Expert: Jennifer - 5/16/2008

Question
My 53 year old brother in law is a diagnosed manic depressive. He is not in therapy,nor is he medicated. He lives with my 78 year old mother in law, in a house in Northern Michigan. His swings are becoming more pronounced, he forgets things, and his anger is becoming uncontrollable. We live in New England, and need help figuring out the best way to protect my mother in law. "Mike" has been given every suggestion, every chance, and he has ignored all of it. Can we get an order of protection on her behalf, or have Mike moved to a residential facility against his will? We are terrified that he will hurt her, plus we are selling the house, so he feels that his safety net is being taken away, so that only escalates the swings. Any info will be most welcome. Thank you so much.

Answer
First, I want you to know that your situation is one that many families are faced with, but it is the fact that you are looking for help with the problem that is the most important.  Almost all  individuals who have bipolar disorder will refuse treatment at some point after receiving the diagnosis.  Has your brother in law been hospitalized in the past, especially if the hospitalization was one requiring a mandatory 72 hours for observation based on the assessment of law enforcement personnel?  If he has been hospitalized but not because of an incident where the police or sheriff's deputies felt that involuntary commitment for observation was appropriate, it will be difficult to show enough cause for the court to order him into a residential hospital facility, particularly if it would require an involuntary civil commitment order to be given by the judge (or judges, depending on the Michigan State Court procedures; I live in California, and there are often several different judges as a case goes through the system, which is determined by the particular type of case involved.)  You can get an order for protection to prevent your brother in law from being within a certain distance from your mother in law's person, home, place of worship (if she attends a church, for example), which would only require you to be able to demonstrate to the police and possibly in Family court, that there is a need for such an order.  
  If you can document the opportunities that he has been given to seek treatment for his condition and can bring either the medical doctors to court to testify as to their professional opinions regarding your brother in law, or at the very least have them write statements and get them notarized, I would recommend trying to have him involuntarily (or voluntary entering treatment but restricted from leaving at-will) committed.
  If you truly feel that he is a danger to your mother in law, and that he poses a serious threat towards the rest of the family, begin the paperwork for a protective order against him that will include your mother in law and also consider getting one for yourself & those living with you -- if he's that unpredictable, threatens to commit violent acts, and is not willing to begin appropriate medication treatments for his bipolar disorder, he could conceivably act out his anger over the situation through violence towards those who he perceives as being the cause.  

Let me know if you have any further questions, & hope that this has helped.  

Jennifer
** additional information regarding mental health issues and the law at the medlineplus website.  I also found the following information specifically related to the state of Michigan:  Michigan Mental Health Code provides that a person
whose judgment is so impaired that he or she is unable to understand his or her need for treatment and whose continued behavior as the result of this mental illness can reasonably be expected, on the basis of competent clinical opinion, to result in significant physical harm to himself or herself or others
may be subjected to involuntary commitment, a provision paralleled in the laws of many other jurisdictions. These types of provisions have been criticised as a sort of "heads I win, tails you lose". Understanding one's "need for treatment" would cause one to agree to voluntary commitment, but the Bazelon Center has said that this "lack of insight" is "often no more than disagreement with the treating professional"[8] and this disagreement might form part of the evidence to support one's involuntary commitment.

Michigan Activities

KEVIN'S LAW TAKES EFFECT Effective March 30, 2005, Kevin’s Law allows judges to order outpatient treatment for people with untreated severe mental illnesses who meet specific criteria, including a recent history of hospitalizations, incarcerations, or behavior dangerous to themselves or others because of their illness.
RESOURCE To learn more, check out the Oakland County, Michigan FAQs about Assisted Outpatient Treatment - or download their brochure "Kevin's Law: What you need to know."
Kevin's law - SB 683, SB 684, SB 685, and SB 686

"Until today, families had to wait until their loved ones made a threat or actually hurt someone before they could get help, and then the only option was inpatient care. Now people can be helped earlier, and on an outpatient basis. If the treatment is successful, the person never needs to reach a crisis point and hospitalization may be altogether averted."
-Sen. Tom George, cosponsor of Michigan's Kevin's Law

MICHIGAN'S KEVIN'S LAW TAKES EFFECT Effective March 30, 2005, Kevin’s Law allows judges to order outpatient treatment for people with untreated severe mental illnesses who meet specific criteria, including a recent history of hospitalizations, incarcerations, or behavior dangerous to themselves or others because of their illness. The package of four bills known as Kevin’s Law was championed by Sens. Tom George (R, 20th District) and Virg Bernero (D, 23rd District) and signed by Gov. Jennifer Granholm in December. Forty-two (42) states allow the use of this effective treatment mechanism, known as assisted outpatient treatment (AOT).
•   Kevin's Law makes treatment more humane
•   Key aspects of Kevin's Law
•   Assisted treatment saves lives
•   Language of Kevin's Law - SB 683, SB 684, SB 685, and SB 686
•   Gov. Granholm says "Kevin’s Law is about protection for the individual and the community
"I want to thank you, and all of those who helped to pass this law that would help to prevent others from passing through the same kind of experience, whether as victims of violence or mental illnesses. Kevin was one of the kindest and most selfless people I’ve ever known. I believe that Kevin would have forgiven Brian, and would also be heartened to know that something good has come from his tragedy."
- Kelly Scaletta, Michigan
New Michigan Law - Gov. Jennifer Granholm significantly reformed Michigan’s mental illness treatment law by signing Kevin’s Law (SB 683-86). Cosponsors Sens. Tom George (R, 20th District) and Virg Bernero (D, 23rd District) battled together for three years to give Michigan a way to better help those who refuse treatment because of incapacitating symptoms of illnesses like schizophrenia and bipolar disorder. Effective immediately, Kevin’s Law allows a judge to order outpatient treatment for someone with an untreated severe mental illness who meets specific criteria, including a recent history of hospitalizations or behavior dangerous to themselves or others. The progressive measure is named for Kevin Heisinger, who was beaten to death in a Kalamazoo bus station in August 2000 by Brian Williams, a man who had untreated schizophrenia. Williams’ illness caused him to cycle in and out of institutions and the criminal justice system for years. When he was in treatment, he was functional, but his condition would deteriorate when he would stop taking medication. Read the press release and find out more about the new law.
Governor Granholm Signs Kevin's Law - Governor Jennifer M. Granholm today signed legislation that will improve care for Michigan citizens with severe mental illness. The new law will allow courts to order treatment for individuals with serious mental illness who do not meet the current criteria for involuntary hospitalization but who need outpatient mental health treatment to protect themselves and others. Read more...
"There are too many people with serious mental illness whom we have not been helping, and Kevin's Law can change that," agreed Mark Reinstein, President and CEO of the Mental Health Association in Michigan (Southfield) and a member of the Governor's Mental Health Commission. "We are worried about people who are homeless and living under a bridge, who would never choose that lifestyle if their brain disorder was being treated. They merit our intervention."
PREVENTABLE TRAGEDIES The Preventable Tragedies database includes summaries of news articles of which an individual with a neurobiological brain disorder (usually untreated) is involved in a violent episode, either as a victim or perpetrator. Search for Michigan episodes by choosing MI in the drop down box.
Other Resources
PRESS KIT Kevin's Law - On Aug. 17, 2000, Kevin Heisinger, 24, was beat to death by Brian Williams, a 40-year-old diagnosed with schizophrenia. To honor Heisinger's memory, his family and Sen. Tom George, R-Texas Township, and Sen. Virg Bernero, D-Lansing, are working to pass "Kevin's Law," which would permit court-ordered outpatient treatment for mentally ill people who are least able to help themselves or most likely to present a risk to others. Michigan legislators and Kevin's family announced their intention to introduce "Kevin's Law" August 17, 2001, on the one-year anniversary of Kevin's death. At the time, both Sen. George and Sen. Bernero were in the Michigan House. Now in the Senate, they reintroduced the measure August 13, 2003, as Senate Bills 683 - 686.

Michigan
Mich. Comp. Laws Ann.
§ 330.1401 Inpatient and Outpatient: (1) Danger to self others; (2) unable to attend to basic physical needs such as food, clothing, or shelter necessary to avoid serious harm in the near future; or (3) unable to understand need for treatment and continued behavior reasonably expected to result in significant physical harm to self/others.
Outpatient: Impaired understanding of the need for treatment makes voluntary participation in treatment unlikely, noncompliant with recommended treatment necessary to prevent a relapse or harmful deterioration of condition, and history of noncompliance that includes two hospitalizations in past 36 months or acts/threats/attempts of violence to self/others in past 48 months.