In Need of Resources for Relative with Bipolar I Disorder
December 11, 2015 3:12 PM Subscribe
A relative of mine is about to crash after a month-long manic episode. Our family has realized that a long-term care plan needs to manifest ASAP so our lives don't get torn apart every time said relative has an episode as bad as this. Can you recommend resources regarding rehab, disability insurance, and retirement (or lack thereof) for Bipolar I individuals in California?
Our main goal right now is to get power of attorney so we can get this person to the right resources when this happens again the future. Next we will probably have to help this relative a) file for bankruptcy and b) file for disability/unemployment because they've spent all their money, maxed all their credit, and lost their home and their job as a result of this super, super bad episode. We're vaguely up to date on how to do all that in the applicable state (California), and we're looking through NAMI as we can. Here's what we're struggling with:
1. Rehab: Relative's bipolar episodes are likely due to multiple concussions over their lifetime. When relative's mania and depression started to manifest, their foolish, foolish doctor decided to put relative on a rotation of all the possible bipolar treatments out there "to see what fits". This was a decade ago. Since then, relative repeatedly becomes miserable, goes off whichever meds they're on, and has manic episodes wherein terrible things happen. Then the cycle starts again, except this time things are really bad and we know relative will refuse to go back on the meds they've been on. We also have reason to believe that they've been experimenting with meth/cocaine/heroin in the past few weeks which is really screwing things up. Where in California/Los Angeles could/should we bring our beloved relative so they can get off the bad meds and onto the good ones with the help of more qualified doctors? Are such places really expensive? Do any take insurance offered through Covered California?
2. Work/Retirement: Prior to this episode, our relative had a stable job for over 20 years. That job is now irrevocably lost, but if/when relative can, relative will want to go back to some kind of job and won't be okay with just being on Long Term Disability. Relative also won't have any retirement or SS to speak of once they reach the limit of LTD. What happens then? What should happen until then? Can they work and still receive support from the state for their disability?
Any resources will be appreciated. We love and respect this relative and want them to retain as much agency as possible. We also want them to be well because who they are when they're manic depressive is frankly a terrifying person. They're physically imposing, verbally abusive, and dangerous as all get out. They're also old enough to be responsible for the things they've done and are continuing to do, so we've agreed as a family to not bail them out financially, though we will provide counsel where feasible and appropriate. (We're also all unable to provide financial assistance anymore so there's that, too.) God willing, they get through this without harming themselves or someone else. That above all else is our main hope and focus even though relative has barred us all from their life for the time being.
Thank you so much.
Our main goal right now is to get power of attorney so we can get this person to the right resources when this happens again the future. Next we will probably have to help this relative a) file for bankruptcy and b) file for disability/unemployment because they've spent all their money, maxed all their credit, and lost their home and their job as a result of this super, super bad episode. We're vaguely up to date on how to do all that in the applicable state (California), and we're looking through NAMI as we can. Here's what we're struggling with:
1. Rehab: Relative's bipolar episodes are likely due to multiple concussions over their lifetime. When relative's mania and depression started to manifest, their foolish, foolish doctor decided to put relative on a rotation of all the possible bipolar treatments out there "to see what fits". This was a decade ago. Since then, relative repeatedly becomes miserable, goes off whichever meds they're on, and has manic episodes wherein terrible things happen. Then the cycle starts again, except this time things are really bad and we know relative will refuse to go back on the meds they've been on. We also have reason to believe that they've been experimenting with meth/cocaine/heroin in the past few weeks which is really screwing things up. Where in California/Los Angeles could/should we bring our beloved relative so they can get off the bad meds and onto the good ones with the help of more qualified doctors? Are such places really expensive? Do any take insurance offered through Covered California?
2. Work/Retirement: Prior to this episode, our relative had a stable job for over 20 years. That job is now irrevocably lost, but if/when relative can, relative will want to go back to some kind of job and won't be okay with just being on Long Term Disability. Relative also won't have any retirement or SS to speak of once they reach the limit of LTD. What happens then? What should happen until then? Can they work and still receive support from the state for their disability?
Any resources will be appreciated. We love and respect this relative and want them to retain as much agency as possible. We also want them to be well because who they are when they're manic depressive is frankly a terrifying person. They're physically imposing, verbally abusive, and dangerous as all get out. They're also old enough to be responsible for the things they've done and are continuing to do, so we've agreed as a family to not bail them out financially, though we will provide counsel where feasible and appropriate. (We're also all unable to provide financial assistance anymore so there's that, too.) God willing, they get through this without harming themselves or someone else. That above all else is our main hope and focus even though relative has barred us all from their life for the time being.
Thank you so much.
Here are some resources that might be helpful:
- The LA Dept. of Mental Health may be able to provide assistance or referrals. They also have some emergency services. They can also assist with a LPS conservatorship (mental health conservatorship - see the last item on the linked page) if that becomes necessary - such as if your relative cannot care for themself and is unwilling to grant you a power of attorney.
- Your relative likely qualifies for Medi-Cal. He or she can apply via the local DPSS office or online. There are inpatient programs that accept Medi-Cal if your relative qualifies.
- I'd talk to an attorney about disability options - my guess is that SSDI is going to be the best / most appropriate option, though I would need a lot more information to know for sure. The National Organization of Social Security Claimants Representatives runs a lawyer referral services that can connect you to an attorney who may be able to help your relative with SSDI.
posted by insectosaurus at 4:24 PM on December 11, 2015 [2 favorites]
- The LA Dept. of Mental Health may be able to provide assistance or referrals. They also have some emergency services. They can also assist with a LPS conservatorship (mental health conservatorship - see the last item on the linked page) if that becomes necessary - such as if your relative cannot care for themself and is unwilling to grant you a power of attorney.
- Your relative likely qualifies for Medi-Cal. He or she can apply via the local DPSS office or online. There are inpatient programs that accept Medi-Cal if your relative qualifies.
- I'd talk to an attorney about disability options - my guess is that SSDI is going to be the best / most appropriate option, though I would need a lot more information to know for sure. The National Organization of Social Security Claimants Representatives runs a lawyer referral services that can connect you to an attorney who may be able to help your relative with SSDI.
posted by insectosaurus at 4:24 PM on December 11, 2015 [2 favorites]
As insectosaurus says, Medi-Cal plus LA-city or wherever-relative-lives-county-level mental health programs (you can google "[county name] mental health" and look for the .gov addresses) are likely to be most comprehensive and the most appropriate for someone with mental-health issues that severe. If for whatever reason your relative doesn't qualify, those programs can still often do assessments and then refer clients to appropriate programs or resources. They may also be able to go out and meet with your relative and see if they can talk them into services.
As far as I understand, power of attorney will not allow you to force your relative into treatment, and a temporary conservatorship ("T-Con"), which can, is something that often can only be initiated while a patient is in and inpatient psychiatric hospital, and often won't be initiated unless the patient has had multiple psychiatric hospitalizations and those records are easily available to the conservator's office and/or hospital treatment team. A lawyer and/or your city/county's converator's office can give you better information, though.
posted by jaguar at 5:31 PM on December 11, 2015
As far as I understand, power of attorney will not allow you to force your relative into treatment, and a temporary conservatorship ("T-Con"), which can, is something that often can only be initiated while a patient is in and inpatient psychiatric hospital, and often won't be initiated unless the patient has had multiple psychiatric hospitalizations and those records are easily available to the conservator's office and/or hospital treatment team. A lawyer and/or your city/county's converator's office can give you better information, though.
posted by jaguar at 5:31 PM on December 11, 2015
POAs are tricky - you have to pick options like whether it's "durable" or not, whether it's active immediately or "springing" (goes into effect when a person is deemed incompetent in a legal sense) and so forth. It is very easy to screw it up, requires that the person is competent and accepting when it is signed, etc. I strongly suggest a lawyer be involved; you also may need to negotiate with your relative with the help of a therapist or social worker.
I also suggest that you work with them to create an advance directive for mental health, as well as a WRAP (recovery plan.) These are tools set up while someone is well, to prepare for a relapse. They're meant to be empowering as well as to improve their safety.
It is BTW extremely hard to do this stuff if your relative changes jurisdictions before it's all written down. My family basically "lost" a person because she took off to hide with a bunch of drug dealers in the desert about a month before it was all settled. Please act with as much responsible haste as possible. You can replace a conservator or write up a new POA far more easily than you can set them up in the first place.
posted by SMPA at 9:01 PM on December 11, 2015
I also suggest that you work with them to create an advance directive for mental health, as well as a WRAP (recovery plan.) These are tools set up while someone is well, to prepare for a relapse. They're meant to be empowering as well as to improve their safety.
It is BTW extremely hard to do this stuff if your relative changes jurisdictions before it's all written down. My family basically "lost" a person because she took off to hide with a bunch of drug dealers in the desert about a month before it was all settled. Please act with as much responsible haste as possible. You can replace a conservator or write up a new POA far more easily than you can set them up in the first place.
posted by SMPA at 9:01 PM on December 11, 2015
This is what happened with my brother. He had no insurance or an income. He was cutoff methadone and had a psychotic break. His therapist(siblings paid for) had police and psychiatric social worker do a safety check.
He was taken to Harbor General Hospital and put on a 72 hour hold. When the psychiatrist called us to come get him, we refused, stating he needed inpatient eval and proper medication for his mental illness.
He was sent to Kedren Hospital in South Central LA. I do not know how you get into this place without being committed by the courts. It changed everything for him. He was properly diagnosed and treated. They helped him get on SSDI.
After 4 months he was referred to a dual diagnosis halfway house. We used a patient advocate to help guide us in the things we needed to ask for on his behalf. I am looking for the patient advocate contact number that we used.
The biggest thing our sibling did was cooperate with our efforts to help, but we had to force the issue of what he needed when the opportunity finally presented itself.
It is a very difficult process to go thru and I wish you and your family member the best.
posted by cairnoflore at 11:44 PM on December 11, 2015 [1 favorite]
He was taken to Harbor General Hospital and put on a 72 hour hold. When the psychiatrist called us to come get him, we refused, stating he needed inpatient eval and proper medication for his mental illness.
He was sent to Kedren Hospital in South Central LA. I do not know how you get into this place without being committed by the courts. It changed everything for him. He was properly diagnosed and treated. They helped him get on SSDI.
After 4 months he was referred to a dual diagnosis halfway house. We used a patient advocate to help guide us in the things we needed to ask for on his behalf. I am looking for the patient advocate contact number that we used.
The biggest thing our sibling did was cooperate with our efforts to help, but we had to force the issue of what he needed when the opportunity finally presented itself.
It is a very difficult process to go thru and I wish you and your family member the best.
posted by cairnoflore at 11:44 PM on December 11, 2015 [1 favorite]
We used Mental Health Advocacy Services on Wilshire Blvd. 213-389-2077. They were very helpful.
posted by cairnoflore at 11:57 PM on December 11, 2015 [1 favorite]
posted by cairnoflore at 11:57 PM on December 11, 2015 [1 favorite]
IAAL, IANYL, I work in this area of law but TINLA. File for SSI/SSDI - your relative can always go back to work in the future if they are able, but if they are not able to work now because of this impairment they should file immediately. Please feel free to memail me if you would like.
posted by bile and syntax at 9:10 AM on December 12, 2015
posted by bile and syntax at 9:10 AM on December 12, 2015
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A lawyer in California can help explain how your relative likely is eligible for SSDI and how they likely can still work and receive SSDI benefits, as well as other public benefits. Hopefully, a social worker can get involved in this situation to help coordinate the available resources for your relative.
Based on your description of the legal issues, it sounds like you should consult with a California attorney who has experience with these kinds of issues as soon as possible, so you can fully understand your options. Please note that NAMI offers a legal referral service.
posted by Little Dawn at 3:43 PM on December 11, 2015