Involuntary Treatment for Sister?

Family
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Hi everyone! I’m comforted to come across this website and from reading others’ posts. To know that my family is not alone gives me such relief!

Right now, and throughout the past seemingly endless years, even though I’m 6’2" and 200 pounds, and she is much smaller than me, I am so scared of my sister. She is almost 32 (I’m 30), and we both live with our mom. I moved back here almost four months ago to get another college degree, and the declined mental state of my sister immediately disturbed me.

I found out from my mom that, except for maybe a couple short trips with my mom to grab some food, my sister hadn’t left the house–and still hasn’t–since before Christmas 2016! She’s going on 8 months now confined to her bedroom and walk in closet day and night. When I first moved back, I could tell she wasn’t herself but she was putting up a sweet front…she took me into her room and closet, where it looked like she had been sleeping on the floor instead of on her bed. She is frightened by the outside world…she has draped blankets over all her windows and even over cubbies and clothing racks in her closets.

She has removed smoke detectors because the red lights made her think someone was watching her…Now, and for the past four plus months, she comes out to use the bathroom or to get something to eat occasionally but then shuts herself back in. Doesn’t usually respond when Mom or I call out to her. She hasn’t been diagnosed or treated, but from my psych degree and research I know it’s a form of sz because I’ve documented conversations with her and things our Mom has told me and also things she’s done that show she has had many delusions and multiple hallucinations (including crawling sensations in her skin, hearing voices and possibly visual).

It’s so sad but also really frustrating…she is extremely moody and defensive. Been walking on eggshells for years and years around her. Because she has depended on both our parents for years for support, I’ve asked them both to help intervene but they are very reluctant to take action as far as getting her involuntarily taken to the emergency room to get evaluated–afraid of costs, fear of her refusing to take medicine. I feel stuck.

But I hate that my sister is stuck. I love her. Recently my mom and I have both noticed foul smells in the air, including feces and since yesterday I smell urine coming from her room, and I haven’t seen or heard evidence of her using any toilets very much if at all for the past several days and weeks. I just want to bust down her door and force her into my car to the emergency room myself but that would terrorize her and traumatize her more. She’s almost completely unresponsive and hasn’t agreed to getting help since May. What should we do?

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Hi, I wonder whether there is a mental health team in your county. Where we live, there is a 24/7 Mobile Crisis Unit as part of the department of health and welfare. The great part is that the social workers take calls at all times and will intervene if needed, but they will also listen to a situation and give advice over the phone.

The team here can work with paramedics to get a person medically cleared for evaluation at a hospital and then take them directly to the hospital instead of ER. But I think ER is a good option if needed. Sometimes when a person is really ill, they are already so terrified that the additional trauma (which is real!) of hospital and ER are not that much more than daily life with severe psychosis, plus there is a chance of treatment and temporary safety.

If your local NAMI is particularly active, there might be someone there who can walk you through the local options.

In the county where I live, if a person stops eating or sleeping for a period of time, they can be evaluated for commitment. Is she eating and sleeping okay?

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My son first got ill at 15. He just turned 28. Up until the past year, he had never been in the hospital, although he did see a psychiatrist.

I never thought he’d voluntarily go to the hospital, but he did this past year - 5 times. Once he got there, they put him on an involuntary hold because he was too sick to make his own decisions, but at least he agreed to go.

Once he would get really sick and really scared, I would gently and calmly ask him when the opportunity came up if he’d like to go to the hospital where it’s safe. Sometimes, it would take up to two weeks of this, but eventually he’d say yes. During these periods, my son goes manic and stops sleeping - every day he goes without sleep, things get much, much worse - that’s why it works for us. If your sister is sleeping and her symptoms are fairly steady, that approach may or may not work. It doesn’t hurt to try though.

I like home to be my son’s safe place, so I’m very reluctant to have anyone come in to evaluate him here. My fear is that it will make him afraid to stay at home the next time he gets sick and he’ll simply walk off never to be seen again. Maybe a little dramatic, but it’s always in the back of my mind. However, if he had ever gotten to the point he couldn’t even leave his room to use the bathroom, I’d have to reconsider.

Good luck to you & your entire family. Your sister sounds like she’s truly suffering.

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Thank you so much for letting me know all this! I will be looking into whom I can call in the area. As far as I know NAMI isn’t active in the county where I live, unfortunately but I can certainly call the state hotline if there is one (we’re in South Carolina.) Thanks again for the support! I pray your loved one is getting help and making progress.

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Thank you so much for your support, slw! It sounds like you know a thing or two about patience and longsuffering. I’m praying something can be done soon, but I just feel so strongly it’s also up to me to do something to help my sister. I know ultimately she has to want to get well and have the determination to take any medicines when she’s evaluated and prescribed some, but right now I believe strongly that she doesn’t even know what she needs…you can smell urine as soon as you enter my mom’s house now, and it’s a big house–her bedroom is upstairs. I knocked on her door last night after writing the first post because my mom and I were really starting to worry about her–if she was even alive. After about 5 minutes and no response–I called out her name several times, too–I straightened a shirt hanger and used it to unlock her door. Thankfully she was in her bed, and although the lights were out I couldn’t see any “mess” on her floor. I heard her leg move in her bed and I could tell she had been lying there awake because she didn’t seem as startled. She just calmly but agitatedly told me I needed to get out, that her room is a “holy place” (she’s referred to it as such for months), and I needed to leave…I remained at the opening of her room and just told her I was worried about her and that I smelled urine and Mom and I want to help her. She said we can’t help her. Then I told her I had brought some food for her, but she refused it and again asked me to leave so I did. I don’t know if she’s just lying there in her pee or if there’s somewhere in her bathroom she’s been storing her excrements but I haven’t heard her flush any toilets for weeks now…I’m pretty sure if I go to a probate court and explain my concern for her they’ll issue at least a judicial order for her to be evaluated. I’m just trying to get our parents’ support first.

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Here are some resources for you and your family - hope this helps:

If you need legal advice on how to help your sister - here are two resources - call them and ask for advice given the situation (I’m assuming you’re in the USA - if not, let me know):

Treatment Advocacy Center
http://www.treatmentadvocacycenter.org/index.php

200 North Glebe Road, Suite 801
Arlington, Virginia 22203
Phone: (703)294-6001

NAMI (Call your local / regional / state office)
https://www.nami.org/

First Aid for Psychosis:
http://www.schizophrenia.com/sznews/archives/005561.html

and

and be sure to watch these videos (really, for the entire family at your house) from Dr. Xavier Amador:

and

and get this book:

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Forced compliance with medication or any type of treatment is a hot topic, but when someone is as ill as your sister is - and as ill as my son has been - it can become a matter of life and death. I mean that literally.

Even if she doesn’t leave her room, if she stops eating or lays in her own urine like that, she’s a danger to herself - even if she never threatens to harm herself. It’s called gravely disabled.

Is her bathroom directly accessible from her room? I was thinking if she has to cross a hallway or anything, she might have stopped going because you’re there and it’s stressed her a little more.

I live in Virginia. I don’t know if it’s the same in all states, but here they have something called the Community Services Board. Bigger counties & cities have their own, smaller ones group together to have a regional one. I think there are 70 or so in the state.

They have a 24-hour crisis line and can send someone out to evaluate someone having problems - no need to wait for a court date. Right now, they either come with trained officers or call them after they’re out because a police officer is the only one who can transport someone after an involuntary hold. They have a law up now to change that so if someone’s not violent an “alternate” person can transport them.

The one time they transported my son from the doctor’s offices to the hospital, the officers were nice as they could be. They would walk out with him so he could smoke while they were waiting on the paperwork and were careful to explain that he was not in trouble or under arrest. He was OK with it, but for a long time he’d say they arrested him for wanting a hug.

If you go to the hospital, it’s a little different. If the person evaluating you thinks you still need an involuntary hold, they’ll call in a community services board person to talk to the person & do the paperwork - it still has to be approved by a magistrate that they can call. Then a police officer serves you with the paper there and kind of hangs out until they get you safely onto the unit.

The first time my son went to the hospital, he didn’t know where he was when he woke up even though he had asked to go. He freaked out & tried to get out, so they classified him as an elopement risk until he got a better in a few days. Since then, he has never been exactly happy about going, but he’s been OK with it.

He does like one hospital over the other. The one he likes is a stand-alone facility, so they patients get 3 smoke breaks a day outside and he says they have really good food.

So, after that ramble, what I really wanted to say was that when your family member isn’t able to make their own decisions about their health, someone really does need to step in for them and make those decisions for her. If they get her on the right medicine, you’d be amazed at how quickly things can turn around for them.

Over the past year, my son went into the hospital 5 times. The first time, his long-term medication had stopped working for him after about 7 years and he became symptomatic & quit taking it. They put him back on the same thing, saw some improvement and sent him home. Within a week, he stopped taking it again.

About 45 days later, he was sick enough to go back and they started him on a long-acting injection he only needed to get once a month. We had high hopes for that, but it wouldn’t last for him - the next 2 hospitalizations the meds just weren’t working no matter how high they raised his dosage.

The last time, they switched him to something else that seems to be working well. Now, we have normal conversations. He’s not perfect, he still has some mild symptoms, but he’s not saying he’s God or the Devil anymore, he’s not all involved in some inner dialog and laughing to himself most of the day, or most of the other things he was doing back then.

If I left to his own devices, to make his own decisions, I don’t think he’d be any better than he was then.

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It sounds like your sister is somewhat able to converse. Maybe you can get a team member from a local mental health team over there to talk with her from the doorway?

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I’m starting to really worry about her…I hear her move around less and less. I haven’t seen or heard evidence of her moving from her bed since our encounter two nights ago. She has to have water. I’m going to have to get someone over to help if she refuses to drink water and eat. Getting ready to call some people to see who can help.

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Start by seeing if you county has a mental health support office, then find out if they have a mobile crisis unit.

You want someone like that to come out along with (probably) officers who are trained in mental health.

This is a link to what our county has - notice the crisis line to the right.
http://www.chesterfield.gov/mhss/

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I’m glad you’re calling for help.

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At this point, I would think that a regular EMT would take her in after seeing her condition. You are a good brother and are doing the right thing!:trophy:

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Thank you very much for sending all this!

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So after calling around and talking to several counselors, our Dad and I have agreed the best thing to do is get a court order for involuntary emergency pick up by police. I went to talk to a counselor at the local State Mental Health Facility, and told her how she is eating/drinking less frequently (I only saw evidence of her eating once last week), and we’re concerned she’s peeing on the floor or in her bed. Because of the danger to herself, I was able to get an emergency pick up order (the other order would be a “judicial” which is to wait two weeks before my sister and I (and our parents) would have to go to before a judge and medical examiners to determine if her condition merits mandatory treatment/commitment…Dad wanted me to pick up pizza (she loves cheese pizza) and take it home with me last night, after getting the court order (which I still need to take to the police station by Sunday), to see if she would eat any of it. To my surprise, when I came home, my sister was in the kitchen! (we are sure she hasn’t eaten or drank anything since last Friday). She was making herself some sandwiches when I brought in the pizza. She looks awful…very pale and disheveled. When I said hi and looked at her, she gave a sigh of frustration, and I placed the large cheese pizza in front of her and said, “It’s cheese.” She thanked me and I nodded and walked away (I didn’t want to distract her from eating.) I was so glad she ended up taking the whole box upstairs to her room along with her sandwiches! …I say all this because while this was very good to see her up and about and making herself something to eat, I was tempted to feel like, Oh crap, now I feel like I lied to the probate judge–that she’s starving herself! But the fact remains that she is still severely ill and needs psychiatric and medical treatment, so I told Dad about this and he wants us to try one more time–today–to see if she’s willing to go to a doctor with us (or at least me since she hates our Dad), and if she says no then I’m going to take the papers to the police by tomorrow morning…Any thoughts on how I should approach her today, and how I should ask her? Any advice for Dad and me as to how we can convey to her what’s about to happen if she doesn’t say yes she’ll go see a psych? Dad is worried she’ll hurt herself before the police come if we tell her, but I’m not sure she would…I just want her to be the least confused and feeling least mistreated as possible (maybe this is inevitable because they have to handcuff her, and maybe I’m just trying to give her the benefit of the doubt like Mom and I have for years and years that she’ll still somehow snap out of this even after eight months of steady regression.)

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It’s too bad that you can’t get an ambulance or a mental health professional to talk to her and take her for treatment. Instead of the police. That sounds like it could be traumatizing; I hope they won’t feel the need to handcuff her!
But if that’s the advice you got, then go for it. Does your sister have a doctor? I doubt that she’d go to the hospital willingly. I wouldn’t recommend going to an outpatient doctor appt. it sounds like she needs more intensive treatment at the hospital.
If it were me, I’d go talk to her in her room. Gently ask her how she is feeling, ask her if she wants help. If so, you can help her get it. Don’t warn her that the police are coming to take her to the hospital. It would just make her anxious. I’m sure the sight of the police showing up to take her in will be so surprising to her that I doubt she’d offer any resistance.
Good luck! It sioubds like you are making good progress! Let us know how it goes🍕

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Thank you, Jan! I’ll try talking to her like you said and let you know how it goes!

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Here, if the police transport, they have to handcuff - when they did this to my son, they apologized, told him they had to do it to everyone for safety and tried to make sure he understood he wasn’t in trouble or being arrested.

They have a law up now trying to change that so if its deemed safe, alternate transportation can be used - maybe an ambulance? It would be less traumatizing for the patient & relieve a burden from the police.

However, that’s what happens if you’re not already at the hospital. They can do exactly the same thing without handcuffs if you can get your family member to the ER - and where I am, you check in at a Kiosk and they have a place to check depression/anxiety/suicidal feelings. If you do, they have you in the locked evaluation unit within minutes.

I’m sorry I have no advice about the “talk”. I have no luck getting my son to do anything until he’s so scared of what could happen that he’s willing to go to the hospital where he feels it’s safe.

I just gently ask if he’d like to go to the hospital where it’s safe & they can help him get some sleep.
It eventually goes from an irritated “I don’t need to sleep, and neither do you” - to a quiet yes. Until I get that yes, I literally sleep in my clothes & keep my wallet, cell & keys in my pocket so I can go at a minutes notice before the yes turns back to no.

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I’m glad she ate something!

At this point, your sister could probably benefit from a basic wellness check at the GP, which is less daunting than a psych doc. There are walk-in clinics for basic physicals. Then, if they notice any psychiatric symptoms, they can refer her.

I have said things like, “I’m very concerned about your health. Please let me take you to the doctor.”

and

“I am making a doctor’s appointment for you. If you go, I will buy you ____.” Usually bought used CDs, a nice breakfast, games. Sounds like your sister doesn’t want anything though.

and

“Do you want to go to the Emergency Room or do you want me to call [the Mobile Crisis team] to come over here?”

Also, I would not tell her about the police or anything regarding the court order UNLESS she asks, then the truth is always best.

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You’ve received some great feedback sz forum members. What you and your mother are going through is very difficult and I also have great empathy for your sister who is suffering. If she refuses voluntary treatment then imho involuntary commitment is something to discuss with mental health care providers. She obviously can’t care for herself and living in her room under current conditions is dangerous and unsanitary and may cause her and the rest of the family to get very sick.

I believe once your sister receives good mental and physical health care treatment she will find her life vastly improved.

I’m glad you found this forum. We do understand.

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Hey everyone! Thanks for all the encouragement and support! So, we ended up delaying my sister’s hospitalization to yesterday (Wednesday.) She started moving around and talking to us again last weekend and she also ate a lot, which was good, but then she withdrew from us again by Saturday, and a stronger urine and feces stench started to come from her bedroom. She also told Mom on Sunday that God told her that great destruction would come upon us very soon, and that we would try to cry to God for help, but he wouldn’t be able to save us. She said we’re following other gods, and that God is very unhappy with Mom. This greatly distressed and disturbed Mom, but I assured her that it’s the illness talking, that she really doesn’t need to worry about God being unhappy! So we got another emergency pick up order from the local mental health outpatient facility, and got the probate judge for the county to sign it, took it to the police and three police came to the house with us to get her. She was not happy about it, but thankfully she complied so they didn’t have to handcuff her. I followed the police who had my sister to the emergency room, and she has been in that unit going on the second night. It’s been difficult for us to find out information about her, like how the observation and evaluation has been going. But we’re hoping that she will be transported to a hospital that actually has a mental health/behavioral health wing with counselors and more trained psychologists (the psychiatrist at the hospital the police took her to, since it’s closest to us, hasn’t been very successful to our knowledge in getting her to open up about her problems, and this hospital doesn’t have a mental health facility/wing.) We’re waiting on pins and needles and hoping they won’t end up discharging her before she can be taken somewhere where they can really tell what’s going on with her and help get her on a treatment/counseling plan!