The following conversation took place in mid 1997 in our discussion areas, but the experience and discussion is a common one at Schizophrenia.com.

Topic: Getting help for our adult son

 From: bob
 Date: Wednesday, April 02, 1997 01:08 AM

Steve is now 33 and is suffering terribly. He is extremely paranoic, he hears voices and has psychotic episodes of uncontrolable anger. Though he has a history of substance abuse he has been clean and sober for more than a year. He says that now drugs make him too paranoid. His behavior has always been volital and antisocial. However in the past six months he has lost his ability to cope with everyday life. His appearance has deteriorated, he claims he is unable to sleep and claims that there are surveilance devices everywhere keeping tract of everything he does. What scares us most is that his psychotic episodes are much more intense and frequent. He has threatned our lives. In his rational moments he is aware he needs treatment but when his mother took him to the hospital for evaluation, he
became paranoid and would not agree to be treated. It seems that unless he harms himself
or someone elce he can not be held or treated aginst his will. He is now out there
somewhere, alone and frightened. How can we get him to treatment?????

Robert, and others...

This is obviously a common problem and I'd like to get all readers' input on steps that we
would recommend in taking to help this person. Here is my first effort at a general plan of attack, I'd like others to comment and add to it as they think appropriate.

Step 1. Contact your local Support Group/NAMI office (or similar help organization in your country) and talk with others who have had similar experiences and find out their successes and strategies.

Step 2. Document (write down, preferably on your computer so that you can easily update
and print out copies for different doctors' etc.) all the things the ill person is doing that
indicates to you that he is ill, and especially his threats, etc. While I hate to see anyone
committed against their will, if they are a danger to themselves or others (as Steve certainly sounds) then it is probably best that he gets help as quickly as possible. So document
everything, with dates.

Step 3. Get in contact with the appropriate officials so that they know about your son (in this case) - I'm thinking you should let the police know who your son is, that he is missing
and probably on the street, and that he is ill. Talk to the family psychiatrist or other resource (possibly provided by NAMI) so that you can get a proper evaluation done when he is
most sick and commit him if necessary.

Step 4. If the officials don't seem to want to treat him, be sure to let them formally know that you believe he is a threat to himself or others (with your evidence documenting this fact)
and send it by registered mail to the appropriate people in the hospital in which you are
trying to get treatment. These officials know that if they refuse treatment and the person
goes on to harm himself or others then they are liable which, in the US, could easily result in multimillion dollar judgements.

Step 5. Repeat step 4. as often as necessary

Step 6. Don't give up on your son - be persistent because frequently the squeaky wheel gets the grease. Read through the archives of this discussion group and you'll see a lot of postings by Carol Wilson who has fought tirelessly to get appropriate treatment for her son. She is a good model.

Step 7. Learn as much about the illness as you can - review the information at this web site, read some of the recommended books, and subscribe to the free newsletter I put out.This
will make you much better prepared for helping your son or daughter.

Other ideas folks?

Brian,

In additon to your excellent suggestions, I would like to add that you cc your letters to the
people over the person to whom you are writing, your local AMI or Mental Health
Association, and your state and federal legislators. Federal and state legislators are very good at assisting their constituents, and many times an investigative letter from one of them has positive results.

Also, document every phone call you make or receive, including date, time, person, and relevant quotes and info. Be sure to quote yourself too, so it does not look one-sided and it will give you more credibility as a documenter.

IF you need to, follow up with a letter,"On such and such a day, I understood you to say
that my son was not a danger to himself and therefore not a candidate for hospitalization. This was after I told you he was not eating due to believing his food was poisoned, and he has lost 75 pounds." You get the idea. CC that letter up the line of authority. People will tell you some ridiculous things on the phone that they would never put in writing.

So you put it in writing for them and create your own paper trail. Send all letter certified mail, return receipt requested. I learned a lot of this from DJ Jaffe's excellent posting here at the AMI/NY website. Be sure to thank everyone who helped you. The secretary of health and hospitals here never acknowledged personally any of my cc's, although he had people investigate, etc., until I sent ones of appreciation or of commendation for staff doing their jobs well. I also had read in the paper where he was engaged, so I sent a congratulatory letter. So, if a major event happens in a policy maker's life, be alert to it, and send them an appropriate letter. That way they see my name besides with a complaint or concern.

Carol

Robert,

My sympaties are with you during this most difficult part of the disease. I have a suggestion based on your posting, although it may be difficult to do. You said that your son had
threatened to kill you. If this happens again, IMMEDIATELY pick up the phone and dial 911. They can make a report of this threat, which will help convince a judge that he may be a danger to society (even though he would probably never act upon his threat.) If alerted, the police may also bring a mental health worker who will have the opportunity to see your son in the middle of a psychotic episode.

Leonard

I am going to suggest two options, neither of which are pleasant. My brother is
schizophrenic, but quiet; wouldn't harm a fly.

The first time we hospitalized him involuntarily was because he pushed my 82 yr. old father lightly. I called the police the next day who put me in touch with the local mental hospital, who
put me in touch with the Missouri Mental Health Coordinator. She came out to the house within 3 hours, and "interviewed" my brother. (Turned out it was me he meant to push, but my dad happened to step between us.) We gave him an ultimatum--go to a private psychiatrist or my dad & I would sign affidavits that he had pushed my father. That's what we ended up doing and he was committed--after at least 15 years of problems, at the age of 38 we finally learned he had schizophrenia. (Unfortunately he denies his illness, refuses all medications, etc.)

The second time, I realized (& I talked this over with my father and a psychiatrist) that I
was going to have to LET him injure me. I just figured that the risk of getting hurt was worth getting him medicated (He now has a progressive fatal illness and the doctors won't treat him for it unless he is psychologically stabilized first). During one of his arguments with my dad, I motioned to my dad to calm down and very quietly said to my dad not to try to disprove his delusions; my brother got up and came over to me. It was a split second decision--I decided to hold my ground. He pushed me and I hit my toe on the table leg. I called the police, who came over and explained to my dad (who had reluctantly signed that first affidavit a year before) that we had to get him committed to get him help. The next day I went to the doctor (fractured little toe) and I called the same coordinator. Luckily I had kept a blank affidavit form, so I just typed up what had happened, got it notarized at the bank, and faxed it to her and the sheriff picked him up within 48 hours. So for a $120 doctor fee and the hassle of wearing that bootie for 3 weeks, we got him in the hospital. BUT IT'S RISKY--You can get hurt badly--I just lucked out.

The second option (which we did not use) and may be considered  unethical. Before he pushed my dad, my dad & I met with a psychologist we knew and described my brother's symptoms. He figured it was schizophrenia, and told us that if the only way we could get him hospitalized was to lie, then we should Lie that he hurt one of us or himself. I was considering it, but within a couple of weeks he pushed my dad instead.

Check with your state mental health coordinator re: the criteria for committment in your state. Find a lawyer who deals with committment hearings for advice. If you're not located near an area with lawyers who deal in this, you're going to have to hope you have a coordinator who will literally speak to you in a way that will help you phrase the affidavit in a manner that will make your request for committment VERY strong.

GOOD LUCK, but remember, even if you get him in the hospital, you may not be successful in getting him to take medicines, or even admit that he is ill.

Dear Bob, Our son was just like Steve a year ago, nothing would convince him to go to the hospital until we threatened to cut ourselves off from him completely. He was stranded with no money and no place to live, all his belongings in a Ryder Truck and no where to go and no way to pay for the truck rental. He had moved out of the apartment in his cousin's house where he had been living because he was convinced that his cousin was trying to control his thoughts and had stolen all his money and that the people next door were spying on him.

We told him that we would do everything in our power to help him if he would go to the
hospital but that we could not have anything to do with him if he would not. Thank God it
worked. We had to have a similar confrontation while he was in the hospital to get him to take meds and another to get him to move into a group home. Today, a year later, he is much better. I don't know if it will work with your son and it is a very difficult thing to say....what if he takes you up on it? You have to really mean it. Once they got him in the hospital he started threatening all the nurses and himself so they would not let him go and committed him. This was his fourth hospitalization. He's doing very well now. Good luck. Keep us all informed. We know what you are going through and feel for you.

Barbara

And now for my two cents: The suggestions above are excellent. Added tip: Most places where you send letters will honor your request if you wish your letter to go in a certain place (your relative's hospital records; counselors record on relative, etc.) Tip: If you are sending your letter to a place where your relative has a record write in the letter the follow: "I am
requesting that this letter be placed in my son"s/daughters hospital record etc.) MAKE
SURE YOU KEEP A COPY OF WHATEVER YOU SEND I know that some of these suggestions are very time consuming and some of us family members are not good at writing, but in the longrun it is helpful. Don't worry that what you write has to be perfect English, spelling or even typed. Longhand is find, if your penmanship is fairly good. If any of you would like samples of how to write certain types of letter, let me know, I'll try to work on some samples. Carry on! Rose

Good point, Rose, about requesting the letter be added to the permanent records.

Also, as far as samples go, I have a host of them in my computer already. Brian, if you
would like, I can make them generic and perhaps they can be put at the website for people to copy?

Carol

Carol, Brian, others; As we all know when we are in a crisis, exhausted or too emotionally drained to think it is very difficult to try and compose a letter. In order not to duplicate
efforts is there anyway we can inform one another what we may have that can be re-written for general use? Carol, you are better than I in composing and probably have more updated material...mine are mainly letters regarding in-patient issues. (I have one requesting that I be
invited to treatment meetings regarding my son when he was hospitalized if you wish me to
rewrite for general use. ) I can e-mail it directly to you Brian first for review...and Carol for
proof-reading..if you wish. Any spelling errors are totally mine!. Poor in spelling and not
much better in typing. Keep me posted. Rose Bauer

Robert, I just read your posting. I hope by now (3 weeks later) you have been able to get
some help for your son. If not, maybe you might try what worked for our family. My
brother in law is close to the age of your son. His sister told him that the whole family,
especially their mom, thought it must be so exhausting to have to deal with the constant
threats and secret messages from the voices, and it must be very scary trying to stay alert day and night to try to figure out the next move the conspiracy was making. When she suggested that under the circumstances, a check-up would be a good idea, because he had to maintain his strength to continue handling all this, he agreed and he checked himself into the psychiatriac unit through the ER a couple hours later. We were totally surprised and enormously relieved that it worked. Maybe something like this might work for your son, especially if it comes from someone near his own age. Please let us know how it's working out. Good luck.