Dear Dr. Archer,
I have a 46 year old sister who is having mental issues. Since she started having these issues, she no longer has her job. They released her, but she can't seem to grasp the idea that she no longer works there. She thinks she's on a family medical leave. She keeps telling us that she has a job, but that she's under investigation so she has to stay home.
I have taken her to a general practitioner who ran some blood work to rule out anything medically wrong, but all tests came back normal. The doctor told us that, based on the information given us, she needed to have a mental health evaluation so we could address her mental issues.
We finally got an appointment at a state-funded mental health clinic. She went to the appointment with much, "I'm not crazy," rhetoric, and she played the social worker so well she was released. They said she has issues, but their hands were tied in helping her in any manner.
Some of her behaviors we have experienced with her include screaming, talking to herself, living in fantasy, combative with family, angry with family for trying to check on her and make sure she gets medical and mental attention. She wants to know why we're in her business, as she does not want us there, and steadily pushes us away. She seems to be very proud of her mean, ugly behavior.
She will be homeless in less than 30 days, due to her having no income and no funds to pay her rent. She refuses to live with any family member peacefully and promises to create havoc if she is made to do so. I feel like my hands are tied in trying to help her. She is my sister, and I love her, but I feel like I am watching a nightmare unfold.
Is there any advice or suggestions that you may have that I could possibly try and get her to agree to help. She is definitely delusional, combative, out of touch with reality and paranoid.
Hutch
Dear Hutch,
It sounds like your sister is psychotic yet doesn’t realize it or want help. Unfortunately this is not an uncommon situation and it is never easy for the family. Also, this is even worse as it sounds like your sister does not meet criteria for commitment to a mental facility against her will. Thus she is caught in limbo, as are you.
At this time your hands are indeed tied. All you can do is to keep trying to help. Sometimes in these cases it takes months or even years before the person in question realizes they need help and will agree to treatment.
My advice is to be supportive yet not pushy. Let her know you will always be there for her. Keep trying to get her to agree to voluntary treatment. Often in a case such as this, medication can make all the difference when she finally agrees to take it.
If things deteriorate to the point where you feel she is a danger to self, danger to others or no longer able to care for herself then contacting the judicial system about an order of protective custody mandating treatment would be indicated.
The good news here Hutch, is that most cases like your sister eventually do come around and agree to treatment. Until then, stay available and hope that she sees the light, sooner rather than later.
Dr. Archer
