suicide attempts don't give their loved ones much if any warning when they put a plan for suicide into action. I feel like repeated discussion of plans for suicide (even if it isn't something she says she's walking out the door to do right now) seems deserving of an emergent evaluation by a professional. I can certainly understand arguments against doing this, though, and I think a careful look at the nuances/context of the situation, knowing what you know about who she is and her past similar behaviors and statements, is needed prior to taking such action. Talking to her therapist and asking them at what point they feel it would be justified to make such a move might also be useful (depending on the therapist) - although they can't share details about her treatment with them, I don't see why they couldn't discuss a hypothetical like this with you.
posted by treehorn+bunny at 8:51 PM on May 27, 2014 [9 favorites]

Would your sister allow you to go with her to an appointment with a GP for a full workup--as spinifex23 suggests--of possible vitamin/mineral deficiencies (which could be a real thing if she's not eating, and can definitely cause neuropsychiatric anxiety/depression), thyroid, anemia, and sleep evaluation? You could call ahead (again, realizing that this will be a one-sided conversation, as with her therapist) to let them know she's gun shy about being referred in the first few minutes to a psychiatrist--and you can ask the doctor to talk to her about the fact that there are in fact many medications now that do not necessarily cause weight gain, if that's an appropriate part of a treatment plan.
posted by blue suede stockings at 8:52 PM on May 27, 2014 [2 favorites]

There is a book titled I Am Not Sick, I Don't Need Help! How to Help Someone with Mental Illness Accept Treatment. that was recommended in another askmefi post. I haven't read it but it might be useful in a longer term way.
posted by metahawk at 9:00 PM on May 27, 2014 [3 favorites]

To me, when you tell a friend you want to dive under a bus, that's a threat of suicide - it seems like an awfully fine line. If a friend or family member did this to me, I would call EMS and get them taken in for a mandatory psychiatric evaluation in the emergency department.

Agreed. This is a lot to put on you and her friends - and I only say that because you're not equipped for it and will only do things like panic and text each other, which isn't helping you and her at all.

Also for the people concerned about vitamin deficiencies, the ER will check basic vitals as well as part of their psych evaluation.

Based on my suicide hotline training if she calls a friend and threatens to throw herself under a bus, that's an action plan plus means which is serious and beyond ideation and merits a 911 call.
posted by sweetkid at 9:04 PM on May 27, 2014 [1 favorite]

From an anonymous Mefite:
I'm not qualified to diagnose anyone with anything, but it certainly sounds to me as if your sister is having an acute episode in a chronic mental illness. My mother had that sort of illness, and without bogging down in nightmare details, I'd like to sketch out a few points.

Although I fully endorse getting an emergency mental health evaluation for your sister when and if she expresses suicidal ideation again, please be aware that the potential involvement of the police can have unexpected and counterproductive effects, and you need to be prepared for some potential complications (e.g. if she resists transportation, she may be restrained in handcuffs or more; if she's perceived as violent, there may be physical countermeasures taken and she may face legal consequences as well.)

After the acute crisis resolves, your sister will need your family's advocacy to address her chronic condition. I understand completely that she isn't cooperating with you in getting care - my mom sure didn't, either - but when you talk to the counselor you can at least express the idea that you are concerned about her well-being in both the short and long term, and that you are very concerned that her illness is interfering with her insight regarding her own mental state and capabilities. She needs ongoing case management. You may or may not be able to get it for her, but it almost certainly won't happen without a sustained effort after this episode has passed.

The challenge of helping is that people who having in a mental health crisis don't generally have enough insight or capacity to manage themselves, but once they're out of crisis, they often minimize how bad it was. This is enormously frustrating and I don't have any answers, but sometimes it helps to know this is a problem a lot of other people have faced.

It's incredibly hard to watch someone who's so ill doing all the things that make that illness worse, and to accept that there's only so much you can actually do without their cooperation. You might consider seeing a therapist yourself - doing something so hard takes a lot out of you, and it can be hard to know when you're falling into the abyss with that person.

Best wishes to you and your family.
posted by goodnewsfortheinsane at 10:22 PM on May 27, 2014 [6 favorites]

I am so sorry you are going through this. As someone who has helped a partner through periods of acute suicidality I know something about how hard this is and I have some advice to offer.

First and foremost. The pressure of feeling responsible for someone's life is unbearably immense. Consequences of doing the wrong thing are catastrophic. I learned, the hard way, that it is too much for any person to bear. Call a crisis line -- just search online and you can find one in your area. Tell them the situation and ask them what to do. I made a decision while feeling more resourced that if I ever felt unsure or overwhelmed I would seek outside support and give them the power to decide what I should do. And I would live with that, whatever happened, as putting that power in the hands of trained professionals is a sound reasonable choice. No second-guessing if it's the wrong choice, or it's not enough, or whatever. Take the pressure off of yourself to know what to do. Call someone.

Second. There is suicidal, and there is suicidal, and it is key to know the difference. You can ask "are you thinking about suicide"; "do you have a way of doing it in mind"; "do you intend to go through with it / do you have a time planned for doing it". The more yes's, the more serious. A yes to the third question means take her to a hospital and don't let her out of your sight. Also, I came to recognize that there is a kind of catatonia and emotional blankness that comes from severely elevated risk. I've also read that if there is a sudden shift to a calm peaceful state that can mean they have resolved to go through with it, so watch out for that.

Third. There may be a prolonged period of depression and suicidal ideation, but an acute suicide risk usually, in my experience, comes and goes within a few hours. If in a crisis state, focus on getting through it. I sometimes take my partner for a drive. A crisis is not the time to negotiate plans of future therapy or try to solve underlying issues; logic is twisted in this state and trying to communicate will make you crazy. Just stand your ground, anchor yourself firmly while the whirlwind blows around you, and when it calms you can reach out to her again. If it is too much or you are not sure it will be okay, call for help, crisis line or 911, or take her to a hospital.

Fourth. The chronic cycle of suicidality can really wear you down. Exhausted doesn't begin to describe it. Nor does terrified. But I feel you. It is very important that you resource yourself as much as you can. A loved one's suicidal crisis is a secondary trauma that you are the repeated victim of. You deserve all the help and support that's available. Again, call a crisis line, and I strongly recommend seeing a counselor yourself, if you're not already. You can drop everything and go see her to help her through a crisis, but you can't do that every day. A counselor can help you balance your own needs against the seemingly infinite problems your sister is going through so that you remain capable of helping her without suffering a breakdown yourself. It is critically important that you remain resourced. The best way to help your sister is to help yourself. Secure your own oxygen mask first. So think about your own long-term support systems. This goes for her other loved ones as well.

Fifth. Perhaps it helps to know the mechanics of suicidality. It's often been described to me that suicide is something that happens when pain and pressure exceeds coping resources. But my partner described it vividly as a game of tetris. Life throws things at you, you organize the blocks and make lines, things are okay. Life gets hard and frantic, blocks come faster, you struggle, maybe lines start to pile up. Most of us have been there. Most of us have plenty of room to handle blocks. But everyone has a limit, and when the blocks get to the top -- you can't go on. You can't keep juggling blocks, even though they keep crashing into you. In my partner's case, self-injuring was like a relief valve, which would clear away some lines from the board. Coping mechanisms like drugs and alcohol can also clear away some lines as well. Mentally overtaxed people use them like power-ups. But they're long-term maladaptive; they clear away the board, but they add an extra line at the bottom. It's also important to note that not everyone plays with the same board. My partner, who is a victim of rape and abuse and lots of other nasty things, plays life on 'hard mode'; she starts with a board that's 80% full of lines. Through long-term therapy and a lot of hard work she's removed a lot of the lines. But it's not easy. In any case, the way to help your sister is to help her with her tetris board. Be a source of support for her. Having a space space to talk about your problems clears lines away; so does exercise, healthy diet, friendships and love. You can also deflect some of the blocks that are coming her way. Maybe she can take a leave of absence from work to focus on her health for a while.

I guess my overall message is that you need to detach your own actions and emotions from the terror of suicide, difficult as it may be, and recognize it as an automatic emotional process that cannot easily be controlled. At the root it's caused by an overwhelming of coping mechanisms. Functioning at this level can be difficult. When overwhelmed, one can be incapable of the effort required to, say, go to a doctor. Health systems can be very dehumanizing which throws more tetris blocks at you. Even contemplating it requires having some space on the board which may not be there. So you need to adjust your expectations. People with chronic debilitating illnesses also deal with similar issues in not being resourced enough to go to the doctor by themselves; it's easier to conceptualize if we think of it in terms of physical energy. Someone can be too weak to walk. Well, someone whose mental systems are so worn out and fatigued from battling can be too weak to walk too.

But with that said, there are things you can do. You don't have to accept her reality that it is impossible that she gets help. She doesn't have the capacity to get help for herself (the weight gain thing about the doctor is a deflection strategy, undoubtedly), but you can drag her to a doctor yourself. She can object and you are free to ignore it. This is what I mean by staying grounded; you don't have to let her lack of capacity stop you from acting. And again, keep the pressure off yourself; call for help and let professionals dictate your actions, and then act confidently in carrying them out.

Best wishes. I'll be thinking of you. Things can get better.
posted by anybodys at 10:23 PM on May 27, 2014 [33 favorites]

Our family went through something similar with a sibling. Our Mother had always been their anchor in life and when she died they fell apart over the course of a year. A therapist was found and they went but it was clear that things were just going downhill. Eventually a crises occurred and we reached out to the therapist who I feel saved their life. She called for a Mental Health Safety Check (I didn't know anything about this kind of thing). A psychiatric social worker and the police went and evaluated them and they were hospitalized that night.

We as family members were really powerless to get them help. We needed the system, that we were really unaware of, to intercede and help them. It worked out very well for my family member. They were hospitalized for a total of 4 months in a hospital that we didn't even know existed where they were given excellent care. This all happened to an uninsured person.

With the right help, good medication, ongoing therapy and a supportive living environment our family member has done well.

I really, really hope that something comes together for your sister. We all thought our sibling was going to die and that we were powerless to stop it from happening. Somehow it all worked out. I will keep you and your sister in my thoughts. Take care.
posted by cairnoflore at 11:03 PM on May 27, 2014 [2 favorites]

If you don't have your sister's therapist's contact info, another option:

Lifenet: "LIFENET assists people who are experiencing a crisis. LIFENET has authorized linkages with the 23 mobile crisis teams and Emergency Medical Services (EMS). This unique, life-saving authority allows LIFENET to provide a prompt response to callers in urgent need of psychiatric assistance.... You can call for yourself or someone you know. We need to know only the age, neighborhood and the type of problem. Your needs are then matched with the proper mental health, substance use, or crisis service professional qualified to address your problem."

From what I can tell (as someone who works in public mental health but not in New York), that number is the entry point for the city's public mental health programs, and so is likely your best bet for crisis intervention or assessment.
posted by jaguar at 11:19 PM on May 27, 2014 [1 favorite]

The previous poster mentioning caution about involving the police is right. However, suicide threats have to be taken seriously. Your sister's life is potentially at risk.

Where in NYC and how close to NYC are you? I have had great luck in the past with calling the non-emergency police number for the NYC precinct where my brother lives. (Precinct map / precinct numbers) They were very understanding and have done numerous wellness checks on him, since no family lives nearby and when he's that ill he has alienated his remaining friends who might help. I fully understand the drawbacks of using the police to assess the mental health of citizens, but sometimes it's your best option.

Having said this, I would first call the therapist to inform him/her of all the things you've heard your sister say.
posted by ImproviseOrDie at 6:20 AM on May 28, 2014 [1 favorite]

Thank you all so much. Sister won't give me her therapist's information -- her friends suspect that she's actually stopped going. I'm going to call the Lifenet hotline and take their advice about what to do. Also, my parents will go up to NY in a week and a half, so hopefully they'll be able to take her to at least one appointment.

To those of you who shared your own stories: it helps a lot to hear how you've handled similar situations, and to know that what I'm feeling is normal. Definitely going to see a counselor soon myself.
posted by Sullenbode at 7:52 AM on May 28, 2014 [1 favorite]

Thinking of you still. More things to offer:

I mentioned a bit how communicating with someone in a crisis will make you crazy. What I mean by this is that you will be unable to make them budge an inch on the idea that their life is worth living or that there is hope for the future. Nothing you say can make them change their mind; there is some twisted logic going on which is like a steel trap. Everything I tried, appealing to how things were getting better and such, was swiftly refuted. Even begging her to stay because I loved her failed ("you'd be better off without me"). However, the solution to this, staying grounded, means being anchored in my own reality. You cannot convince your sister that her life is worth living. However, you can believe yourself that her life is worth living -- and you can refuse to budge an inch on that. This is what I meant by staying anchored and grounded in yourself. You can tell her this. I believe you have value and that your life matters, and nothing you do or say will ever affect this. This can be something of a mantra. I can't change you or the way you think, but I have my own conception of you as a person who deserves love and who is not beyond hope and my conception has a right to exist too. In better times, she sees herself this way as well, and when the crisis begins to lift, she can look towards me to help lift her out of it.

Something else. When someone talks about suicide, we (very appropriately) get alarmed and want to call in the psychiatrists and such. It's a symptom of a broken mind. However, I gradually learned to see things from her perspective when she is in a crisis, and I came to understand her point of view and even agree with it. As in, her life has been really terrible and she has been hurt very deeply and feels unbearable pain, and in the moment it is impossible to feel any reason for optimism and hope, and instead it feels like all she can expect is a lifetime of pain. If these feelings were true (and they feel true for her, in the moment), then suicide is actually a rational plan. Any of us would think about it if we were in that state. Again, think of a terminal cancer patient whose daily existence is incredibly painful. If all you had to look forward to was endless pain, you would look for a way out.

Thus it's important to think about suicide not as the problem, but a symptom. You can't fix her by making her not want to kill herself. You have to fix her by helping her see the optimism and hope, and help her find a conception of her life that it not all pain. What's broken is that negative feelings and maladaptive mental patterns have severed the link between herself and hope.

Also this means that if she does decide to go (i.e. permanently), it can be okay, and you can forgive yourself if it happens. I struggled with this a lot. But I came to realize that maybe I didn't know what it was like in her head, and that maybe I would get tired of life too if that was me, and that I would therefore be able to find some peace with the idea of her leaving. If it happens, I'll be devastated beyond words, but I'll be able to see her as someone who found peace after a long struggle. It won't be about me and how I failed her. I don't think this is likely for me at this point, but I don't know. Life can throw giant tetris blocks at anyone, at any time. It's important to take the pressure off myself, and realize that maybe I can't guarantee that I can save her, and it's okay if all I do is the best I can.

I think what your sister probably needs is more comfort and connection on the human scale and long-term treatment to begin unraveling the mental patterns she is stuck in. It is important, I think, that you validate her struggle and empathize with her. 'You shouldn't kill yourself' will kind of bounce off. It's totally irrelevant. "I can tell this is really hard for you. But I believe you will feel better and there is hope for you." That's better. But what is it that's really hard? What's at the root of this? She needs people to talk to that will listen in a safe non-judgmental way without trying to fix her. Medication and institutionalization can be scary because they might just steamroll everything and blunt the emotions which is dehumanizing, so fixating on institutional help as the solution might just make her feel unseen. You should engage institutional help, of course, but don't pretend it will 'fix' everything, and don't make it seem like what you want for her is to be fixed. She needs you to care so she is not alone in her struggle, even when she's fighting against you and actively pushing you away. (No-one said it would be easy.)
posted by anybodys at 8:19 AM on May 28, 2014 [3 favorites]

I would definitely call Lifenet or other psychiatric emergency services before the police -- the psych emergency people might need to get the police involved (if your sister needs to be transported to an involuntary psychiatric hospitalization, for instance), but at least in that case there are also mental health professionals present and aware of the situation and able to advise the police about what's going on, which I think makes for better outcomes. At the very least, it can relax the responding officers because they know that there is a plan in place for the person they're picking up and that they don't really have to do any assessing, just transporting.
posted by jaguar at 8:26 AM on May 28, 2014 [1 favorite]

Is there anything at all I can do to encourage/force her to seek treatment?

The book The Noonday Demon: An Atlas of Depression was really instrumental in convincing me to get help. There is a part early in the book where the author explains that when these episodes happen, they alter the brain making it more likely that these episodes will recur in the future. That was enough to scare me into seeing a therapist and then a psychiatrist.

It's a lovely book that performs an insightful and deeply sympathetic exploration of depression and describes the author's own experience with the illness. I would give her that book. It might help her to really recognize what she is going through.
posted by kitcat at 11:10 AM on May 28, 2014

« Older Help Me Hack a Timeshare   |   What should a children's book author's website... Newer »
This thread is closed to new comments.