You can't force a 51/50 hold on a family member, or can you?

A sign I once saw: "If the brain is part of the human body, why can it not get sick too?"

Rather new to the forum, but I can't find answers anywhere else to date - so thought I'd give it a shot here. As a family member who has a brother that suffers from Bipolar manic episodes, we cyclically run into "events" every few years. Usually brought on by a stress trigger or catalyst, when someone starts to behave manic they often cannot identify the situation themselves. Maybe this is different for different people; from my experience there isn't really a gradient or stages.

My situation is that my mother and I both know my brother is having a manic episode. He appears to be taking some of his medication but it doesn't appear he's taking the right dosage nor is he being diligent about taking it every day. Some specific events have occurred in behavior, speech, and social interaction where we know he's sick, but we cannot convince him to walk into a hospital to try and get a 51/50 hold on him - so that he can be medicated.

This is the conundrum that I'm sure many people/families wrestle with. The police/Sheriff cannot get involved because mental illness is not illegal. They have to wait for:
1) Is s/he a threat to himself?
2) Is s/he a threat to others?
3) Is s/he gravely disabled?

In my case the threats are not there, and he presents well enough that he can talk law enforcement out of his need for assistance. It isn't until he does something extreme that law enforcement will then step in - but by then it's too late and you can possibly have legal charges, jail time, physical altercations, etc.

So I guess I have two questions:
1) Has anyone found a technique that works under these circumstances - whereby you can get the family member to trust you and walk into a hospital?
2) Are there any buzzwords or phrasing that works best when dealing with law enforcement?

EDIT: Also I assume some jurisdiction and states treat this maybe slightly differently; my brother lives in California - for what it's worth.

Unfortunately, there really isn't much you can do. You just have to let it run it's course until he is a danger to himself or others. I work in the mental health field so I would give you any buzz words if there were any. Are there any specific behaviors that are of particular concern when he is manic?

This is where the dignity of risk comes into play and it's really difficult for family members to allow their loved one to make "bad" decisions. Ultimately, he is responsible for his decisions, manic or not. I know that this is difficult especially where I'm on the other side of the fence here. When I am in a full blown manic state, I also am not usually aware of it, though those close to me just have to sit back and watch. It's hard sometimes as well because once you come down from that manic state there are sometimes serious consequences that effect the rest of your life, and there can be a lot of feelings of shame for some of the actions that you've done. It just comes with the territory of having a mental illness I suppose.

One thing that I've found helpful is that when I'm feeling well, to sit down with someone and make a list of what different stages of not being well looks like, and what I should do during those times. For example, I use a 1-5 scale for my mania (I won't type up the whole thing but you'll get the idea)

1.What it looks like: talking fast, excited, lots of different ideas
What I need to do: Make sure I get a good nights rest, give credit card to S/O, exercise, etc
2.
3 Insomnia, getting into more arguments, taking on/planning lots of projects, some "magical" thoughts etc
What I need to do: Call psychiatrist, take PRN, exercise, write in journal etc.
4.
5. Believing I know what other people are thinking, very agitated, yelling, self injury, paranoia, fixed beliefs etc.
What I need to do: Call my psychiatrist (or have family member call psychiatrist) take PRN, call Crisis line, go to ER

having this written out for me is sometimes helpful. I can look at it and kind of objectively think about what is going on in my life and where I'm at, and it tells me what I need to do. It takes the guess work out of it for me. I know that it's not always going to work, for example, if I'm having some of my "fixed beliefs" I probably won't recognize that they're pretty outlandish and not possible, but I can usually identify with how agitated I'm getting, or whether or not I start to self injure.

So anyways...hope some of that helped.

My now Ex-Boyfriend's parents actually sort of did this. They some how proved legally that he was a threat to his own self by not being able to keep a job, running up debt, blowing all his money on crap, self-medicating with Adderall and also Pain Killers. He could not provide for himself if kicked out of the house. He either had the choice to go to a Psychiatric Hospital for his self-medicating he was doing or go to jail (He was on probation for a OWI conviction). I'm not positive on all the details but he was brought to the hospital then transferred to the Psychiatric Hospital where he stayed for 2 weeks. They legally held him there until he was evaluated and placed on medication, turns out he is Bipolar Type I with Psychotic Features. He was able to leave though after he did routine group therapy, found the right medication for him and the doctor could no longer hold him once he was able to function fairly reasonably. The doctor had wanted him to stay longer as a recommendation because he knew he still needed therapy so he did a outpatient program with him for a while afterwards but legally could not hold him there any longer.

Sometimes, like in my case, this adds insult to injury.

I was drinking, bugging out, manic and just plain mad about the state of my life. The drinking wasnt helping me, I knew that had to stop and wanted help. I had already spent years as a psychiatric pill lab rat and that didnt help and quitting all that was very painful and difficult. I wasnt starting that again

Help came in the form of locked doors and threats of injectable form medications (chemical rape) to try and coerce me to go along with what ever pill experiment they wanted me to try. This happends to alot of people subject to inpatient psychiatry. Real doctors don't use fear, force and threats to treat there patients, only abusive mideval quacks do this. This adds insult to injury.

It took me a long time to get over my resentments towards my family, I dont think they know what goes on behind the locked doors of inpatient psychiatry if you refuse medications for what ever reason.

Cheze2 wrote: Are there any specific behaviors that are of particular concern when he is manic?

Yes, in the past my brother has been arrested and served 45 days for various charges. Being incarcerated is not where you get treatment; county jails are not setup to treat mentally ill patients so trying to intervene before that happens is always ideal. But when we try to relate those previous experiences and consequences to my brother, they don't have the kind of influence you would hope. He does not have the capacity for the reminder to resonate. He hears the words but is not able to correlate the tremendous anxiety, embarrassment, discomfort and bad feelings that he associates with that incarceration experience - not while he's symptomatic. Terribly unfortunate; you cannot reason with someone that is unreasonable. They simply don't have the capacity.

Cheze2 wrote:This is where the dignity of risk comes into play and it's really difficult for family members to allow their loved one to make "bad" decisions. Ultimately, he is responsible for his decisions, manic or not.

It's difficult to watch happen, but more of a concern are legal ramifications and truly the associated costs (which have been tens of thousands of dollars). The financial repercussions have been staggering and so there is the fear of personal safety coupled with financial distress. "Dignity" would be the least of our worries.

The list idea you talked about is "reasonable" however as I stated, you cannot reason with someone that is symptomatic (typically) so the list would be pointless. Perhaps it would be effective if someone were manic at a lease severe level...? Not sure. The list would not be perceived as intended in my brother's case. Not because my brother isn't bright (he has a B.S. in Physics), but because he simply does not have the capacity right now.

Cheze2 wrote:So anyways...hope some of that helped.

The good news this evening is that my brother has made contact with his doctor and there was a prescription that was picked up. Hopefully he can become stable before something regrettable occurs. The big factor is sleep; exhaustion is simply the enemy. At this point, it could still go either way - we might get out of this with minimal damage, but things could still go horribly wrong too. My brother has the ex-inlaws from hell and they make his life absolutely horrific when he's not symptomatic, when he is ill they are just cruel, evil people...but they have custody of my nephew so my brother must continue to deal with them on some level...which is terribly unfortunate because they are truly mean, evil people with zero compassion.

-- Wed Dec 12, 2012 11:15 pm --

bittersweetx3 wrote: turns out he is Bipolar Type I with Psychotic Features.

The psychotic features is the tough part; that's the scary one for people unfamiliar with mental illness (it's even scary for people that are familiar - like family members). When their sense of trust is compromised, when they're delusional - that is extremely challenging. Paranoia can be so difficult to get around when you're trying to convince someone that is ill that people are trying to help.

Mental Illness can be a brutal, vicious illness for the patient... just heart-breaking to have to witness.