Family and Caregiver Schizophrenia Discussion Forum

Treatment without involuntary commitment?

My brother is hearing voices and thinks people are out to get him and that someone is coming for him he is not violent he’s kept a job for 8 years he’s completely normal other than the delusions but he is obsessed with them and it’s getting worse he is willing to seek treatment but he does not want to be involuntarily committed what can I do we live in Nevada

Here in Florida, involuntary commitment is only done if the person is a danger to self or others (i.e. wants to suicide or wants to hurt others). That danger has to be observed by a police officer or perhaps in a hospital emergency room. If your brother is not violent toward himself or others, nor does he threaten to become violent in front of an authority with power to commit, he probably will not have any risk of involuntary commitment, but I don’t know Nevada rules.

Keeping a job, and being willing to get treatment are both very good signs. Is there a NAMI meeting or group near you? They would probably be able to recommend some outpatient treatment clinics. It is best to get treatment sooner rather than later, in my opinion, so I hope he goes soon.

In some cases even if you have a committal hearing, you have the option to enter the hospital voluntarily. Looking back on my experience, I found it odd no one mentioned this option until I had a hearing at the hospital. They seemed to assume I didn’t want to go. The deputy offered me the option of leaving the situation and returning with a family member, or going to the emergency room.

I was afraid of my parents at the time, and I didn’t have health insurance. I think my parents were concerned they would get stuck with the bill. They also seemed to have trouble finding a bed for me, so I waited at the emergency room for many hours. I believe there was some delay getting a judge or magistrate to sign the order and further delays for arrangements to transport me the two hours drive to the hospital. I think I still have the form they gave me.

A parent signed an affidavit about me, and the deputy and i’m guessing corrections officers or bailiffs only got involved to transport me. I would have driven myself if they asked, but they had tricked me out of my keys. Which makes sense, as I probably wasn’t safe to drive.

Have you considered offering to take him to a doctor for treatment? My experience is folks fall all over themselves to treat people outpatient, but a doctor will refer someone for a voluntary hospital stay if it is warranted. It’s all about cost containment and the scarcity of beds. Much of this depends on his health insurance or Medicaid status. Laws have changed significantly on insurance, and my experience was a long time ago.

I’d consider contacting a doctor and/or a lawyer or legal aid and see if they can tell you how to navigate things. A NAMI chapter in your area should also be able to help.

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The biggest thing to me is:
with involuntarily committed they pay
with voluntarily committed you pay

I am not familiar with this protocol for insurance payment. Could this be state-specific? or type of insurance?

I think it is the same everywhere in the states and a function of insurance company.

Thank you thank you so much for taking the time to tell me your story I really appreciate it a counselor or somebody looked at him the next morning and said get out of here he didn’t belong there so they couldn’t involuntarily commit him thank God but the damage was done he is gun-shy about getting treatment now he went to see a doctor the other day but didn’t tell them the whole story because he was afraid

You’re welcome. Sorry it didn’t go as well as you hoped. Don’t give up. It can take some time to overcome misconceptions most people have about the experience of treatment. Remind him he’s still free after his encounters and has the option of returning or going to another doctor when he’s ready. It took me a year of psychotherapy, a near committal, a voluntary hospital stay and fear of losing my job to go on medication. You have the advantage that he recognizes he has a problem, many of the caregivers on this forum don’t have that. Insight into the illness generally means a better prognosis. It may help you to look into Dr. Amador’s LEAP institute for information on how to build the trust you’ll need to move him toward treatment.

Here’s a link to his website: https://leapinstitute.org/home

I feel most portrayals on movie and TV overdramatize and mystify the process and make it more traumatic than it needs to be for all parties. I’m working on a project that may help with that. I think that potential caregivers and patients alike are poorly prepared for what to expect in outpatient and hospital settings.

One portrayal I think was better than most was House MD season 6, episodes 1 & 2. It’s still dramatized, but tries to be the anti-One Flew Over the Cuckoos Nest. The show was supportive of NAMI and Hugh Laurie has been frank with his experiences with depression.

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I looked this up a bit more. Since the 2014 Affordable Cares Act, health insurance companies are required to cover mental health care in line with what it covers for other care (“parity”). If an insurance company does not do that, a complaint should be filed. For example, if I have a pain of unknown source in my abdomen, I voluntarily seek medical treatment to determine and resolve the problem. It is the law (but not always the actuality) that mental health care is covered by insurance in the same way. But to be receive treatment, the person would have to visually present with or be able to describe real mental health concerns.

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