Expert: Libby Bonner - 4/8/2005

Question
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Followup To
Question -
Hello,my mother had been diagnosed with bipolar disorder about a year ago. She is 50 years old. She has been hospitalized about 7 times within this past year and her condition has not improved. She does not believe that she has this disorder and is non compliant with her meds. When I ask her to take her medicaton, she becomes angry and storms out of the house. She wanders off in the middle of the night, has caused us to be in extreme debt and has had delusions. She has also been arrested several times because of her erratic behavior. She becomes irritable easily and I just don't know what to do any more.
         Thank You

Hello again. i wanted to thank you again for your help. As far as who lives in my household, there is just me and my 2 older brothers. It is her house and my grandparents live downstairs from us. We have tried a mental health warrant which was served. None of the hospitals seem to be on top of things and seem not to help. She has been in outpatient programs before. She would go for a week and then never go back. My father moved out of the house and he(as well as his family) are pressing charges on her. They do have protection papers against her and have had arrested about 2 or 3 times. The other times she got into a mess all on her own. The court has issued a mandatory meeting between her and an official selected by a court. The elected official is supposed to evaluate her and is this person sees that she is non compliant or if my mother refuses to go to her appointments, she will be automatically arrested. I do not beleive that having her arrested what she needs. As far as finaces are concerned, she had maxed out all of my father's credit cards and cleaned out their joint account, his account as well as her own account. She also denies that she has done this act also. Any further advice? It will be greatly appreciated. Once again, thank you for your help...Michele
Answer -
Would help to know who all lives in her household - and do you live w/ her or she w/ you, or neither.  Also are you in debt re medical costs or her wild spending or both?  And how is it that you are responsible?  She stole? Forged checks?  Used joint accounts?  [If she did illegal things, you can get tough and file charges.   And see below; other ways to get tough.]

These are my thoughts, not knowing the above:

You can go to www.psychlaws.org to see what the situation is in your state about getting "assisted outpatient treatment."  You must not have it there or it surely would have been suggested to you.

You need an atty.  You need one to see who is responsible, legally, for the repayment of the debts.  Also to see how you can get spending 'authority' removed from her, if possible - and get her name off joint accounts, etc.
It may be that you also need to think about either having someone become her guardian [wish I knew more about guardianships] OR the person in the family w/ the legal right to do so probably needs to have her committed for treatment.  I realize she has been in and out of the hosp, but once she is under a committment order, that order, once she is out of the hosp, again, will continue for months or years, and she will have to show up from time to time to prove she is complying.  It's sort of like being on parole.  Varies by state, but I think you might consider  this.

Be very very careful about your safety if you do this.  Be sure you are safe and that she is not aware of this until it takes place. She is going to be angry and possibly dangerous.  And she may be angry w/ you for months or years.  Your atty should be someone who has dealt before w/ committments - or someone who can coordinate this w/ the court, and maybe the sheriff's office or the police, maybe the doctor or hospital. [If you have guns in the house, move them and lock them up. Although, unfortunately, anything can be a weapon to an angry person.  So be very careful.  And be very careful - committment or not - about deliberately, or accidentally, provoking her when she is "irritated."  Manic irritation can change to dangerous rage in a second.

If she lives w/ you, there is the option - a tougher one than committment - to turn her out of the house and change the locks.  She can return if she takes meds regularly and goes to the doc regularly.  And then you do have to let nature take its course.  She will eventually end up, for some time, in residential treatment or in jail.  [Why has her doctor not gotten her into residential treatment after about the 3rd hospitalization?  Something to talk over w/ NAMI - see below.]

Go to www.nami.org to see if there is a NAMI affiliate where you are.  I hope there is one, and that, in addition to speakers, they have a support group.  You will get a ton of practical info from people there, who have dealt w/ exactly what you are dealing with.  If there is one nearby, call there and see about going to their meetings; see if someone in their group can give you some advice right now.  If there is none nearby, call the state office and see what kinds of help they suggest.

If you are in a city - doesn't sound like it - you may also find a Mental Health Assoc in the phone book.  Give them a call.

A very very good book to BUY and HAVE is by Woolis.  Title is When someone you love has a mental illness.  This book will help you now and forever....and you will also feel less helpless when you read it.  It is a godsend.

There is a book about compliance by Amador called I am not sick; I don't need help.  Might borrow a library copy to see if it can help you.  Can't hurt; might help.

Good luck w/ your very tough situation.  Your mother is very, very sick and all of her rotten outlandish behavior is because of her illness.  Pls write again if you wish.


Answer
The only futher things I can think of, since the system seems to be failing you:

Every state has one or more Protection and Advocacy Offices.  They protect patients from abuse, poor treatment, etc.  I'm not sure whether they are an appropriate source of help for you or not, but you can call, saying that the system has failed your mother.

You could call or write or visit our own state legislators - again, to report system failures, and to ask for their help in getting responsible people to contact you.

You can go online, or use the phone book, [or ask a legislator] to see who provides tax-paid mental health care in your state.  Might be Dept of Human Services, or a Dept of Mental Health. It varies.  You can start locally and work your way up to someone at the state level w/ your complaints.  Also, the state may pay a for-profit company to manage or provide its mental health care.  Definitely contact to them about this.  This might be a question that a state legislator could find out, the name of the 'provider.'  [So - you might have complaints w/, contact w/ actual state employees and also w/ any outside private company that the state pays to provide some services.]

It's very important, as you make these contacts, to write stuff down [who you spoke w/ and what they said] and also to LEARN the lingo and learn how the law in your state says the system should work.  At best, it can only do what it is compelled to do.  [For instance, if non-compliance legally leads to arrest and not treatment, then that is a failure of the laws in your state and not much can be done about that.] BUT - once you know what is supposed to happen - then you can jump on them for failures to perform.

Is a mental health warrant like a committment?  Find out EXACTLY what should have happened w/ that - and follow up on anything that should have and didn't.

IF you can get an atty involved, his writing a letter on his stationery gets a lot of attention.  If ANY hospitals have dropped the ball in any way, he could write them and relate the consequences of their failures.  We can assume they don't want to be sued.

Do pls go to www.psychlaws.org to see what's what - many of your answers about how things should be are there.

That's my basic answer.  How should your state laws have worked?  Find out, and then make them work in the future, and do what you can about past failures.  Know what you are talking about, and be firm about expecting that help that should be provided IS provided: the squeaky wheel definitely gets the grease in mental health care.

There is also the issue of your mother's income.  Did she work before she was ill?  Has anyone applied for Social Security Disability for her?  If she gets SSDI, she is certainly going to need a payee, not get the money herself.... We are maybe back to guardianship.

Pls start going to NAMI where you can get ongoing help as you unravel the system in your state, how to make it work, how to get SSDI, etc.

Good luck.