How do I help my bipolar brothers?

April 8, 2018 5:31 AM

I've got two brothers, both bipolar. How can I help them access social services and get their lives together (from a distance)?

I have two brothers, one in his early 20s, one in his late 20s. Both have been diagnosed as bipolar, and are having a really, really tough time.

The older one mostly lives in San Francisco with my father and stepmother, though he has tried to travel elsewhere while manic, typically disasterously. He no longer has ID, and has no bank account. He's been institutionalized briefly, and hasn't really been employed for a few years, though sometimes he helps my stepmother with her small business. He was previously on city insurance, but is now off it for some paperwork related reason that I can't understand.

The younger brother lives in Chicago. He's done a little better, but he's also just seen his symptoms blossoming in the past year or so, so it's hard to say to what extent he was just young to have symptoms. He is uninsured. He's also had some hallucinations, and some doctors have suggested he may have been misdiagnosed and could be schizophrenic. There's history of both conditions in our family.

Neither brother is particularly good at helping themselves, whether manic or depressed.

I'm older and gainfully employed, but I live in another city. I have the income to contribute to their welfare, but I don't really know how. I've got three young kids and a demanding job, so while I can contribute money, my ability to travel to them or even just be actively engaged with them is limited.

Neither of them gets regular mental health help, and while I've offered to pay for regular therapy and psychiatry, neither has been able to take advantage of that. My father is unable to be helpful, and while my stepmother does her best, her best is only marginally helpful. Lately, my brothers have been asking me for money. Given their health, I'd rather spend it on regular services than have to decide every time if they're in an emergency situation or "deserve" cash.

What do people do in these situations? I feel like what they really need is a caseworker of some kind: just someone who helps them with public aid, checks in regularly, helps them access health care, knows the system, etc. But I don't know who that person is, how to find them or how to hire or access them. At least right now, I probably have the means to put a couple thousand bucks a month towards this if need be.

I know plenty of happy and productive people who struggle with bipolar, and I want my brothers to have fulfilling and safe lives. Because I love them.

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

People who are bipolar can have hallucinations while in a manic state. It is very hard to help a person with a mental illness who doesn’t want or doesn’t recognize the need for help. I help the person in my life by paying for psychiatric visits because the copay on their insurance is so high and by being an emotional support as needed. I made it clear that as long as they kept the doctor’s appointments I would pay as that was priority #1. However, this person accepts that they need the medical support. I had another family member that was schizophrenic who did not want medical help and it was very, very hard. She eventually became homeless in spite of my attempts to get help for her. The laws in the US are not very helpful in this regard. The best you can really do is try to help the person see the need for help.
posted by tamitang at 6:25 AM on April 8, 2018

I can't speak to Chicago, but as someone who works in county mental health in California, I suspect that getting your SF-based brother's Medi-Cal paperwork straightened out would be the most helpful thing going forward. Medi-Cal covers "specialty mental-health services" that include case management and psychiatric treatment. In California, these services are provided by each county. So if he's actually in the city, then you can contact San Francisco Behavioral Health Services at [phone] or [phone]. If he's outside city limits, then googling the county name plus "mental health services" and looking for the .gov addresses should get you the contact number (or MeMail me and I'll help).

The issue then becomes that the services are voluntary and he might not want them, though the staff should be at least somewhat trained in getting/keeping clients engaged.

I would imagine Illinois has a similar Medicaid-based program, but I don't know the ins and outs. Basically, the first step, at least, would be getting them both on Medicaid/Medi-Cal.
posted by lazuli at 7:41 AM on April 8, 2018 [1 favorite]

Yes, strong second to SFBHCS for SF brother. If they're difficult to contact, try the the Health Consumer Center (must call with brother on the line to give consent to speak or have power of attorney) for free legal assistance with Medi-Cal issues.

Feel free to DM me for more specifics re: possible caseworker sources-- I have a referral list my org puts together, but I'd need to know a few more details to give you good leads.
posted by peppercorn at 7:57 AM on April 8, 2018

You might want to, for the Chicago brother at least, look into a private patient advocate. This would require his buy-in and permission, of course.

Most often, you hear about them in regards to elderly patients, who might need people to visit the doctor and help them understand and take medications, etc. But you might be able to find someone to help your brother navigate the services available to him locally.

Here's an article about it. You might also want to contact NAMI and see if there are any resources there.

Basically, hiring someone who might be a former nurse or social worker to help your brother(s) navigate the system. Whether it's helping them apply for Medicaid, taking them to therapy and doctors appointments, checking in on them and reporting back to you, whatever. It's not cheap, but it sounds like if you can find the right person (via a professional organization), it might be a fit for you.
posted by Marie Mon Dieu at 2:04 PM on April 8, 2018

Basically, hiring someone who might be a former nurse or social worker to help your brother(s) navigate the system. Whether it's helping them apply for Medicaid, taking them to therapy and doctors appointments, checking in on them and reporting back to you, whatever. It's not cheap, but it sounds like if you can find the right person (via a professional organization), it might be a fit for you.

I agree with this but only if you've made sure he's exhausted (or doesn't qualify for) Medicaid resources. A lot of these things are covered by Medicaid (which is why the disability-rights community is pushing for Medicaid for all rather than Medicare for all), and I would be thrilled to hear that my tax dollars, rather than your personal contributions, are helping support your brother. If the Medicaid resources are inadequate or inaccessible, then definitely look at private-pay options, but please take advantage of whatever public options are available to your brothers first.
posted by lazuli at 5:41 PM on April 8, 2018

It's obvious you love your brothers and I know you're in great pain not being able to do more. You've very generously (VERY generously, considering you have your own family) offered to pay for psychiatric care. Based on my own experience, fewer things in life are more difficult than watching someone you love suffer. My adult daughter has had horrible problems with addiction and depression. At its worst, I often felt like I was watching her on the opposite shore of a lake in the jaws of a monster; I couldn't get across to her no matter how hard I tried. We were very lucky - she did eventually ask for help which we gave willingly and hopefully. She's been sober for almost three years and her mental health problems are under control. She sees a fantastic therapist once a week. I don't take a single day for granted, but I can tell you - she is my hero.

The most important part of my story is that she asked for help and accepted it when it was given. Until that happens with your brothers, truly, all you can do is let them know you love them, you're available to listen and will be ready to provide the help you've offered when and if it is accepted. You can't prevent really bad things from happening to them. It might take a calamity before they are ready to ask for and accept your help. Giving them money may be forestalling the thing that finally makes them realize they need help. I really hope not. Until then, take care of the family you've created -- your three young kids. Our family of origin has great emotional pull on our hearts, but once we start our own family, they have to become priority number one.

I've been where you are. It's unbearable at times. Please take care of yourself. Do you have a strong support system, people you can talk to? Your own therapist? My therapist was absolutely the reason I got through my daughter's trauma without losing my mind. Good luck. Keep us posted.
posted by para722 at 3:41 PM on April 11, 2018