Medical Family member with mental illness

  1. Greg Bernhardt

    Staff: Admin

    Does anyone else here have a family member with a mental illness? I have a family member (Bob) with schizophrenia. Bob was diagnosed about 4 years ago. Since then it's gotten progressively worse. Bob can't hold down a job and lives off social security. Lives in a shanty apartment. Bob dropped out of community college last year with no future prospects. It's intensely difficult because Bob also has substance abuses and often misses taking medication. Over the last few years Bob has been in and out of the hospital every couple months. It's a complete merry-go-round feeling. Bob is also starting to turn on family members and even case workers. Bob has been in the hospital the past week and we just found out last night. Because of privacy laws there is nothing we can do but watch Bob slowly disintegrate. We can't even talk to Bob's doctors. The only way Bob can be held against his will is if he hurts himself or someone else. That is a horrible thing for a family member to hear and it's weighing very heavily. It is a matter of time and that makes me so angry at the system.

    My heart is so heavy right now. So helpless.

    Does anyone else suffer with family with mental illness? How do you cope?
  2. jcsd
  3. jedishrfu

    Staff: Mentor

    You can talk to Bob's doctors if he agrees to it. If he commits himself and signs over care to you then you can see the Doctors and he won't be released until the Doctor says so. The problem here may be whether his insurance covers the treatment.

    The other problem is that he'd be commiting himself to the Psychiatric ward where there are many different cases of mental illness and its a very controlled environment similar to a prison using reward / punishment methods.

    If you call 911 when he is in some manic phase where you fear he may be a danger to himself or you (makes threats...) then the ploice mental health officer canmake the determination to commit him involuntarily.

    This is something new to us as well.
  4. Greg Bernhardt

    Staff: Admin

    Bonus blocking the family by not signing a release for us to know anything. I don't understand why the system lets someone completely out of their mind to make such decision. We've called 911 and had him taken to a hospital prolly 5 times. Each time he's released after a week and the merry go around continues.
  5. Monique

    Monique 4,445
    Staff Emeritus
    Science Advisor
    Gold Member

    Maybe you should make an appointment with a psychiatrist to discuss how one can deal with such a situation? Or maybe there are mental health organizations that could advice you? Do be careful when dealing with people with such a track record.
  6. jedishrfu

    Staff: Mentor

    Hospitals handle acute cases and try to release as quickly as possible with the proviso that the patient must followup with outpatient treatment and counseling.

    However, what happens is that the patient decides not to continue treatment and instead goes back to his old behavior and the cycle continues...

    As Monique says you'll need to find some organization that handles these kinds of issues and figure out what's available to him and what's best to do. Maybe Narcotics Anonymous or AA have classes on it.
  7. Greg Bernhardt

    Staff: Admin

    True that that is what is happening. I know he's been in a city mental facility for up to a month. Seemed to get better and we were upbeat, but next thing we know we get a call from his case worker to let us know he was back in the hospital because he was found roaming his apartment building, talking to himself with blood shot eyes.
  8. jedishrfu

    Staff: Mentor

    Its almost like you need a nursing home for the person. Family cant be there all the time.

    One family tried once and things worked well until my friend went back to his home then his grades dropped, left/lost his job and then lost his car and dropped out of community college.

    Eventually he got back on track with his girlfriend, a job and a car and with the extra money started having troubles again.
  9. Monique

    Monique 4,445
    Staff Emeritus
    Science Advisor
    Gold Member

    Several weeks ago I watched a documentary of a son murdering his mother in a gruesome manner, after he was released by a psychiatrist from jail (being apprehended after physically assaulting a female). He had a history of mental illness and violence since childhood and should thus have been observed instead of released. His sister now tries to help him, since it's his illness and the failing system that facilitated the murder. A sad story, the institutions involved have received an official warning from the justice system so that they'll be more careful in their future evaluations.

    Clearly it's a complex issue of when and how much help a person needs, but when a family is very concerned extra attention should be given (because they see the real troubles, opposed to the short (telephonic) interviews by professionals).
  10. jedishrfu

    Staff: Mentor

    People with mental illness are not stupid they may in fact be very clever at manipulating the system, hiding their feelings and saying what people expect to hear until they are free.
  11. Greg Bernhardt

    Staff: Admin

    Agreed, but he is an adult, we can't force him to do anything. In fact most of the time we can't get a hold of him.

    Agreed, none of his help seems comprehensive, but again, he's an adult and not given our family the proper tools to help him. We feel helpless.

    Yes this is very true and makes it extremely difficult to figure out the situation. We are constantly trying to figure out if what we are seeing is the illness, the drugs or poor character. Most of the time it's a damning combination of all three.
  12. Monique

    Monique 4,445
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    Science Advisor
    Gold Member

    Exactly, that's what happened in the case I described. His mother would alert the coach, who would call asking how things were going, the son would say "really well, I'm improving a lot", while in fact the opposite was true. The mother took on the role of primary caregiver, because she couldn't get him admitted.
  13. jedishrfu

    Staff: Mentor

    Some mental illness is like a read-only disk, you can reboot, run programs, do interactive stuff. It just won't be remembered later on.
  14. I am mentally ill but not schizophrenic. I have been on meds for 20 years.
    I am the worst case in my family. only some cousins had some temporary anxiety or depression problems.
    however, meds work very well for me and I feel good and calm 7/24.
    I have a Bs degree in physics but I am an expert musician.
    if meds didnot exist, I would be kept in mental hospital or prison because it is impossible for me to manage my anger without meds.
    my ex-wife was a psychotic but she was functional by the help of meds. she is now a retired teacher.
  15. jedishrfu

    Staff: Mentor

    Last edited by a moderator: Sep 25, 2014
  16. Greg Bernhardt

    Staff: Admin

    Last edited: Sep 25, 2014
  17. jedishrfu

    Staff: Mentor

  18. The first thing is that the doctors may not be allowed to talk to you but you are allowed to talk to them to make sure that they are not getting a one sided version of the story as often happens and that your concerns have been heard.

    I would suggest having a look at the UK Schizophrenia Commission paper to see what optimal care should look like and how it fails in the UK.... and usually much worse in the US. It would be a good guide for what to insist on.

    Family therapy can help in order to reduce expressed emotions that they find unsettling and there is strong evidence for the use of specialised Cognitive Behavioural Therapy which essentially teaches rational decision making rather than counselling. The long term is starting to look brighter for schizophrenia. A new pilot has just concluded using Avatar Therapy that has shown extremely encouraging results.

    There is probably not a lot else that you can do because of the drug abuse. That complicates things at every level and including his prognosis unless he decides to give up. It is almost as if it gives him extra rights since substance abuse is not grounds for compulsory psychiatric admission. It tends to lead to a different sort of long term legal admission.

    In fact, deep crisis of one sort or another sounds like it may be the only thing that can break the downward spiral that he is in. You really are going to have to be philosophical and think of the long term where there are at least glimmers of hope. That hope all revolves around his decision to give up the drugs and nobody can do it for him whilst he is in the community.
  19. Psychiatrists have a name for 'poor character' in cases like these. It could be Borderline Personality Disorder which would need a different treatment, Dialectic Behavioural Therapy.
  20. A good friend of mine was diagnosed with Schizophrenia couple years ago. I really hope that he's not addicted to these drugs in the way that he can't live without them. This is a serious illnes and it's hard for these people to percive reality in a normal way, drugs make it double hard. All I can say is that the family should at first help him to get rid of drugs, only then he can know what is happening and only then he could want to help himself. But then again, every help is seen as an attact from his perspective probably, so one should be firm but not showing any anger or something like that. First of all he probably feels lonely and need a warm approach.
  21. bobze

    bobze 651
    Science Advisor
    Gold Member

    That's a hard situation Greg. This is a common problem with schizophrenic patients, they get better while hospitalized for psychotic episodes because of anti-psychotics. Once they are stable they have to be released. There is nothing legally we can do as medical professionals to hold a stable schizophrenic. The problems often arise when these patients get back out into the community and decide they don't need their meds anymore or they don't like them because of the very real side effects they often have. Off their meds they go and back into psychosis and another hospitalization. Each "psychotic break" a schizophrenic patient has damages their brains more and more--its additive. Often causing a progression of symptoms, usually negative ones, you see in long histories of uncontrolled schizophrenia.

    The good news is the newer generation, ie; 2nd generation, neuroleptics (anti-psychotics) are much better at controlling both positive and negative symptoms. They have some available in depot form (IM injection) which takes the compliance issue of oral neuroleptics out of the patients hand. Unfortunately I feel like a lot of psychiatrists (particularly the older ones) use these depot forms less because they simply aren't used to them. Its something that certainly needs to be utilized more. That might be something to consider talking to his doctors about the next time he is hospitalized (depot forms that is).

    You're right to worry about the substance abuse too. Schizophrenia with any comorbid disorders (be that anything from depression to substance abuse/dependance) has a worse prognosis. Unstable home environments, stress and substances can all be harbingers of psychotic episodes.

    If he can get the schizophrenia under control (preferably with something like a depot neuroleptic) then it would be a good time to discuss an inpatient substance abuse and treatment program, which it sounds like he needs too.

    Down the line there is specialized social training therapy for schizophrenic patients to help with issues like personal hygiene and social interactions. Which sounds like it would be useful for him, but he's going to have to get the schizophrenia controlled and the substance issues taken care of before that type of thing would likely be useful for him.

    Its unfortunate that the cost of psychiatric and substance abuse hospitalizations can be so costly to patients and families.

    I wish you and your family the best of luck.
    CalcNerd, Greg Bernhardt and Evo like this.
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