Manic episode with delusions - what are treatment programs?

June 27, 2015 6:40 AM

Friend is having a manic episode with pretty strong delusions. Doc is treating her as an outpatient (she is not threatening suicide or to kill anyone), so she's still "on her own" in between doc visits, which is leading to some undesirable outcomes to say the least. A question on treatment: is there anything like a "halfway house" for those with mental illness where they can cool down from these episodes in a safe place? She doesn't need a hospital bed or a padded room, but does need someone looking after her so she makes the right choices.

As an example of bad outcomes: She's vandalized the inside and outside of her apartment as an "art project", and now they've started eviction proceedings. Massive shopping trips on a credit card (she's already dead broke). Uprooting someone's garden in a "gardening project." Threatening her neighbor who has started to get a restraining order (she's having really strong paranoid delusions).

Seems like there should be a better way to handle this other than just giving her drugs and hoping for the best?

posted by mtstover to Health & Fitness (18 answers total)

This sounds pretty serious. Is there something like a mobile crisis team in your area? If so, call them and ask about them coming out to evaluate your friend. They're the ones who will make the judgment call.
posted by Marie Mon Dieu at 6:55 AM on June 27, 2015 [8 favorites]

Depends on the city. Where I am, there are a few crisis housing options. None of them offer medication management, but they can provide safety and structure if she qualifies. When I've used them in the past, I've gone through the county mental health center. I'd suggest looking for something like that or trying a local crisis line. I have no idea if they'll say her symptoms are too severe or not.
posted by mermaidcafe at 7:17 AM on June 27, 2015

Part of the problem here is viewing hospitalization as "a hospital bed or a padded room". There are many inpatient programs designed for exactly this type of situation, they may also be connected to an intensive outpatient program at discharge. Check with your local psychiatric hospitals and discuss options. Her behaviors are suggesting inpatient treatment, especially if she lives alone.
posted by HuronBob at 7:31 AM on June 27, 2015 [18 favorites]

It sounds like she is going to end up in jail, and that she is a danger to herself and others, so it does sound like inpatient treatment, at least on a temporary basis, is appropriate. The NAMI Helpline may be able to offer you support and ideas for how to protect your friend from further harm.

A competent local mental health professional should be able to explain the fastest way to help your friend get into the treatment she needs to stay safe. While it sounds like your friend will need a lot of legal help to deal with the debt and other legal fallout from her severe disability, the priority appears to be getting her safe and stable.

The "cool down" may start with a 72-hour hold in an inpatient facility, although this may vary by location. A lawyer in your jurisdiction can explain how the civil commitment process works, but hopefully your friend can find appropriate treatment before that becomes necessary.

MeFi Wiki Homeless Survival Guide - includes mental health treatment locators.

MeFi Wiki Get a lawyer - information about finding a lawyer and free and low-cost legal resources.
posted by Little Dawn at 7:38 AM on June 27, 2015 [5 favorites]

Seconding what HuronBob said about psychiatric hospitals. Does her doc know how bad her behavior has been? There's nothing stopping you from calling the psychiatrist's office and letting them know. Around here her behavior would absolutely justify hospital admission.
posted by arrmatie at 7:39 AM on June 27, 2015 [2 favorites]

Concurring that hospitalization is exactly what is called for in this situation. There are is a spectrum available and they can be wonderfully supportive environment be with nary a hospital bed or padded room in sight. If you have their number, call her therapist to let them know the true extent of the dysfunction. A challenge with treating someone suffering from delusional thinking is that the self-reporting the therapist relies on may not be accurate.
posted by saucysault at 7:40 AM on June 27, 2015 [2 favorites]

Saucysault has a good point about the self-reporting, another issue is relying on someone in this condition to take their meds as directed. Probably not going to happen
posted by rudd135 at 7:53 AM on June 27, 2015

Response by poster: To be clear, I have been on phone with her psychiatrist and detailed these behaviors. He is IS NOT recommending any psychiatric hospitalization or any of these options to her, only telling her "she should not be alone." And then he told me that "if she gets really out of control take her to an emergency room."

Seems absolutely ridiculous. Would have thought there would be a better escalation plan?
posted by mtstover at 8:25 AM on June 27, 2015 [1 favorite]

The eviction proceedings may help your case to get her put on an involuntary hold, if she's refusing to go to the hospital. Not having housing due to one's mental health symptoms is a big flag for being unable to care for oneself. Each state is different, but in California there are three categories for being placed on a hold -- danger to self (as you mention), danger to others (as you mention), and gravely disabled, which is the category most often used for people in the midst of manic and/or delusional episodes. "Gravely disabled" means that your mental health symptoms are interfering with your ability to provide shelter, food, and clothing for yourself, thus placing you in danger. I'm not sure if that category exists everywhere, though.

Many clients "present well" in front of their doctors, which can make it hard for doctors to realize the extent of what's going on. Assuming she lives in the US, I would Google her city (if she lives in a big city) or county (if she doesn't) name plus "mental health" and look for the .gov domains. There should be a crisis line that you can call for an assessment (I work in county-level mental health, and what you're describing qualifies as a crisis, though it may not be severe enough to warrant involuntary hospitalization), or they can help send out a mobile support team if that's available. They can likely talk you through the other local options, as well, and they should have familiarity with the most appropriate resources in her area.

(If she's willing to be hospitalized and you're local to her, you could also just bring her into an emergency room, ask for/insist on a psychiatric consult, and explain to the psych team what's going on.)
posted by jaguar at 8:27 AM on June 27, 2015 [5 favorites]

Response by poster: Also, part of the problem is I'm trying to do this from east coast, and she lives out in Berkeley, CA...
posted by mtstover at 8:27 AM on June 27, 2015

On non-preview: Emergency rooms really are the first-line response in these situations, mainly because most other programs are going to want to rule out any medical issues and so generally require an incoming client to get checked out at the ER first, anyway.
posted by jaguar at 8:29 AM on June 27, 2015 [3 favorites]

Mobile Crisis Team (MCT) for Berkeley Mental Health. Looks like you can leave a message at [phone], but it doesn't look like they're available until 11:30am Pacific. I would let them know she's at risk of being arrested (for the vandalism and destruction of property) and of being homeless.
posted by jaguar at 8:35 AM on June 27, 2015 [7 favorites]

telling her "she should not be alone."

Ya, passing the buck to (usually family) caregivers is rife in psychiatry. If he is expecting that these free caregivers will somehow emerge from the woodwork then he is also suffering from delusions. Please get her competent, inpatient help as soon as possible. You are a good friend for advocating for her.
posted by saucysault at 8:58 AM on June 27, 2015 [13 favorites]

There is a crisis stabilization house called Woodroe, run by BACS, in Hayward. She may qualify. She is unlikely to be hospitalized without being an imminent danger to self or others, unless she had really good private insurance. You can also Google "partial hospitalization programs" in the East Bay.
posted by latkes at 9:32 AM on June 27, 2015 [1 favorite]

Just the presence of other people can help deter crazy behavior. Can you look into adult daycare programs? Once she is homeless, look for day shelters. Look for ways to keep her constructively occupied, preferably in a group setting. Sometimes, this can even be done via internet. I used to stay online and just talk with a suicidal friend until they could sleep. I also kept in touch via email throughout the day and began blogging to try to get them more access to me.

Maybe try to get her to channel her artsy bent into a web project? Encourage her to blog anonymously about what is going on in her head?
posted by Michele in California at 10:07 AM on June 27, 2015

I happen to know mental health professionals in the Bay Area. They say the best and probably only recourse is to call the police for a wellbeing check. If she meets criteria for a 5150, which it sounds like she does, they will take her to a hospital where she will be evaluated by a psychiatrist who knows how to make these kind of decisions. The psychiatric ER docs may admit her or refer her to other appropriate programs. Once your relative is in a hospital program you can provide collateral information to the treators.
posted by reren at 12:11 PM on June 27, 2015 [5 favorites]

I do assessments and admissions for a psychiatric hospital. If she came to me I'd admit her in a heartbeat. Her doctor would have nothing to do with that decision unless he/she had admitting privileges at my hospital. See if you can get her assessed by a psych hospital (or the ER can do it as well). You can call Fremont Hospital and ask their admissions department the best way to get her assessed. DISCLAIMER: I work for a hospital in a different state that is owned by the same company that owns Fremont so I am familiar with the general process, but I do not work specifically for Fremont. However, in my work I get very similar questions. My advice would be to see if she can be assessed by an admissions team at a psych hospital (it's perfectly fine to call and find out if they take her insurance first) or if she's in the middle of an out of control moment and can't safely get herself anywhere she can utilize 911 or the police to get to an ER.

Hopefully she would be willing to sign herself in so that she wouldn't have to be court ordered, but that's also an option. MeMail me if you want to talk specifics privately.
posted by MultiFaceted at 9:04 PM on June 27, 2015 [8 favorites]

Also wanted to add that a psych hospital would know about any day treatment or partial hospitalization programs she could utilize if she absolutely didn't need inpatient. Additionally, a psych hospital or unit in a med/surg hospital is structured with a daily schedule of therapy groups...they don't lay in a bed all day like a patient does with pneumonia or medical issues. So don't let the "hospital" word throw you off. It's not the same.
posted by MultiFaceted at 9:07 PM on June 27, 2015 [2 favorites]