Good psychiatric hospital in Florida?

July 29, 2016 10:38 PM

How can I find an inpatient schizophrenia program that will treat my brother like a human being?

My brother (currently 25) was diagnosed with schizophrenia 7 years ago and after about 6 months of treatment entered a period of relative functionality (held a job for several years, took college classes). For the past 3-4 months he has seen a reemergence of his symptoms and no improvement when his doctor increased his dosage (only sees her monthly). Drug/alcohol use is co-occurring. He is slipping deeper and deeper into denial that he is experiencing anything abnormal, is almost never lucid, and is becoming less able to remain engaged with the outside world and more involved with the voices. He's living alone in my mom's house but unable to care for himself; he no longer has a job, frequently forgets to feed the dog, leaves food cooking on the stove and burning when he gets distracted, and is having trouble remembering to take his medicine. My sister had been staying with him for the summer but will be returning to college next week several hours away. I live in the Northeast. My mom recently moved across the country and my dad is unwilling to let him live with him.

My/our thought is that an inpatient program would provide the support, structure, and monitoring needed to a) stabilize his condition and find the right medication regimen, b) care for his basic needs, and c) remove him from opportunities to make self-destructive decisions while in this compromised state. We are also certain that he must make the decision to enter such a program voluntarily. The goal is for the stay to be temporary, not a permanent assisted residence, that would aim to return him to the functionality he was experiencing before, not to pacify or sedate him into a state of minimal responsiveness.

However, it is so difficult to find reliable information about medical services, especially psychiatric it seems.

Any advice on the following questions would be greatly appreciated:

1) Known recommendations for psychiatric hospitals in Florida or the Southeast USA, especially for treatment of schizophrenia? Also, ones to avoid!?
-- Any experience specifically with North Tampa Behavioral Health or Park Royal in Ft Meyers?

2) We are trying to get him either health insurance or medicaid/disability coverage but either will take at least a month or more. Any options you know of for obtaining health insurance more rapidly that will cover preexisting conditions much appreciated.

3) His drug/alcohol abuse is a significant issue and has been a problem for years, and may have contributed to this relapse. What is the difference between a psychiatric hospital/behavioral health program and a rehab facility that specializes in people with serious mental health issues and substance use problems?

Thanks very much for any advice you can offer; if you think of information not relevant to any of the 3 questions, it is still welcome.

posted by grokfest to Health & Fitness (6 answers total)

I hope someone can be more specific for you who is in your area but: Does your brother have a social worker? If not, get him one immediately. The essential resource for this is likely NAMI. They are used to bridging services to people in acute mental crises so start with them. If he's got a recent appointment coming up, you can also request one through a referral from whatever doctor is seeing him or directly from the Florida Dept. Of Children and Families.

This is too complicated to navigate alone or long-distance. If you can't go yourself, or get immediate help for any reason, someone else has to be on the ground to monitor him during this process to make sure he doesn't seriously injure himself, your sister, or your shared property. Someone else must step up. I wish I could say it's unbelievable that two siblings are trying to handle this alone -- at least one of whom is college-aged -- but I did it myself throughout much of my childhood. I needed emergency help then, and your sister who is living alone with your brother needs that same intervention. So please: get someone -- anyone decent and trustworthy, if you know any people like that -- to help and protect your sister, too.

In the interim, if your brother requires money for his care that you don't have, please don't be shy or reluctant about asking or help. Do a community fundraiser with everyone you know, if you must. I've donated to people privately through justgive.org and it seems simply designed and intuitive, but make sure to research your options to find the site that gives you the biggest possible donation cut. Other people may have better ideas along this line, if you require them. The best option is always cash, but most people are too far-flung these days to make passing a hat around too feasible. But if your family happens to have close community ties -- a religious home, a friendly neighborhood group -- this is the sort of thing people just do for each other, however and whenever they can. People often give food, if nothing else. But they can only do that if they know you need it.

This next idea tends to make already stressed-out people nervous, and isn't feasible if you or your sister are financially dependent yourselves. It also won't work if your parents are broke, or are themselves seriously mentally ill, or generally deeply unreliable people whose connections are much the same way. However: if either of your parents have financial means --most especially, if they have professional jobs or reputations that would be tarnished by it being publicly known that they have abandoned all of you to this complex and heartbreaking work -- solicit every last person you can reach in their extended family and social circles for emergency cash. That sounds a lot like vengeance, but it's not. It's an honest admission that you are in crisis alone. It's survival. It's one of those options people call "nuclear," but so is leaving your children alone to manage a desperately ill sibling.

Whatever else you do? However this works out? Don't have shame. This isn't your error and it isn't your shame. This isn't your brother's shame, no matter if he self-medicates or doesn't. It's a lot of people's shame, including just about every major government, medical, or otherwise prestigious social institution in the US you might name. It's the shame of every last person who stigmatizes and abandons the profoundly mentally ill to the unkind whims of fate. But it isn't -- and could never be -- any shame of yours.
posted by melissa may at 4:31 AM on July 30, 2016 [5 favorites]

His current psychiatrist is probably the best resource as far as the quality of different facilities, the range of options available locally (such as more intensive outpatient support either in lieu of or following an inpatient stay), what needs to happen to trigger insurance authorization, whether he would even be considered a candidate for regular psychiatric inpatient if he's got a concurrent alcohol/drug abuse problem, etc.
posted by drlith at 8:19 AM on July 30, 2016 [1 favorite]

In looking up some options a few months ago, I came across the University of Alabama Medical School programs. I do not know how hard they are to get into or what the costs are like, but they do have a program specifically for schizophrenia. I would call them (unfortunately, his psychiatrist is not guaranteed to be any good at figuring out where to go or insurance, as some of them are...just not into that) and see what they say about next steps.
posted by Lyn Never at 10:20 AM on July 30, 2016

You might try calling the local agency managing government-funded behavioral health programs to get information on other resources. It looks like the Florida state agency is the Dept. of Children and Families (even for adults without children, it seems). Their Get Help page has a drop-down menu by county. If your brother's in Lee County, it looks like Central Florida Behavioral Health Network (telephone [phone]) is the right contact.
posted by lazuli at 12:01 PM on July 30, 2016

The key phrase you're looking for when discussing mental health and substance abuse in combination is "dual-diagnosis." A psychiatric facility with dual-diagnosis treatment will have people experienced in treating these problems in combination.
posted by epj at 6:15 PM on July 30, 2016 [1 favorite]

Do not choose a program that is primarily for addiction issues and calls itself "dual diagnosis." Since around 50% of people with addiction also have mental health issues, virtually all rehabs will make this claim, but they will not actually have the expertise to deal with serious mental illness. Rehabs also will be more oriented towards "tough love" especially in Florida, and this is counterproductive and especially harmful to people with mental illness. The higher the education levels of the day to day staff, the better. This is one of the few cases where inpatient treatment is probably warranted, but the best inpatient facilities will be aimed at getting people back home as fast as is possible because they know that people actually heal best when in the most comfortable setting, which is typically home.
posted by Maias at 2:47 PM on July 31, 2016 [1 favorite]