When My Crazy Father Actually Lost His Mind

Locks appeared on the property, and started moving daily, if not sometimes hourly (different keys, combinations, etc.) I invested pretty early in a good set of bolt cutters.

I learned quickly to start any approach and conversation with "Hey, dad" otherwise he would seem to decide I was a stranger up to no good and try to run me off the property.

He would have moments of lucidity where he would admit he was terrified, that he was pretty sure he was losing his mind. But they were pretty fleeting.

I remember one night he kicked my mother-in-law out of their house, claiming he was going to kill anyone who came in. The Sheriff was called and it was mentioned that not only was he a Korean war vet, he had guns in the house.

That was the night SWAT stayed outside our houses (we live next door) until morning, as my father-in-law hung up on the Sheriff's Deputies and refused to answer any subsequent door knock or telephone call.

Early that morning it was surreal to see the SWAT team serpentining across our lawn, guns drawn. My father-in-law answered the door, invited the Deputies in for coffee, was confused when they took him into custody, then handed me his keys saying he didn't know what he did, but apparently he was in trouble and I better watch over the place.

Turned out he had a toothache no one was aware of and was having a hard time coping with the pain, since he couldn't stay focused long enough to tell anyone about it.

Luckily, no one was hurt over that whole period and my wife got to spend the last year and a half with her father before he died of cancer and complications from Alzheimer's.

It has also resulted in some long talks with my wife about how long either of us wants to be kept alive, in the result of not being mentally with it, or mentally awake in a failing body.

We learned quite a bit about Power of Attorney and Medical Directives, as well.

You expect a schizophrenic man to argue to the judge that he shouldn't be committed because when he said he was going to shoot his kids with a shotgun, he didn't really mean it; you might not expect his perfectly sane court-appointed lawyer to pick through every detail of your records looking for a reason to let him out.

My mother called me last week upset nearly to tears by a phone call she'd had from a "doctor" employed by an insurance company, who was trying to argue that her patient's mania (which he knew nothing about) wasn't a serious enough medical problem for them to pay for treatment.

At this point she's planning to get out of clinical work; she wants to help people, but she feels like the system just isn't set up to let her make a difference.

We need to fix this a decade ago.

I am the IT manager at a non-profit Mental Health organization and I spend my days supporting the people who support the mentally ill. I also have mental illness in my family.

Contrary to the portrayal of mental health professionals in the piece, these people are intelligent well-meaning individuals who are severely over-burdened and undervalued (A masters-level social worker starts out making $12/hr). Combined with the absurdity of state laws and general ignorance in most communities, it's a wonder that anyone gets treated at all.

In the UK there is someone called a "nearest relative". This person is defined in law[1] and has some powers. If the nearest relative says that a person should be detained in hospital the clinicians must "consider" that option. They don't actually have to do it, but they have to record that they've heard the request, and that they've considered the request, and that they've declined that option.

When you are worried about the mental health of someone you should call their GP. This can be an emergency appointment. S/he will come and assess the person, and maybe ask for a local "crisis and home resolution treatment team" (might not be called that in your area) to come and assess the person. Hospitalisation is sub-optimal, patients have strict[2] rights, and so it can be hard to have a person detained against their will in hospital. It is not lawful to say things like "Go voluntarily or we'll section you", but sometimes the person can be persuaded to go voluntarily.

If the person is out of the home you should either get them home and call a GP; or call the police. The police have something called a "section 36" where they can detain someone for a short time for assessment. This should be a "place of safety" - unfortunately this place of safety can be the police cells, rather than a special building.

Once someone has had a psychiatric incident it's a really good idea to make a "Rainy Day Action Plan". You keep notes of useful phone numbers and contacts[3] and instructions from the person about signs to look out for, and what to try and do, and what to do when things get really bad. You make the person write on this, and sign it. It is their document, and it's important that it's their words and wishes. This certainly helps if you need to get them hospitalised or medicated in future.

UK law is a bit complicated. Every patient should have advocacy available, and I certainly recommend that people try to get hold of advocates.

I am not a doctor or clinician or etc. This is just anecdotal advice from a random internet stranger.

[1] (http://www.dh.gov.uk/en/Publicationsandstatistics/Legislatio...)

[2] Sometimes those strict rights are ignored. It's very annoying.

[3] There's a lot of churn in staff in MH services. Don't expect those contacts to stay valid for very long.

"21% of patients with bipolar disorder and a diagnosis of severe substance abuse (alcohol or illegal drugs) were convicted of violent crimes, compared to 5% of those with bipolar disorder but without substance abuse, 5% among the unaffected siblings of bipolar patients, and 3% among general public control individuals."

Source: http://www.ncbi.nlm.nih.gov/pubmed/20819987

I haven't actually read the study much less the rest of the research on this, but the actual statistics on this (whatever they are) seemed conspicuously absent from this article. In fact there really really no statistics whatsoever. It's a heart wrenching story, but there are good reasons why it's generally not a bad idea to create public policy based solely on individual cases.

Granted there isn't nearly as much research as there should be, and at some level you eventually do have to go with your get because of that, but at the same time there is a hell of a lot more evidence than was presented.

But in 2011, when she had another bout, the hospitals refused to hold her for more than a week, and she was returned home only to be a nuisance to her landlord and a weirdo on the street. The social worker said to ask the police to take her to CPMC or St Francis (private hospitals) who will be more likely to hold her for long enough to recover instead of SF General, but since then she hasn’t been an imminent threat; merely a loud, paranoid insomniac who can’t get anything done.

It’s very difficult to reason with her regarding her illness, which she denies when she’s manic. I don’t know first-hand the facts of her police mistreatment or landlord interactions or whatever she happens to be angry about, so I can’t convince her that she’s wrong. Oh, and she refuses to take her medication because she’s convinced that they will ruin her liver. I sometimes wonder whether a smarter, more introspective manic person would be able to deduce logically that their paranoias are irrational and rein themselves in. But alas, her poor concentration and temper hare never allowed her this power.

I recognize the need to expand involuntary commitment laws to include evidence of recent events beyond the past 15 minutes of an interview. I agree that something does need to be done about dangerous people in general, regardless of whether they are mentally ill or not. This is a problem that needs restrictive and supportive measures on many fronts.

However, most mentally ill people are not dangerous. The author's use of circumstantial stories, instead of statistical evidence strongly distorts the reader's understanding of a typically mentally ill person. In her story, almost every mentally ill person she mentions kills someone. But as the author says in the end, the mentally ill are statistically less likely to harm another than to be harmed by someone else.

I think that some of what the author hopes for is a good idea, but if people could be forcibly treated for mere delusions or minor symptoms, then that also includes the huge percentage of normal Americans who believe in or claim to have seen ghosts. Do unusual religious beliefs count as insanity? Are your political views ever considered 'irrational' by someone else? What happens to free thought and religion?

The problem with creating laws that chip away at civil liberties is that these laws can be abused or stretched to cover people who are in a 'grey area' and aren't a real danger. Those in power can take laws and apply them according to their personal preferences and values, at the expense of those who do little harm.

I think it's a good idea to have involuntary commitment laws only for the rare dangerous cases that exist. But in addition to that, human support is needed. Treating people well and showing gentle empathy will help win them over to the side of those who are trying to help. In the end, let's not harm the large majority who are closer to the middle of the grey area, and aren't dangerous.

There are similar issues in the UK (another member has posted a summary of the UK legal position below).

What happened to 'asylum' in the original meaning? Places of refuge?

But since we are in the USA, this will take decades to happen, if ever. The only hope is a massively profitable, universal drug is invented, then pharmaceutical companies will fall all over themselves spending a fortune to market it like viagra and make it "hip".