Each week, I receive emails from parents seeking advice. I am not a trained therapist, psychiatrist, psychologist or social worker. I’m just another parent. But I feel compelled to answer most of these emails with suggestions that are based on my travels and personal experiences.
What follows is an email that is representative. In addition to publishing my response, I have asked several highly-respected advocates to respond to the same email. I will print one of their responses each day this coming week. I hope this week-long exploration will spark a helpful exchange of ideas and give parents practical advice.
We have tried to get our son professional help. I think he has bipolar disorder, although he possibly could have schizophrenia. We know he has an alcohol addiction. He has not cooperated with hardly anything, and we’ve been unable to get him to go to our local mental health center, although officials there said he is eligible for treatment.
We feel like our hands our tied. The few times that we’ve gotten him to a psychiatrist, our son denies that he is sick, won’t take his medicine, and is extremely hostile to doctors for the short time he’s being seen by them. We’ve had him in our house for several months with his erratic moods and high level of anger. Yesterday he asked to go to a homeless shelter and he is now on the streets. If we try to visit him, he runs away.
His dad and I are at the point where we feel resigned that there is no hope nor help for our son. The system has worked against us at every turn … and he needs help. People have recommended “he needs to hit rock bottom” and that we need to wait for him to *want* help. We simply don’t know what to do. Do we wait for him to hit rock bottom on the streets where we know he is not safe?
In our view, the mental health network has been ineffective at best, and is rolling the dice with people’s lives. Now we can see how barriers in the mental illness system keep people from receiving basic services. This has been hell for his dad and me, and I’m sure worse for our son.
If you have any advice please let us know.
— A concerned parent.
Dear Concerned Parent,
From my dealings with my son, I know how horrible this can be and how worried you are. Here are ten suggestions.
1. Please know that you are not alone. There are many parents dealing with the same issues as you. I would urge you to contact your local chapter of the National Alliance on Mental Illness or Mental Health America. Perhaps some of the parents in those organizations can offer you guidance about how to best deal with your local mental health system. You also might wish to take NAMI’s Family to Family course. It can help you gain perspective.
2. Have hope. Never give up. Sometimes parents have to change their expectations. These are cruel diseases that last a lifetime, but without hope no one ever gets better. You have to believe your son can get better if you want him to get better.
3. If your son is living in a homeless shelter, contact its director. The shelter might be a way to get your son into a local treatment program. Don’t be shy about being an advocate even if your son doesn’t want your help. Let officials know that your son has someone watching over him.
4. Find out what is available from your local mental health department. Does it have a crisis response team? I would NOT call the police. Even if you are fortunate enough to get a Crisis Intervention Trained officer, your son has not broken any laws. Both times that I called the police, it ended in a disaster. My son was arrested and shot with a taser. Only call the police if you believe your own life is in danger.
5. Seek help from others. See if your local mental health department or a mental health group has a peer to peer program and if so, learn if there is someone with a mental illness willing to speak to your son. Reach out to someone familiar with mental illnesses who your son might trust. Don’t waste time arguing with your son about his delusions.
6. Familiarize yourself with the law. The Treatment Advocacy website is a good place to learn about involuntary commitment laws. But I would only seek an involuntary commitment if your son became so psychotic that you feared for his or your safety. You mentioned that your son has an alcohol problem. That is not uncommon among persons with mental illnesses. About forty percent self-medicate. Many states have laws that permit parents and others to have a loved one involuntarily committed for drug or alcohol use. In Florida, it is the Marchman Act. These laws have lower thresholds than “dangerousness” because addictions are already considered dangerous. Again, I would only use involuntary commitment as a last resort because it will more than likely drive your son further away from you.
7. Contact professionals. Xavier Amador has written a book called I’m Not Sick, I Don’t Need Your Help. In it he offers practical advice. You can read more about his work at LEAP Institute. Another excellent source of information is Shrink Rap. There are several other websites that offer insight into mental illnesses. If you seek professional help from a psychiatrist in your area, do some research and make sure the doctor is worth seeing. Oftentimes, community psychiatrists are more familiar with patients, who don’t think they are sick, than private doctors.
8. Realize that the healing process will take time. Your son didn’t get sick overnight and he is not going to get well overnight either. There are no quick fixes for severe mental disorders. You are in this for the long haul.
9. Understand that there is a limit to what you can do. I wear a chain around my neck that has the Serenity Prayer on it. “Accept the things I cannot change.” But I add — accept them begrudgingly and only for this moment. Advocate for change.
10. Get involved in helping others reform our system. Helping others will help you too.
Tomorrow: Dinah Miller, MD., a psychiatrist, author and past president of the Maryland Psychiatric Society responds to A Concerned Parent.
Dr. Miller is best-known for being a co-founder of The Accessible Psychiatry Project, along with Annette Hanson, M.D. and Steven R. Daviss, M.D. It strives to encourage dialogue about psychiatric disorders and their treatment in order to explore issues of controversy and misunderstanding in the field. Through open dialogue, in both new media and print, the three doctors foster discussion about the work that psychiatrists do, and work to decrease stigma associated with the treatment of mental disorders. Components of the Accessible Psychiatry include:
Shrink Rap: Three Psychiatrist Explain Their Work, a book endorsed by Pete Earley
Shrink Rap: A blog, now going into it’s fifth year with more than 1,300 posts
My Three Shrinks: a podcast, with 55 episodes aired on iTunes.
Dr. Miller’s newest book is a novel, HOME INSPECTION. It is a fictional story about Dr. Julius Strand, a psychotherapist who plods along in his already-lived life until two of his patients inspire him through their struggles to find love.