How To Hospitalize a Loved One (Child or
Adult) With a Mental Illness
At least once a month, I receive a
phone call from someone (an adult son, parent, good friend) trying to find a
way to hospitalize their suffering loved one.
Two recent examples:
- A 29-year old male calls seeking help for his severely depressed father, age 65, who lives in another state. He has received calls about his dad’s declining well-being from concerned neighbors; “He is not leaving the house, and has begin to give away special belongings. Dad is talking about what a burden he is on others.”
- A 37-year old woman calls about her 9-year old daughter. Over the weekend, her young daughter became so explosive that she physically attacked mom. The child is being treated with mood medication moods sees a therapist. Mom believes that she has no choice but to admit her somewhere for closer evaluation.
General guidelines to know – please understand that state’s vary; I will
speak mostly to Californian’s as our laws are the most client-centered, in
other words, California allows adult individuals autonomy and decision making
powers.
·
It is very difficult to commit someone to an
institution. Being depressed
is not sufficient. The person
must have behaved dangerously towards themselves or another, OR be stating that
they plan to hurt themselves or others in the very near future, i.e. “I am
going to take all of my pills tonight. I hope I die,” or, “I am going to his
office to shoot him.” These threats are specific and immediate in nature, not,
“I hope he dies someday” or “I will kill myself if she leaves me.”
Because of
confidentiality laws, it is virtually impossible to call your loved one’s
therapist and have a chat about your concerns. If possible, secure your loved
one’s authorization, in writing to speak to any therapist or doctor that is
working with your family member. You can always “speak” to the person, i.e, you
do the talking and share your concerns, but the clinician has no obligation to
communicate his position or even acknowledge the fact of his client.
·
People don’t want to leave their home. Once this crisis in play, the sufferer is so
far-down the rabbit-hole he or she cannot think clearly. Paranoia (“I don’t
trust anyone”) is a symptom of depression as are feelings of worthlessness,
“Who cares anyway?”
·
Create a paper trail. Begin to document. When any comments are
made that appear dangerous or injurious, notify the police. The more the
better. Police have the supreme power to admit a “crazy person.” Often times
this is the very best avenue, while heartbreaking and painful. Many families
find this act to be almost impossible as it feels like a betrayal, yet, it can
be life-saving. Memorialize the worsening pattern.
·
Hospitalization is never the solution a loved
one hopes it will be. This is the
strongest point I’d like to make, as most family members will put all of their
eggs in this basket, believing that once
someone is hospitalized they begin a mental health recovery. In fact, hospitalization is simply one step along the
way. It is intended to be a short-term solution for someone in IMMINENT
DANGER to themselves or others.
·
Once a person has been admitted to a
psychiatric facility, a “72-hour
hold” (or 5150) will provide immediate physical, psychological and emotional
attention. Any current meds will be reviewed and likely adjusted to be more effective.
An introduction to social and therapy services will occur and basic needs can
be addressed. Once the patient is determined to be safe, or when the 72 hour
mark lapses, patient is released, usually prematurely.
This is the
most critical time for a family to mobilize, formulate a plan and assemble resources
for the patient’s discharge. If the patient doesn’t have a strong treatment
plan in place, do everything in your power to keep the patient in the hospital
(this is the most likely point when I
will receive a phone call from a panicked family member.) Time is of the
essence. When the facility is ready to discharge patient, which is always premature and the most expedient for their benefit, resist their plan until you feel 100% confident that a long-term aftercare plan is in place.
·
Current medication regimens matter. What psychotropic medications is your loved
currently prescribed? What others have been tried and failed to help? This is
helpful information when the authorities are trying to make a decision about
admitting or discharging. Obviously, if your loved one is not on any
medication, they appear untreated, and are not under a physician’s care. If
medications are prescribed by a physician, the case is made stronger by the
fact that the individual has made sound attempts to manage their moods, and
their efforts are coming up short.
·
An invisible step ladder is in place. Beds are severely limited and only the
sickest of the sick are admitted to costly higher levels of care. One does not
jump from kindergarten to college, and so it is in the mental health system.
The least
level of care is tried first (weekly therapy is an example), then medication
under the care of a psychiatrist specializing in the related area (for children,
a Child Psychiatrist). Sidenote: my strong clinical bias here is that a General
Physician or an OB/GYN should not be the physician on board prescribing
medication. A Psychiatrist is best equipped expert to monitor medication
regimens of psychotropics.
Next,
multiple medication trials, then outpatient treatment, then day treatment,
finally, longer term care (maybe 30 days) then even longer term residential
treatment. Please note it is very rare that long term care is covered by insurance
for adults. It is cost-prohibitive for most folks but the residential
treatments that exist are by and large fantastic and life-saving.
·
Outpatient Psychiatry is offered in most large cities through a
hospital and covered by most insurance. I highly recommend this viable option:
panel of physicians, usually made up of therapists and psychiatrists, oversee
each case. Clinical protocol usually consists of daily visits, utilizing
Cognitive Behavioral Therapy, Support Therapy and resource building. In the event
of mental decline, the overseeing clinicians are on-board to respond
effectively.
For Children:
·
Stick to very Specific Behavior. My child: wets the bed, scratches her skin,
isn’t eating, screams 20 times a day for 30 minutes or longer, stole a purse
from Target last week, wrote on her bedroom walls with permanent marker, says “I
hate my life and want to die,” etc
·
Avoid labels or drifting into emotional
language. “I know she’s depressed and anxious.
I can feel she is not the same person anymore,” “She has had a hard year,
or, “He is reacting to the divorce. He is angry and I’m afraid he’ll run away and get hurt.” Be less anecdotal and more factual. Stick to behaviors.
or, “He is reacting to the divorce. He is angry and I’m afraid he’ll run away and get hurt.” Be less anecdotal and more factual. Stick to behaviors.
·
Admitting a child to an institution is easier
when an IEP is in place, as
this often supports facts of special emotional, psychology, or mental needs as
well as behavioral difficulties. Bring this documentation when calling the
police or speaking to authorities about your concerns. If the child has a
diagnosis, share that information.
·
Residential treatments in California are primarily county contracts,
managed by excellent clinicians and child care providers. Because of the cost
associated, many families opt out of California and into Utah or Arizona for
residential treatment. There are many reputable agencies that will work
collaboratively with a family, often times 6-12 months, to stabilize a child
and facilitate new ways of interacting within the family dynamic, making a
reunification successful and healthy for all involved.
For a private consultation, or an in-person intervention, please email Christina Neumeyer at carlsbadcounseling@roadrunner.com