treatment for family member with bipolar disorder
April 24, 2020 1:17 PM   Subscribe

I have a two-part question related to getting treatment for a family member with bipolar disorder.

They have had multiple severe manic episodes in the past. Currently, they are showing a lot of the standard signs of an early manic episode — constant rapid speech, grandiose plans, excitement about new religious and philosophical insights that they want to explain, fear of people conspiring against them, etc.

As far as I know, they are prescribed a mood-stabilizing medication of some kind, although it doesn’t seem to be working very well. I don’t know whether or not they are actually taking it.

1. HIPAA protections generally make it difficult for a doctor to communicate information about a family member to other people, for good reason. But what about the reverse — can I convey information to someone else’s psychiatrist? This would include a description of symptoms and some long and troubling documents written by my family member.

The desired outcome here would be for the psychiatrist to be aware of these symptoms, which my family member is probably smart and lucid enough to not reveal during a checkup. Hopefully this would inform their professional judgment.

I haven’t communicated with my family member’s doctor before. I don’t know if this kind of communication from a patient’s family member, who was not previously involved in treatment, would be welcome or not — is it some kind of professional breach?

3. In the past, situations like this have eventually escalated to serious episodes resulting in arrests and involuntary hospitalization. Given COVID-19, are psychiatric hospitals even accepting patients right now? They seem like bad places to be, but probably better than jail.

My family member is not currently a danger to anyone and is able to function, but past experience suggests that things may get much worse, and I would like to know what would currently (given coronavirus) happen if someone needed to be put on an involuntary psychiatric hold.
posted by anonymous to Health & Fitness (5 answers total) 1 user marked this as a favorite
For #1: You can convey whatever you want. But you may get either no response or the response I give people's family members when they share unsolicited information with me (a therapist): "Thank you for reaching out and for sharing this information. As you know, without a signed release of information I am unable to share information about clients, or even acknowledge that someone is or isn't a client."

Depending on the severity of the information shared, then the next session might start with "Hey, so your Mom called me really upset and said X, Y, and Z. What's going on there?" If this becomes a regular issue, we talk about whether a release of information with observant family members would be helpful in managing their mental health needs. It's possible to engage with family members ethically and effectively, and it surprisingly involves disclosing next to nothing about the client themselves.

In many wrap-around persistent mental illness case management-y settings, there are more open lines of communication with family members.
posted by MonsieurBon at 1:34 PM on April 24, 2020

Yes, you can definitely communicate information to someone's psychiatrist. The psychiatrist cannot share information with you (or even confirm that the person is their patient), but they can (and likely will) listen to your information. The only real risk here is that the psychiatrist could choose to tell the patient that you had called to share information, which might be difficult for your relationship with your family member. However, given what you described here, it seems worth the risk and most mental health professionals would probably not disclose the details to the patient (i.e. might say that a family member had called to express concern, but probably wouldn't say "So-and-so called and told me XYZ").

Regarding psychiatric hospitalizations, the procedure right now is basically the same as it was before COVID-19, with some additional screening measures. I work in psychiatry at a major university hospital, and our inpatient psychiatric programs have been largely unchanged by the current situation. All patients are tested for COVID-19 prior to being admitted to inpatient, and there is very close monitoring of any symptoms (in patients and staff) to reduce the chance of any exposures. The process and criteria for being admitted is still the same as it was before.
posted by scalar_implicature at 1:43 PM on April 24, 2020 [1 favorite]

You can tell the psychiatrist whatever you want but there's no guarantee that they'll hear you out. They're more likely to listen to a voicemail than have any sort of discussion with you over the phone. It's worth asking your family member if they'll give consent for you to speak to the psychiatrist.

In NYC many inpatient psychiatric units have converted to COVID units, but unless the hospitals in your area are heavily burdened I would assume standard operation procedures when it comes to inpatient admissions.
posted by fox problems at 4:46 PM on April 24, 2020

Is there any chance of this family member CONSENTING to your involvement in their care? I've condensed to this in the past with my spouse, which has let them come to my appointments, talk directly to my psychiatrist, etc. I've remained in control of my care, and kept the ability to revoke consent at any time, but I've found their presence and input very helpful.

Of course, this requires consent, and I've never been as badly manic as it sounds like this person is. If I'd lost reality checking, or just hadn't trusted my partner as much, I don't know if I'd have agreed to it.
posted by nebulawindphone at 7:18 AM on April 25, 2020

I work on a psychiatric unit, and while things have changed, we're definitely still open. Might vary in your jurisdiction, but where I live, there is the expectation that both COVID negative and COVID positive people will require psychiatric care, and we shut down another unit to create a ward for each. Patients aren't allowed visitors or passes right now, but otherwise it hasn't really turned into a terrible place to be.
posted by unstrungharp at 8:28 AM on April 25, 2020

« Older Prescription Sunglasses for High Rx   |   Can't Shelter In Place WIthout A Roof Newer »
This thread is closed to new comments.