Need help committing a family member

Jules A, MSN · Oct 29, 2008

Hi,

The only advice I can offer is to take her to the ED.

Good luck.

SuesquatchRN, BSN, RN · Oct 30, 2008

I wish I had something to impart.

My sister has schizophrenia, has had for 35 years now.

I'm sorry you and your family and your sister are going through this.

Jolie, BSN · Oct 30, 2008

I'm sorry for your situation, and sincerely hope you are able to get help for your sister, for the sake of your entire family.

We have a bi-polar family member, and when he needed (but refused) treatment, the local police became our best friends and advocates. He was creating disturbances all over town, so they were well aware of his condition. When his behavior reached the point of being "a threat to self and/or others", the cops helped us to get him to the ER. They also provided testimony before the judge in his commitment hearing. We desperately needed their objective testimony of his escalating behavior to convince the judge to force him into treatment, since this family member was good at "behaving" in front of influential people.

It was probably to our advantage that this took place in a small town where he was well-known to the police force. In a big city where a different cop responds to every call, it might not work so well.

Take care.

TraumaNurseRN · Oct 30, 2008

I'm sorry for your situation, and sincerely hope you are able to get help for your sister, for the sake of your entire family.
We have a bi-polar family member, and when he needed (but refused) treatment, the local police became our best friends and advocates. He was creating disturbances all over town, so they were well aware of his condition. When his behavior reached the point of being "a threat to self and/or others", the cops helped us to get him to the ER. They also provided testimony before the judge in his commitment hearing. We desperately needed their objective testimony of his escalating behavior to convince the judge to force him into treatment, since this family member was good at "behaving" in front of influential people.
It was probably to our advantage that this took place in a small town where he was well-known to the police force. In a big city where a different cop responds to every call, it might not work so well.
Take care.

How did you go about committing him? Who did you contact first?

Jolie, BSN · Oct 30, 2008

There was an incident at a local business. The manager called a family member to come intervene. The family member then called the police and asked that they meet her at the business. The cops agreed to try and talk him into going voluntarily to the ER, but would have taken him forcibly, if needed. He ended up going without force. The cops hung around until he was safely admitted to psych.

RN007 · Oct 30, 2008

Is there a mental health facility near you that you can call? In my crisis stabilization unit, we frequently get triage calls. We either refer them to our admissions social workers who conduct further assessments or to the ED on weekends/nights, where the RNs do the assessing. My heart is with you ... keep us posted ....

flightnurse2b, LPN · Oct 30, 2008

i don't know where you live, but many states have programs where if the patient is either a harm to themselves or others, they can be involuntarily committed and evaluated for atleast 72 hours, then a psychiatrist will evaluate and see if she needs further treatment, longer stay, etc, and will also keep her safe in a psych facility or hospital until she is medicated and has had some therapy sessions.

in florida, it is called the baker act, and anyone can call a concern and an MD can initiate it, and we used it in the ED alllllll the time. i know other states have similar laws. especially if you work in the ER.... someone there should be able to help you with crisis intervention.

i wish you and your family the best.

Mariposa88 · Oct 30, 2008

i think how you go about it is dependent on the state you live in, also the age of your sibling.Probably calling a crisis or psych unit, or ED would be a good start. Especially if she is in immediate danger to herself or others.

TraumaNurseRN · Oct 30, 2008

Alittle bit of background:

3 years ago her husband left her and at that time she lived nealy 5 hours way. During a phone conversation late one night with me she threatened suicide. I pleaded with her to call 911 and go to the nearest ER. We got in an argument on the phone and she hung up on me. Refusing to answer her phone. I called 911 from my home 5 hours away. They took her to a hospital ER where she was then admitted to there MICU after 75 pill OD, then transferred to the CCU due to increased potassium levels. I drove down that early morning to the hospital where she was admitted and basically had to beg them to admit her to the psych unit. (She had manipulated them and they were going to dischage her) Knowing I couldn't obviously stay in her town forever, and she was alone there.....I forced her to pack as many clothes as she could and drove her to my home town where my parents sill reside) My sister was 37 @ the time. Since that time she has been living with my parents, has divorced from her husband. Has been unemployed and attemtping to obtain SS bennifits to no avail. She did obtain a good paying job but was fired before her 6 months probation. (She has a hx of losing jobs) Since she has resided with my parents....episodes of drunkness, manipulation, poor behavior, bad decisions seem to wield it's ugly head every 3-5 months. Her license has been taken away due to a DUI and uncooperative behavior with the police. At what I call "Drunk School" she was kicked out because she threw a fit about wanting to take more than one of her prescribed meds for anxiety and the nurses refused so they called my parents to come and get her. She had to repeat the school at later date. She is out of control.....and now there is another issue going on that I will speak later about once I get more details later today. I know I can take her to the ER...I have done it before. I guess my question is....How do my parents get her committed for more than a 24-72 hold in some psych unit? She needs to go somewhere long term. Right now since she is not working and has no insurance, the hopitals aren't going to keep her.....you guys know this, I know this. How can my parents can legal documentation to deem her incompetent I guess is my question...because at this point they can't force her to do anything. :cry:

PS: Thankyou for all the advice

goettin98 · Oct 30, 2008

TraumaNurseRN,

So sorry to hear of your situation. It's difficult to face a relative going through a hard time.

First of all, it infuriates me that they did not admit your sister to psych after such a serious attempt (her OD)! That's pretty much unwritten protocol in my hospital- the pt comes in, goes to ICU until they're off the vent, then gets transferred to us. I don't know the whole story, but from what you said, that borders on medical neglect in my book. At that time, your sister would have been totally appropriate for an involuntary admission (I don't know where you live, I am just telling you how it would have been done under IL mental health code).

The criteria for having someone involunatarily committed is "Are they a threat/danger to themselves or someone else at the time of admission?" If the answer is truly yes, and that answer can stand up in court and an MD will be willing to back it, we've got a case. Understandably, if there's not good reason to commit someone, the MDs won't do it because they're legally responsible.

As far as your sister's behavior goes, sounds like she may have quite a bit of an Axis II diagnosis going on (just my opinion, not diagnosing). Those are hard to treat and even more frustrating for the families, so I am sending you lots of support. When you say she's having episodes of drunkenness, is she getting a little drunk once a week or super, blacking out belligerent drunk every night? What I'm saying is, do you think there are enough severe behaviors to have her committed? Honestly, I work as charge RN often and I hear about many pts in the ED who I think are will be admitted right away and then I hear back later that they got sent home after screening because the MDs don't think they can commit them. It's shocking, really. Please don't think I am in ANY WAY discouraging you, I just want you be prepared for what could happen because it does happen frequently (where I work, anyway).

Also, the long term hospitalization- in IL once you're admitted, you're there until the MD discharges you. It might be a day, it might be 3 months. There is no set period and we make sure to tell pts that upfront. If the pt is involuntary, they will be going to court hearings on the floor and the MD and nurse documentation have to maintain good reason for that pt to still be here. If that can't be found in the chart by the judge, usually the pt gets to sign a voluntary which usually means they sign a 5-day notice as well, or the MD has to release that pt. Sorry I can't offer you better advice on the long-term hold part, we don't have a set 24-72 hours for our pts. You also said that your sister doesn't have health insurance, but I would say 90% of our pts either have Medicaid, Medicare, or are self pay.

Let us know how it goes. We are thinking about you.

Jolie, BSN · Oct 30, 2008

My experience was in IL as well, where the standard for involuntary admission is "immediate threat to self or others". Other states have standards that are easier to meet, such as "unable to care for self".

So my first bit of advice is to find out what the standard is in your state.

Secondly, I would suggest that you obtain the paperwork necessary for involuntary admission in advance and begin to fill it out. We had to document a number of episodes of dangerous behavior that demonstrated a consistent pattern. With the forms in hand, we were able to document incidents over a number of days, while they were fresh in our minds, and while we had access to witnesses. When the "final" episode happened, the cops were willing to intervene because we had documentation of multiple examples of his behavior. If we had not recorded the previous incidents, they may not have been willing to intervene when they did.

Keep a written log of things like drunken behavior, drug use, mixing of drugs and alcohol, threatening others, driving while impaired, creating "scenes" at local businesses, rages, small crimes such as shoplifting, driving off without paying for gas, etc.

Best to you. You are not alone.