family member with progressive "mental issues"

[MellyOne]

I'm looking for advice.

Mental illness appears to run in my family, though only one or two individuals has ever sought treatment-really there have only been 2 of us who admit that something may be wrong. One of my family members, my aunt, does not seem to realize that something may be wrong, but she is really starting to become "scary." (btw, I requested advice about an aunt and radiation treatment side effects in another thread. This is not the same aunt.) She is becoming increasingly paranoid-to the point where she is certain her step-father is either a.) going to kill her, my sister and I or b.) hire someone to kill her, my sister and I. She strongly advises my husband and I to leave our current home now because we are in danger. She will not come to visit us because she feels that someone will follow her here, and she can't risk putting us in more danger. In the past she has told my dad that he was in danger because my grandfather was angry and was going to kill him (not a chance). After her first husband died, she packed her bags and went to the river to wait for him to pick her up. I could give all sorts of stories, but the point is that I am afraid that she will either inadvertently hurt herself or someone else in trying to protect them. I don't know what to do, so I figured you people here have had experience with these matters and can direct me in the right path.

She's such a kind, caring, selfless person whom I love very much. I don't want to see her like this, but don't know how to even start helping her.

So, if you have any advice, please let me know-either here or PM. Thank you so very much!

[traumaRUs, MSN, APRN]

So very sorry. Please contact the National Alliance for the Mentally Ill. With medication, many mentally ill people can keep their symptoms at bay. Many communities have emergency assistance too - usually under Emergency in the phone book. In my area, they come to the homes to do emergency assessments and emergency committments if necessary.

[rn/writer, RN]

Keep a diary of her behavior and statements. This could come in handy if it comes time to do an involuntary committment.

Keep an eye out for areas of neglect--hygiene, nutrition, finances, etc.

HIPAA ties your hands on many things but if you know who her physicians are (check prescription bottles or mail), you can give them information, even though they can't tell you anything without her permission. They really can't even confirm if she is a patient, but you can acknowledge that and say, "If she isn't your patient, ignore what I'm about to tell you. But if she is, it might help you to know that she's . . ." Then tell them anything that is pertinent. Try to track down all the meds she might be on. They can influence mental status.

Write up a basic family history that lists the type of problems ( hers and others') that you've seen over the years. Include instances of substance abuse because bipolar disorder has something like a 75% co-morbidity rate (it's an attempt to self-medicate because they KNOW something is wrong).

If there are any supportive family members, enlist their help in coming up with a plan.

I have been a psych nurse and and EMT and if she is truly delusional, you may be able to get a temporary involuntary committment for the purpose of an evaluation. If she has some kind of budding psychosis, that really needs to be looked at. You don't say how old she is, but the onset of schizophrenia is usually late teens through the twenties. It CAN start after that time, but it isn't as common. There are a number of other conditions--internal and external--than can give rise to paranoia and they should also be checked out.

She really should be screened for depression, thyroid problems, Alzheimer's, dehydration, med interactions, etc. Your family history might indeed by what's behind her current problems, but she wouldn't be the first person who has something else going on that was missed because of an assumption about the "obvious" diagnosis. She may have more than one thing going on at the same time.

If you can get her to designate you or some other trusted person as her HPOA, that would be great. Then you could openly discuss some of these issues with care providers.

Do call your county mental health dept. and ask for ideas, referrals, admission criteria, etc. If you can have a plan ready in case a crisis hits, so much the better. If your aunt is older, seek a clinician who has experience in gero-psych issues.

When your aunt starts going off on a rant, ask her questions. Listen to what she is saying. Many times, a mentally ill person gives clues about what's troubling them, but the information is in code or it uses symbolic threats to speak of real ones. Also, you should be able to get an idea of what she perceives is happening to her. It may be totally off the wall, but you need to look out through her eyeballs to know how scared she feels.

Don't ever feel you need to "play along" with delusions. Tell her you aren't seeing the same things or you don't share the same ideas, BUT you can still be supportive of her as a person and let her know you care about how frightened and unhappy she is. Offer to get help for her. Go with her to the doctor if she'll let you make an appointment.

Once again, keep a record of what is going on. Besides being potentially helpful with an admission, it might also reveal a pattern or an escalation. Document it just as you would patient charting. Quote her own words. Describe what you see (not what you think it means). List attempts to help her and make note of the results. Keep a record of anything that seems to make things better or worse. Write down whatever you think will help you "paint the picture" for a doc or a police officer who might have to take her in against her will. Give them the tools to see that she is deteriorating and needs help.

She's very fortunate to have a caring and competent family member looking out for her. I wish you both well.

[Thunderwolf, MSN, RN]

I am sorry to hear this as well. You have received some valuable input here. I hope this helps.

[MellyOne]

Thank you all for the help! I appreciate it!

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I am sorry your aunt is suffering from this. I hope she gets treatment somehow. It must be an awful feeling to be paranoid constantly.