What I’m about to write may alarm readers who have not had to deal with significant mental health issues in their immediate family. But I’m writing it with the hope that it can provide some guidance for those who have and feel powerless to get the inpatient help their loved ones need at a point of crisis.
It’s not as uncommon as one might think. According to a study published in World Psychiatry before the pandemic, as many as 14.5% of older adults suffered from one or more psychiatric conditions which required help. According to a national poll on healthy aging, one in five older adults say their mental health has gotten worse since the pandemic began.
While isolation has certainly exacerbated underlying mental health conditions, before assuming the cause is psychiatric, it is wise to set up an appointment with one's primary care physician assess the situation. There may be a physical explanation for their behaviors. For example, a common urinary tract infection left untreated can cause some psychotic behaviors, as can certain drug interactions. Older people metabolize medicines differently. Additionally, some early studies have shown negative impacts of the pandemic on nutritional intake and exercise, as well as alcohol use. If one’s primary care physician cannot identify anything going on and one is unable to get an appointment quickly enough with a geriatric psychiatrist or wait for a new medication to take effect, then here are some steps that may enable you to get your loved one admitted inpatient for a psychiatric evaluation.
What can one do, if you don’t have Power of Attorney or Guardianship of your loved one and they refuse to get help?
The criteria for an involuntary commitment are extremely (with good reason) hard. To be involuntarily committed, the admitting attending physician must determine that the person is at risk of harming themselves or others.
Here are some ways to access outpatient help more quickly.
- Make a list of the most extreme or worrisome behaviors exhibited over the last 24-72 hours. Stick to the facts. The list need not be exhausting, but it should be specific (for example, insulting, screaming, head-banging, threatening, calling 911, etc.) and convey this list to your loved one's primary care physician and/or psychiatrist to see if they can fit you in immediately. They may direct you to go to the hospital.
- Call a crisis hotline. In the Triangle, Alliance operates a mental health help line and they can either advise you where to go, such as the local crisis and assessment center, deploy a mobile crisis team (mental health professionals who provide assessment and crisis stabilization within the home and community) or give you the direct phone numbers of local psychiatric hospitals and psychiatric treatment units within general hospitals to call for more information. (Alliance's phone number is 800-510-9132).
- Every major town has a “Crisis & Assessment Center.” (Google that term and your town if you are outside this region.) In Wake County, there is one at Wakebrook. Call ahead and ask what they recommend you bring and what the process will be.
- Find a hospital or psychiatric unit yourself with an available geriatric bed. Older people have different psychiatric needs than what is treated most commonly on a typical psychiatric unit/hospital. In the Triangle area, there is Holly Hill Psychiatric Center and these hospitals with geriatric psychiatric beds: UNC Hospital, Johnston County Hospital and (the new) Triangle Springs.
- If there are no geriatric psychiatric or regular psychiatric beds, you may try in the ER to get your loved one admitted for a physical health condition that has been exacerbated by their poor mental health.
- If it is a true crisis, you may need to call 911 and provide them with the list of alarming behaviors from the last 72 hours. Depending on the situation, they may deploy both the police and an ambulance.
In the ideal world, no one would ever seek to hospitalize a loved one against their wishes, but sometimes, unfortunately as difficult as it is, it is warranted. And fortunately, with the right care, they can stabilize and get better.
Importantly, the caregiver can also have a reprieve, get some rest and support and space to assess the wisest way to move forward.