Helping adult family with mental health
August 27, 2016 5:29 AM   Subscribe

Interested in hearing from 1) adults who have suffered from mental health issues for most/major part of their lives (depression/schizophrenia in particular) and were persuaded* by family to seek help (aka go to a psychiatrist). 2) family of the adult who was suffering from mental health issues and recognised that something was off/not quite right/blatantly bizarre/had classic symptoms of mental health issues (isolation, hygiene, job loss, distorted thinking and more). Additional twist- the adult in question can't stand immediate family and is convinced they are "toxic".

For both groups, would you be so kind as to share the following:

1. How precisely did the family persuade* the adult to actually get up and go see a doctor/seek help?
2. How did it work out?
3. What was done properly? What do you wish was done differently and how?
4. What do you wish you had known/done sooner?
5. Any advice?

I would really appreciate in-depth anecdotes/ information on how to go about this. And, if I had more resources on this then I would not be writing here. That is unlikely to change but I will soak up all that you generously share. Thank you!

* persuaded because I am not sure what the right word is here. I mean you can't just take them against their will, kicking and screaming if they keep insisting that everything-is-fine/I-can-take-care-of-myself etc.
posted by xm to Health & Fitness (13 answers total) 3 users marked this as a favorite
I don't know about other countries' policies. Here in the US it is extremely difficult to make someone get help, even if their symptoms are blatant.

My mother had schizophrenia, I had to put her in psych wards twice. The first time after hours of me talking with a local crisis team my mother finally and unknowingly complied with the requirement that she show violence. I called the police, showed them the destruction, introduced them to my 85 yr old grandma in whose house said destruction was happening, and they whisked my mother away.

The second time, a few years later, after waiting for several hours at a psych hospital for a doctor to come evaluate her and admit her, I ended up just leaving. I lived 70 miles away, it had started snowing, and I had three kids at home to whom I had promised that I would not bring her back.

If a person is not violent and is not threatening to do violence to themselves and/or others there is not much you can do to compel them to seek help.

It may be that the best you can do is encourage family members to see a therapist so that they can learn how to deal with their relative's mental illness.
posted by mareli at 6:06 AM on August 27, 2016 [3 favorites]

Actually there are 3 potential reasons you can force someone to be evaluated for their mental health in the USA, and possibly be admitted to a psychiatric hospital against their wishes, and the 3rd one might be most relevant to you.

The first two were already mentioned: threatening or doing violence towards themselves or others.

The third reason is if you believe that the person is so mentally impaired that they cannot care for themselves, although they are not intentionally trying to do themselves harm. This is the category that many schizophrenics fall into, because they do not have thoughts of self harm, and they are not suicidal, but all the same they have dangerous delusions or hallucinations that aren't compatible with being able to make it through life. For example, someone who might believe they could walk on water because they are the reincarnation of Jesus. Unfortunately, someone who has obvious delusions (for example, that their neighbors are aliens who are spying on them through the television, or that there are tracking devices implanted in their body, or something like that) who despite those delusions is managing to get through life and doesn't seem to be severely impaired by those delusions will probably not qualify.

But let me be clear, you do not have to play psychiatrist and make the determination of precisely how impaired your loved one is. If you believe they are significantly impaired that is enough to call to send EMS/police for a 'wellness check' and bring them in for a psychiatric evaluation - make sure you say something specifically to the effect that you believe they are severely impaired by their mental health issues and need an emergency psychiatric evaluation. I've also seen family members trick their loved one into coming to the emergency department for 'other reasons' (sometimes using their delusions in some way to convince them they need to come) and once they arrive and are all checked in, saying that they need to have a psychiatric evaluation so that the ED will hold them even against their will. I think neither strategy is optimal, but I do understand taking an 'ends justify the means' attitude towards it. Unfortunately there is not much of a middle ground - I think it would be great if there were some way you could just bring a psychiatrist to their house and make them talk, but it just isn't possible. To me it sounds like the 'wellness check'/EMS call option is probably the better one if the person in question won't talk to or spend time with the family members who are worried about them. If they go for an emergency mental health evaluation, expect the provider who is evaluating them to call you for collateral information. Your contact information may be listed on the form that the EMS/police bring your family member in with that serves as a legal document to 'hold' them for psychiatric reasons. This form differs from state to state, so if you haven't heard from anyone after a couple of hours, you could try calling the emergency department where your family member is being evaluated and see if you can talk to the social worker or psychiatrist. That person is more likely to be in house if the patient is brought in during daytime hours. If it is nighttime hours, unless the patient goes to a large tertiary care center, they may have to sit around for however many hours it takes until the morning psychiatric team comes on (i.e. like 8-9am). My last tip would be that if you have any degree of control in where the person goes, take them to a larger hospital, because from what I've seen typically small hospitals have very limited mental health coverage and patients can end up sitting around for days with no active mental health care going on, while awaiting 'placement'. Sometimes if you are in a rural area though, you might not have much of a choice.

I noticed that you have 'NAMI' as one of your keywords but didn't mention NAMI in your post. I strongly recommend looking for a NAMI chapter in your area and attending their support group. I hope you're doing this already. Consider talking to the people in the NAMI group about this issue as they will know your local area/laws.
posted by treehorn+bunny at 8:31 AM on August 27, 2016 [5 favorites]

I think it would be great if there were some way you could just bring a psychiatrist to their house and make them talk, but it just isn't possible.

Actually, there may be, kind of, especially if the person has no insurance or has Medicaid. I'm a therapist working for county-level mental-health services in California, and part of our job is engaging uninsured and Medi-Cal (our version of Medicaid) people with severe mental illness to help them get the help they need. This work is referred to as "outreach" or "community intervention programs." My co-workers and I have literally gone over to many people's homes (after being alerted by the police, by health centers, by family members) to talk to them about what's going on and try to convince them to at least talk to our case-managers and psychiatrist. It certainly doesn't always work (though it certainly does sometimes!) but it at the very least gives the person experiencing symptoms of severe mental illness (and their family, if the family member calls) a contact person in the mental-health system.

Different states and different counties have different systems. You might Google the name of the county or city where your family member lives and "community mental health center" or "community intervention program" and look for .gov websites. Even if your family member has private insurance, you could try calling the local city or county mental-health main Access or Referral or Crisis or Information phone number and asking for local resources. (Feel free to MeMail me if you want help finding that for where your family member lives.)
posted by lazuli at 8:54 AM on August 27, 2016 [4 favorites]

(And if your family member is not in the US, my offer to help find local resources still stands.)
posted by lazuli at 9:00 AM on August 27, 2016

And in my experience, focusing on the person's "stress" or "anxiety" rather than other symptoms is often a good way to get them in the door ("This sounds like it's really stressing you out/making you anxious. There are a lot of ways we can help lower that anxiety"). I also tout our case managers as being able to help with stuff like housing, insurance, benefits, food, which is often something the person actually wants help with. Basically, rather than telling the person what types of interventions they should have (e.g., antipsychotics), finding out what types of interventions they're willing to have (e.g., someone to help find them housing or treat their anxiety) and focus on those.
posted by lazuli at 9:05 AM on August 27, 2016 [5 favorites]

Yes. Call NAMI. They are incredibly helpful.
posted by jbenben at 9:53 AM on August 27, 2016

Pulling this from lazuli above: find out what types of interventions they're willing to have (e.g., someone to help find them housing or treat their anxiety) and focus on those.

(I've dealt with a version of your story and was constantly battling another interested party who continually talked "at" the person who needed help, telling her what she must do in order to receive his support. He failed spectacularly and made it even more difficult to get her to consider other options.)

Edited to add that I agree with everything lazuli said.
posted by she's not there at 10:21 AM on August 27, 2016 [3 favorites]

There's a whole book on this topic: I'm Not Sick, I Don't Need Help. It gives you some tools to talk to the person about their experience in ways that help you build an alliance and open the door to help in ways that they are willing to accept.
posted by metahawk at 2:08 PM on August 27, 2016 [2 favorites]

I came in to recommend the book metahawk mentioned. It's basically the bible for dealing with these situations.
posted by MexicanYenta at 7:19 PM on August 27, 2016

Speaking as someone who has several family members with mental illness.

Don't forget to take care of yourself, too. Growing up, it was a constant refrain of, 'your mother is sick, she doesn't mean it,' and 'your mother is sick, you have to adjust.' Yes, well, I'm a human being with feelings, too, you know! It took me a long time to acknowledge that I needed help and support, a long time to set boundaries. Therapy probably saved my sanity.
posted by Tamanna at 9:20 PM on August 27, 2016 [1 favorite]

Who does this person trust? If the person hates the immediate family, they may not be in a good position to persuade her/him of anything? But if there are others the person does trust, they may be in a better position to suggest sources of assistance, or even to point out the existence of the issue.
posted by decathecting at 11:18 PM on August 27, 2016 [1 favorite]

Additional challenge: the 'normal' communication is minimal/ non-existent. Did I mention isolation?
posted by xm at 5:40 AM on August 28, 2016

Seconding contacting your local NAMI chapter. It was a life saver for my parents - and as above, it's very difficult to get someone help if they resist. but NAMI is the best in terms of knowing local services and advocacy. my thoughts are with you and your family.
posted by bluesky43 at 12:36 PM on August 28, 2016 [1 favorite]

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