In defense of families! 

Conventional wisdom says that those with mental illness have a better chance as they go into recovery if they have a loving and supportive family. Over the past few weeks we have had a marked increase in support calls from parents of adult children who are in need of help and support as they try to get services for their children. It is interesting that in the cases of which I, personally, am familiar, the adult children are all male and range in age from the mid-twenties to the mid- forties. Those in the mid- forties have had mental health issues for several years, and it has been a constant struggle for concerned parents and families. In my own personal life, I have witnessed these same issues and frustrations endured by my parents as they dealt with my brother from the time he was diagnosed at age twenty until their deaths many decades later. This personal history, as well as observing and helping with the problems faced by these five families over the past few days, has renewed my desire to explore and hopefully better understand the issues which arise for families trying to help adult children during a mental health crisis.

 

There are three issues which come to mind as the most frustrating for those trying to help. Two of these issues, the HIPAA laws and the Section 12 guidelines, are rooted in legalities and are confusing and are often interpreted in different ways. The third issue is the very role of families as seen by the staff that cares for the mentally ill person.

 

The HIPAA laws, enacted to ensure the privacy of medical records, are often very frustrating when applied to a mental health crisis. In theory, if the patient is of age, they prevent any medical information from being shared with family members. They will often prevent the family from even learning if their loved one has been admitted to a facility. Privacy is very important, and due to the remaining stigma about mental illness, people often feel the need to keep any treatment for mental health especially private. A medical facility can share information with a family if the patient signs a release form granting permission. However, in reality, when a person is undergoing a mental health crisis, this is very often the very last thing that they are going to do. You are actually asking a person who is not thinking clearly in his present state to make a rational decision. So very often, the family is cut out of the whole process and suffers extreme anxiety not knowing about treatments, diagnoses, or prognoses. One thing for the family member to remember is that even though the medical worker cannot disclose information to them, they can talk to the medical staff and relay important information to them. I would hope that a good doctor or nurse or social worker would listen and get all the background information possible. These parents have been living with this situation and can very well have more insight than even a very good doctor or other staff member can gain in a short observation time.

 

Section 12, is a legal device used to admit a person to treatment without their consent. It is most often used by the police when they witness a person in a severe mental crisis who is unwilling to go for help or refuses to admit that he needs help. The standard phrase used to determine if a person should be sectioned "is he an imminent danger to himself or others." Again, this can be subject to interpretation. One interpretation is "is this person at this very time suicidal or homicidal?" There have been some new federal guidelines of late and they are worth examining. In the past week, I have seen a person with a long history of mental illness and hospitalizations being seen as 'unsectionable' and then finally sectioned and released by a hospital. He was finally re-sectioned and held a few hours later after decompensating further. Again, the family who knows the history of the individual could have predicted this. I have been told, and I saw it in my brother, that each time a person decompensates and as he ages, it is doubtful that he will regain his former baseline. I know that the law is protecting the person's freedom, but again, if a person is in a mental health crisis, is he capable of deciding if he needs medical treatment. Family members who have been involved with the individual can often determine danger points based on experience and history.

 

And finally, it appears that families are sometimes not treated respectfully by medical workers. They are seen as part of the problem rather than as a part of the solution. The families with whom we interact have often taken our Family-to-Family course, attend support groups, and seek information and education regarding their loved one's conditions. Having a mentally ill child changes one's life from the norm to a life of walking on eggshells and waiting for the other foot to drop. Again, I repeat, conventional wisdom says that those who have a supportive family have a better chance of staying in recovery. Between HIPAA laws, very high thresholds for sectioning, and lack of collaboration with medical staff, the caring family suffers. We will continue to do all we can to support the families that come to us when there is a mental health crisis with a loved one.