7.23.2012

Interventionist - How to Hospitalize a Loved One


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.
·        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