Dealing with mental illness

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My brother has gone crazy – I for once, am being serious. My older brother has always seemed a bit off, but he has completely lost it. After being fired, he has slowly declined. It was too the point that he became so paroid he won’t leave the house. My poor mom has been dealing with this with some help from my brothers and me. Mostly my other brother that works in the medical field.

My nurse brother has been reaching out to his medical collegues but unless my brother volunteers to admit himself to the hospital there has been nothing anyone can do. Last time I saw him – a couple of weeks ago he was very thin and seemed for lack of a better term crazy. He reached out to my daughter and just hugged her for quite a while. My daughter, being the sweet heart she is just hugged him back and smiled – she loves hugs any way.

I was away this past weekend with one of my daughters and I guess it got really bad. My nurse brother went to my mom’s house – my mom wanted him to look at my brother as it appeared he had bruises on his arms. He couldn’t determine how he got them, but was able to get the police, ambulance to come to the house. They were finally able to convince him to go to the hospital. He is there now, being medicated which he has refused before. He will be there at least into next week.

What to do next? Seriously I am worried for my mom – that is the only place for him to stay. What will happen in the future? Hopefully he will continue to seek help – but the way mental illness is handled now – you have to get a court order to force someone to get medical help if they refuse. It seems the system in place does not help unless someone volunteers for help – but how do you get someone crazy to agree to get help?

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@Linkat,

What to do next depends on his condition, but generally speaking, try treating him like a normal person. He probably won't get much of that, and will more than likely greatly appreciate it. As long as he's not getting in to trouble with the law, he's relatively free to be crazy if he wants to be. It's difficult for most people, but if he's not endangering others, try to respect that freedom. Good luck with it, I know it's tough

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@thack45,

What happens when my mom gets too old to care for him? If he still keeps being crazy and unable to care for himself? I see homeless people all the time that are lack of better words crazy...I can't see me taking him in - with kids and to be honest my husband probably wouldn't he doesn't have much patience with his behaviour now as it is - for some reason my husband thinks if he just got a job he would be fine.

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When my best friend's younger sister finally had a full psychotic break the docs told their dad that he had to stop taking her into his house. They told him it was allowing her to pretend/think that everything was fine. She had to spend some time on the street.

It was awful, and it took a couple of years, but she finally got into a program that helped to some degree. She will never be able to live on our own, but she's in a good safe group home where they monitor her meds and moods very carefully. They also got her on birth control which was a big deal as she kept getting pregnant.

My friend and her husband are H's legal guardians now, and she does listen to my friend's husband about some things. He's nice but very firm with her.

__

I feel bad for the people who adopted her children. I hope they were told that the children's parents were mentally ill, so they could be aware of any genetic predispositions.

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@Linkat,

I've dealt, both privately as well as professionally, with many of those persons. But any advice from here would be stupid, since we have a totally different approach (care related) to mental illnesses here.

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There will most likely be an evaluation at the hospital. Try to attend, since he is in danger of hurting himself right now. Try to get him into an at-least 2 week stay so his state of mind can be evaluated. (It could be malnourishment, sleep deprivation, etc.)

Explain the living conditions at home. Your brother may need in-patient treatment, but getting him to commit himself may be a problem.

The next step is the court system.

Good luck. Seems like every family has a member who is having coping problems. It affects the entire family.

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You can probably use some of the same legal tools we dementia and Alzheimer's caregivers have to use at times. The ones you probably want for your family are power of attorney and guardianship.

Check out the options here:

http://www.alz.org/care/alzheimers-dementia-legal-documents.asp

Quote:

Power of attorney

The power of attorney document allows a person with dementia (called the principal) to name another individual (called an attorney-in-fact or agent), usually a trusted family member, domestic partner or friend, to make financial and other decisions when the person with dementia is no longer able. The agent should be chosen carefully; it is recommended that this individual have a thorough conversation with the principal about what the responsibility entails. In addition, a successor agent or agents should be named in the event the original agent is unavailable or unwilling to serve.

With regard to individuals with dementia, power of attorney documents should be written so that they are "durable," meaning that they are valid even after the principal is incapacitated and can no longer make decisions.

Power of attorney does not give the appointed person (agent) the authority to override the decision making of the person with dementia (principal). The person with dementia maintains the right to make his or her own decisions — as long as he or she has legal capacity — even if the decisions are not what others believe are good decisions.

The agent is authorized to manage and make decisions about the income and the assets of the principal. This agent is responsible for acting according to the instructions, and in the best interests, of the principal.

Quote:

Guardianship / conservatorship

If a person can no longer make his or her own financial and/or health care decisions, someone else may have to become the person's guardian (also known as a conservator in some U.S. states). A guardian or conservator is appointed by a court to make decisions about the person's care and property.

Turning to the courts to appoint a guardian or conservator is not common, and often occurs when families are in disagreement about financial, legal and care decisions for the person with dementia.

Guardianship is granted by the court when it finds that a person is totally or partially legally incapacitated. In the case of dementia and its effect on the brain, legal incapacity refers to the person's inability to make rational decisions about his or her care or property.

Once a court determines that an individual is legally incapacitated, it may appoint a guardian or conservator for that person. A guardian has the legal authority to make decisions about the person's care and custody.

While the process varies from state to state, after a person seeking guardianship files a petition in court, the court generally issues a summons (a notice to appear in court) and a copy of the petition (a formal application made to a court in writing) to the person with dementia. The petition includes the name of the person who wishes to be appointed guardian.

The person with dementia has an opportunity to object to the guardianship. The court will hold a hearing at which time he or she (or another individual) can object.

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@PUNKEY,

Thanks - yeah my brother has been involved much more as he is a nurse supervisor so he has a better handle on how to deal with hospitals - although he doesn't have much involvement on the psych side of things.

We wanted to avoid the whole court thing - it does seem like some malnourishment and sleep deprivation so my brother also asked him to be checked for his health as well.

But there is definately a mental side - he has had issue off and on but nothing huge - I know something happened when he was in the marines but no one knows exactly. He did see someone at one time way back then and although he had some problems he was able to go to college and get a job. He has always had difficulty holding a job -- his bosses were all dumb, he was smarter than them, all those sorts of excuses ... he had problems with authority.

Then he fell into a job that fit him well and he worked pretty successfully not huge money, but enough for him to live. Then he got fired after working there quite a while -- it seemed to be a set up to get rid of him.

And since then it spiraled downward.

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@Butrflynet,

Thanks - I am a little familar with those - my husband was power of attorney for his grandmother and grandfather and he had to implement it when his grandmother had Alzheimer's and cancer. Even with the legal work, it gets ugly with family - his grandfather didn't remember signing the forms (probably didn't read them as the grandmother took care of everything and he didn't even know how to write a check). She/they had a good bit of money too so this caused friction with family--not to mention grandmother didn't want any of the family know that my husband was power of attorney and trustee of her estate as he was the youngest grandchild - but knowing the family he was the best choice.

Any way my brother has no money so the financial side is more trying to get proper insurance coverage with no money. And with his paroind state of mind it is difficult for him to trust anything like that - why it was hard to get him to a doctor and/or hospital.

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I do have a service with my work that I can call for advice, I might just do so. Personally I would like to get him into some sort of home for mental illness. It is tough for my mom to deal with - he was difficult before and now even more so.

Cute my littlest niece says grammy you are old, he should be taking care of you.

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@Linkat,

There is no substitute for professional help . Nothing will change for the better until that happens . Do whatever it takes for him to get that help, even if it is without his permission . There are more lives at stake than his .

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@Linkat,

Oy, that's a terrible situation for everyone around, especially for your mom.
Since he's in the hospital already, I think it would be easier to get him into a group home from there. He needs the recommendation of a physician, but with your nurse brother being there, it might be easier to get him set up.

It's so disgusting that the government doesn't step in and help ex-military
people who obviously have PTSD and need help. They were good enough to fight for the country and once that's done, they're tossed aside. Shame on America!!

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@CalamityJane,

He actually never was involved in combat .. sorry I didn't mean ft it to sound like that..he got a general discharge something occurred but we do not know what it wad. It seemed to make him distrustful and a bit paronoid.

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@Linkat,

While your brother is in the hospital, he should have a social worker as part of his treatment team. That person should be very involved with his discharge planning--where he will go for his follow-up psych care, where he will live, etc.---and your family, at least your mother and nurse brother, should meet with that person ASAP if they have not already done so.

Your mother can refuse to take your brother back into her home, in which case the social worker would be obligated to find an alternative living arrangement for him, even a temporary one, because they can't just discharge him to the street. Beside group homes, there are all sorts of supported independent living programs, day hospitals, and other arrangements that might be available and suitable for your brother. That's why the family needs to discuss this with a social worker who is familiar with your brother's psychiatric condition, and with your brother as well. Since your brother is now taking medication, is his functioning/thinking any less paranoid? Could he now participate in his discharge planning?

I think the best thing your family could do now would be to lean on the hospital staff responsible for your brother's current care and enlist their assistance in both short-term and long-term planning for both his psych treatment and living situation so that your family doesn't have to continue to struggle with this on their own.

Hopefully, they will have your brother on some meds that alleviate his paranoid, and possibly depressive, symptoms without causing him unpleasant side effects--that might increase the probability he will continue to take the meds after his discharge. However, medication non-compliance is a major problem with the mentally ill, and they will often discontinue their medication because they feel better and don't think they need it any more. Unless they are posing an immediate threat to self or others, medication cannot be forced on a person. The best approach is, therefore, to do everything possible to support voluntary compliance with medication--and the treating psychiatrist plays a big role in that. Your brother has to be helped to understand and control his illness, with medication, so that it doesn't wind up controlling him. And he might be quite capable of understanding that, particularly with the ongoing help of a therapist that he trusts..

I really hope your family--particularly your brother--will be able to get needed assistance and support--and intervention-- from the hospital staff before he is discharged from the hospital. Among other things, they might help him apply for disability if his psychiatric problems interfere with his ability to work. If disability is granted, it will also provide him with Medicare health insurance coverage.

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@CalamityJane,

Its not only America, it is every country that sent troops to Afghanistan . OEF consisted of many nations but the main combat was borne by the USA (23,000), United Kingdom, France, Spain, Poland, Netherlands, Germany, Romania, Australia, Canada (1,100), in a rough descending order of combat troops with support troops from many nations . Most of the casualties were from the USA and Britain . The duty of helping has fallen to the soldiers who have recovered from PTSD enough to be able to help other soldiers .

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@Linkat,

Quote:

He actually never was involved in combat

The majority of PTSD cases are soldiers who trained for combat and never saw it, just the day to day stress of mental preparation . I dont think soldiers would ever look down on another for not being in combat but is having problems .

Quote:

It seemed to make him distrustful and a bit paronoid

I assume he also has fits of anger and times when he is very distant . Trouble sleeping...he will be prone to road rage, suicide and self medicating with anything from alcohol to drugs . There are soldier help centres in the USA would you like a contact ?

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@Linkat,

Your brother may have a neurological problem ( brain tumor) plus an emotional/mental health problem.

If I were you, I'd check out his health insurance policy to see what is covered and what isn't. Next, your brother needs a full medical workup to determine his precise state of health.

From there his mental condition needs to be evaluated by trained MDs.

I suspect that your brother may have a severe form of depression, steming in part from the lost of his job. The fact that he refuses to leave his home suggests that he has a form of agarophobia, of unknown cause.

I recall that you mentioned that your nurse brother worked at a local Boston hospital, whose name I won't mention. Do not send your sick brother there. Care for mental health issues leave much to be desired, to say the least.

The best in the Boston area for mental health issues is McCleans (?) in Belmont, which is expensive but is probably worth it in the long run.

Check your brother's health insurance to see the duration of stay that is possible in a mental health facility. Your family doesn't need any surprises, when the bill comes due.

Bes wishes.

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@Miller,

He doesn't have health insurance and because of his paronoid state won't sign anything to get mass health or medicare. He won't even fill out the form in the hospital for his meals. He is talking now though which is more than what he has been doing.

My mom is hoping they keep him for 30 days but doubts it.

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@Linkat,

Your fall back position might have to be as firefly says. They can't make an "unsafe discharge", but if you get him out the door, they might not let him back in.

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Have you tried the service available through your employer? I used one once relative a family member with an eating disorder, and it was very helpful.

Dealing with a mentally ill loved one who doesn't want treatment can, as you know, be very difficult, but we're all better off for it being very difficult to hospitalize someone against their will. Not every family acts with the best interests of an ill member as their primary motivation.

Good luck.

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