Discouraged at Mean Behavior

Well, the good news is they moved my brother to the psychiatric ward of a hospital from the behavioral center where he was being treated when his Medicaid mental health benefit ran out.

So, at least maybe he will continue to get treatment (hopefully).

But now he has decided that everything that is wrong in his life including his being in the hospital is my fault. (Never mind that I wasn’t even there when he was admitted.) He is refusing to let me talk to his nurses about his care as well.

There are other ridiculous accusations as well.

I know this is part of the disease so I shouldn’t be hurt. But the truth is that I am hurt. My adult daughter pointed out that his mean comments to me are abusive and I shouldn’t put up with it. I’m not sure that she’s wrong.

This is pretty common. My brother is convinced that my parents ruined his life by taking him in and helping care for him. (Ignoring that before that he was homeless and failed to keep any job.)

Technically, he’s not WRONG, in the sense that you or others directly influence his stay in hospital and the reason he is there. (Unless he was picked up by paramedics) But his frame of reference, like my brother’s is extremely skewed. Before being in hospital every single detail of his life, when it comes to paying for food, finding shelter, and getting work, was something his delusions made him unable to handle. While we tried to give him as much independence as we could (letting him cook some things with supervision or help only when he asked for it.) his perception is off. We lived with the reality for years.

In another sense, I agree with your daughter, it is a form of abuse. He wants to blame you and the emotion (and lack of gratitude) are hard to cope with. He can’t perceive that he is wrong and yet it still hurts. Such to the point that if he were given the chance to be on his own, you know better than anyone what a zoo it would be. My brother hasn’t managed independent living the 6+ times we tried to get him into low income or regular housing, no matter how much support he was given because he tried to light things on fire, couldn’t/wouldn’t stay on meds ect.

The scary part is knowing his obsession with fire and touching/holding “light” means, he can and does burn himself, and he would be willing to burn down other areas if we didn’t at least try to contain him. Cartoons are a particularly fraught medium because most kids can recognize what playing pretend is, they can recognize it, have fun, but then reintegrate what they experience into the real world and a delineation of what it true and false.

A person with your or my brothers issues cannot. He thinks of them as some sort of spiritual message or code from the universe or the antigovernmental agencies. Likewise, being put in hospital is a limit to his freedom but it’s necessary especially if the services who picked him up deemed straight away that he needed an intervention. Their metric for “Something is definitely wrong” is WAY more tuned in than ours.

My only other advice is get in contact with Social Services and explain the situation. If he won’t accept help from you (or more specifically blames you for his problems, thus, getting back to the problem of no accepting help), they need to be aware of what is going on. If you get the ball rolling on supportive housing and economic benefits ect, then he will hopefully be better off than just waiting for the meds and his eventual discharge to come around the bend.

In summary, I can only say, “Get him the help he needs” but realize you’re probably never going to get an apology or a call of thanks from him.

His mental illness is such that there is little to no self-perception going on, hence why most approaches to reality testing or bargaining don’t work. He’s willing to likely be inconsistent with his demands or feelings in a way that is unreasonable, thus, there’s only so much you can do whilst working around them. The LEAP method works, only so long as the person can agree to some form of internal consistency with their delusions, desires, or wishes about living that you, their caretaker, can also agree with. It’s one of my only strict caveats to Dr. Amador’s approach to bargaining and treatment/therapy. You have to get someone to agree with something, but if the internal reality is so chaotic that no point of agreement can be reached, then we are at an impasse. Make what little agreements that you can, and then go forward.

Best of luck and my deepest sympathies. If he decides to reject you totally, your next position is to defend what people cannot defend themselves in your family and try to move along. It’s not easy and not something that anyone wants to contemplate, but it unfortunately happens. The number of mentally ill homeless people on the street that have family but have been kicked out after so many times of attempting to get them on their feet, is testament to this. Ultimately, moments of lucidity where they finally come to a realization that they need help are shockingly rare.


Thanks so much for your comment. I was feeling down today.

I do realize what you’re saying and know it’s true. But it’s still disconcerting to have someone call you and yell at you.

We do have a group home lined up for him, but he can’t go there unless he’s compliant with his meds. And based on his last call to me from the hospital, he might not be.

But I did find out that the hospital is planning on discharging him next week. I’ve been trying to get in touch with a social worker, but it goes straight to voicemail.

I guess I’m not sure how to use LEAP in this situation (I’m fairly new to it). Especially since he calls me and talks (or scolds) without stopping and then hangs up.

Your brother is blessed to have you looking out for him.

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I understand. I really do. My brother goes back and forth ALL THE TIME. Most days, he hates the world and his illness and that reflects back to hit us. He blames us for getting him on meds and in hospital but his periods of lucidity have made all the difference in him realizing (in small amounts) that his living situation was untenable. He hasn’t so much as admitted that he is ILL but that whatever his previous self was (his words, not mine) is something he can’t let happen again.

The clearing of the fog, when it comes the severity of his paranoia and inability to judge reality, has meant he has SOME way to test whether or not his feelings are real. The meds don’t really get rid of the psychosis for him, they put the dampers on everything for long enough that he can function.

I hesitate to ask what meds he’s on (and it’s likely you don’t know) but long acting injectable meds have been a lifesaver. My brother was previously unmedicated despite having had pills prescribed over and over again. With these, so long as he shows up to his appointments, we have an LRO filed with the court so that if he doesn’t show up, the cops and paramedics/mental health home visit team, come around. If he refuses treatment with them, he goes right back to the psyche ward and onward to try more medications. (As the paranoia/refusal is an indication they aren’t working anymore, especially after a stable period) They can give him his meds AT HOME, and he deals with a sore arm but no other real side effects.

An LRO (Least Restrictive Option) give community health and social work advocates the leverage they need to force my brother into talks and doctors appointments at a minimum. It doesn’t always gaurentee that he will take his meds but it means he has to have a conversation. If he goes or remains catatonic, and continues to say “yes” to out patient care without following up on Tx, he goes right back to the psyche ward. He knows this and we have NO other ways for him to manipulate us at this point. It’s entirely on him and a state aporatus that has meticulously documented the type and severity of his illness as a result of non-compliance and Tx.

We’ve been contacted by charlatans in the past. STAND League, is a direct agent working under the auspices of the (COS) Church of Scientology, if you’ve read or seen anything in the news about them or The Citizens Global Commission on Human Rights, you’ll know how much of a fraud they are. Lisa McPherson, is a member of the group who died as a result of the pseudo-scientific and unlicensed/unregulated Tx of her MI. The case is referenced extensively in shows like “Scientology and The Aftermath” by Leah Remini and Mike Rinder. (Former Head and Spokesperson for the COS). The founder of the “Church” L. Ron Hubbard, has Psychiatry labeled as persona non grata, thanks to the APA (American Psychiatric Associations) refutation of his book “Dianetics” and the subsequent religious cloak thrown over the entire range of practices and beliefs that ends up killing rather than helping members.

I realize this is a tangent, but it’s worth noting as people like this and subsidiaries of the COS, HAVE contacted my brother before. Suffice to say, any and all of their B.S especially considering the outcome of the Lisa McPherson case (she died after becoming severely dehydrated and malnourished)

(Warning: There are photo’s from the autopsy, ect linked within the webpage, which you don’t NEED to look at to get the full story. It’s gruesome enough but the entire archive is searchable in Google if you’re interested.)

means I don’t want these people anywhere near my brother. He’s ill, likely to be screwed out of his money, and desperately in need of Tx that can manage his Sx appropriately.

Thanks @Wederington034985

You’ve given me a lot to think about.

As far as I know, he has not been approached by Scientologists (not sure he would tell me if he was).

So, his psychiatrist was attempting to switch him to Invega (one injection only). After the initial injection he quickly went downhill. But now the hospital wants to try Invega again as he’s refusing oral meds.

I’m not familiar with the LRO—especially the part where refusing the injection is enough to send the person to the hospital. It took multiple 911 calls for this hospitalization (him getting sicker between each call).

Is the LRO available in all states? How did you get it?

LRO (Least Restrictive Care) options are available for any state which has something like the Baker’s Act, Kendra Act, Joel’s Law Petition, ect available. What it means is that you collect all information which shows a person is “grossly incompetent” or “disabled” meaning usually that they are unable to care for physical and daily health and wellness needs without assistance. Once this evidence is gathered, you submit it to the local court, where a judge will review the petition and see if service intervention with a 72-109 hour hold. WA state with Joel’s Law actually has one of the best policies in this regard. It guarantees 5 days for a mental health assessment instead of the usual 3 and will try and connect other’s to mental health and outpatient housing options, although like everything in the space the waiting list is massive. In other words, getting on the list sooner rather than later is the best available course of action.

This is called among the MH circles, the “Most Restrictive Care Option”. In a court hearing, it means that a patient is stripped of all of their rights to refuse care BUT the state by obligation MUST provide and attempt all other available avenues of treatment and continuing support services.

The “Least Restrictive Care Option” is an order, also granted by the court, which allows the COURT and local health officials to intervene as soon as a patient either A) Does not improve on their current round of Tx. Especially if they are in danger to themselves or others. or B) Does not continue with scheduled appointments and talking to the local health officials. While they cannot force them to take meds, somewhat ironically, if they don’t take meds OR follow up with therapy and timely personal checks from the Social Services (they genuinely do their best to get people situated with jobs, housing, or other Disability Aide and help/healthcare/money, options) then, they go back to Involuntary commitment. An LRO is usually what is put into place after an Involuntary Commitment Order, in order to get follow up care to these patients. The care team for your brother, as it sounds as though he was put in without your consent but via the assessment of the MH team, actually means they may be able to help file a court petition, so long as you outline how often he hasn’t been compliant with Tx.

The doctor wanting to retry Invega (if he has already had it before with little success) may actually warrant more follow up services coming to home or making sure that he attends Appt. With these meds, my brother is not yet able to drive but MAY (key word may) be able to get into a community car pool. This is faster than Community Transit, and allows him to have more weekly freedom when it comes to shopping. Disability Transit is good, but they have a problem with others either disallowing large items or on regular busses, things being stolen or scammed off of the mentally ill. (Someone literally offered my brother $40 for a brand new touch screen phone. It wasn’t the best model out their but the person in question wanted to hock it for drugs.)

This is a last resort after the patient has made repeated failures to show up for or attend treatment. It doesn’t mean they go to jail, but very often they are forced to talk to mental health professionals, and through them, get a different variety of treatment which may help their case better than their current medication regimen. What it means, is that for the most part, the entire apparatus makes it impossible for the Mentally Ill to be missed out by the legal, medical, and social care system. Given the number of people who have anosognosia or have never been fully Dx for Tx and medication because of their families shame/legal inability to intervene in an adults MI, it is a life saving law. Contrary to many of the naysayers, most patients resolve with either Tx or more support services (regardless of medication status) and allows them to have a degree of independence and community integration that otherwise would not have been possible under strictly voluntary and criminal or interpersonal violence and detention prevention measures. These have been the status quo since the 1960’s and their continued failure is why most states are trying this approach now.

Anecdotally although it doesn’t hold up to an objective assay, my brother has for the first time, been stable. He interacts with his care team, even IF he regularly throws abuse my way. He cannot and does not have the ability to harass us via his delusional thinking. Contrary to popular belief, the MH care police and Social Services unit has been nothing but kind and helpful to him, making follow up calls and counseling appointments to his permanent housing. He has a stipend for monies that takes what he needs out of his rent and has a health care aide that helps with things he can’t manage on his own. (Cooking anything outside of microwave, or dealing with his septic wounds. Gross, but absolutely a complication of his lack of hygiene due to MI and periods of homelessness.) He went to the dentist for the first time in YEARS. While he needs tons of work done, it means that he can eat more than mushed rice and soggy vegetables. He has put on 30 pounds of much needed weight.

NAMI has a list of resources on states which have involuntary commitment petitions, as a warning, most states are not so integrated with the legal precedence that it takes to get one of these petitions passed. We were denied with our version of the petition 3 separate times before my brother was FINALLY forced into hospital care for stabilization. He hasn’t been rotting in a jail cell without help as he has done in the past. He has a place to stay away from my parents but with enough supervision, that we as a family, have some peace of mind that should anything happen to us, something will be there to help him. With the lives we’ve lived, I’m never one to assume someone ends up homeless just because they’re mentally Ill or Lazy or worth less for picking jobs that don’t pay (or more realistically) haven’t paid a market rate, with a market share for housing, that is accessible to EVERYONE.

I know I will get labeled as a “Damn Communist” for one, but working with the MI and homeless for as long as I have, no one, no one really sees what it means to be homeless. Every movement that proports to “save the homeless and the youngest generation” has been a lie. Instead of insuring legislation works to afford multi-unit AND valuable stick built housing units (thereby also improving land usage rates and local wildland preservation) nothing has been done. bureaucratic toe stepping, and a quagmire of inaction has ruined whole sections of Seattle, San Francisco, and Denver. Taking action would mean that instead of waiting for people to cycle on the poverty breadline where they cannot care for their homes, they learn skills, have health and safety nets that mean they cannot or will not be in such a horrible place, when it comes time to work or retire or live. In a partnership with local land regulation, people could have solved the problem of homelessness, by doing what most of Europe has already done, make minimum land provisions that allow people to have affordable housing be built without exemption, into the land use code. If there isn’t some proportion of the population being guaranteed quality housing, regardless of economic status, it isn’t going to be built.

Letting go of the idea of “Not in my back yard” and actually providing land and healthcare and job opportunities that actually builds up viable cities will save people in the long run. The average lifespan of a homeless member of the population is 45. This is a life expectancy roughly equivalent to a pauper working dog-hours in Bangladesh or a blue collar tradesman, 100 YEARS AGO. This is unacceptable. It effects me. Has impacted my parents, and has meant that my early twenties was largely spent taking care of my brother instead of laying in my career roots, all because of a lack in social safety nets. This needs to change. There is no such thing, in my mind, as a “Pull yourself up by your bootstraps” mentality. Yes, you have to motivated to work, but almost everything is driven by convergent forces of opportunity and misfortune that we cannot control. Housing, healthcare, and education/retraining provision means that NO ONE has to face a reality where they die, of dehydration, of hunger, of poverty, of illegal drug overdoses, if only people were willing to look out for one another.

Ugh. Sorry. If you couldn’t tell, I have a passion for cutting through the B.S. Instead of telling me when the buck has stopped, tell me, the housing went through, that contractors and city officials actually got out of their padded offices and took care of someone. That they watched people seize from a Benzedrine Overdose on the street. That they bandaged gangrenous feet of a junkie and MH patient that couldn’t be housed because of insufficient patient care and follow up with medication and housing. The political jerrymandering has to stop some time, and the time is now.

No worries about the mental healthcare system being broken. It’s painfully obvious to me that the so-called protections for the mentally ill are really about spending as little money on them as possible.

What is Tx? I’m thinking my state must not have a LRO.

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Tx is shorthand for treatment.

An LRO is available once someone is actually in the MH system and needs to either be assessed to stay in a facility for more time OR that they can get by with community support. It is a court adjucated (enforced) order that makes patients accountable to come in for services and perscription pick up/maitnance. What it means is that patients can’t fall through the cracks again if they get out of the hospital. It’s not something that you can get UNLESS someone was already admitted to hospital.

An LRO is also granted if a citizen’s petition for a requirement for Mental Health treatment is submitted by family or friends who can vouch for that persons state of being. This is also evaluated by MH professionals and Social Workers. Unfortunately, with this system and the judges whim in the mix, it’s still not a guarantee without an LRO, that a patient can get the services they need.

Looking for any of this under your state’s laws is the best way to see if you can get them involuntarily committed. Calling the Volunteers of America Hotline for assessment services for an involuntary commitment might work, but they have to come out in a heavy case load and will only commit if someone is in immediate danger to themselves.

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Thanks. I’m leaning a lot.

But even in the hospital he’s not being compliant and has lots of faulty ideas

It is complicated. My suggestion would be that when he brings up that topic you can say it is not your fault and lets change the topic. If he insist you just leave.


Thanks Hope

Right now he seems to just be ranting at me and hanging up. There’s really no chance for me to get a word in.

The other day I just put the phone down and stopped listening. After a few minutes he hung up. He probably didn’t even know I stopped listening.

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Sometimes that’s all you can do. I got off the phone with my brother a few days ago after I wouldn’t pay for his flight to a foreign country or for a “silver disease protection device” on ebay. He’s still convinced he’s dying of a “government disease”, when what he actually has is immunodeficiency related to an active cellulitis infection and poor circulation due to drug abuse.

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Thanks for answering my rant.

I wish things were different for all of us.

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My son also in the hospital and jail refusing medication. He’s paranoid and delusional. He lost his apartment he lived in for 20 years because of his bizarre and aggressive behavior. I tried for months last year to stop this from happening but he refused to listen. His behavior his such that he can’t really live anywhere till he gets stable. He’s in jail waiting for a competency test for court. If he fails the judge can order treatment. That is what im hoping for. my heart is broke but at least I know i am not alone in this dilemma.

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