Many friends and family members of people with bipolar disorder become frustrated with the fact that they can rarely, if ever, “make” their loved one obtain treatment. This is more of a challenge when the person is manic rather than depressed. In a manic episode, your loved one is more likely to think that you’re the problem. They are neurologically incapable of having the “insight” to realize that anything they’re saying or doing is out of the ordinary. In fact, they might feel better than ever – on the top of the world!
Fortunately, current laws lean toward protecting the rights of everyone to make decisions for themselves. This is fortunate, because nobody wants to create a police state in which one person can have another institutionalized just by accusing the person of being irrational. (People with bipolar disorder are just as intelligent, oftentimes more so, than others and have every right to get into heated discussions when they disagree with someone, without having the threat of a forced commitment hanging over them.)
It’s unfortunate, however, when, as in the case of bipolar mania, the person’s brain is incapable of realizing that something’s wrong, and destructive (and self-destructive) behaviors are allowed to continue unchecked – emptying bank accounts, destroying relationships, and placing the health and well being of the individual and others at risk.
Hospitalizing a person against their wishes is a very sensitive issue, and I don’t want to come across as though I am “taking sides” here. Nobody really knows what it’s like from either person’s perspective until you’ve been there. It’s difficult for everyone involved. In many cases, however, patients who have been hospitalized against their wishes look back and are thankful for the care they received. Very often, a brief stay in the hospital helps reboot the brain, stabilize moods, and give everyone some pause to catch their breath.
By law, the official line is that only medical or mental health professionals can evaluate a person and mandate that the person stay in a hospital or mental health facility… and only on the condition that they “deem the person to be a danger to themselves or others.” The word “danger” is generally interpreted in terms of physical danger. If the professional thinks that the individual in question is likely to harm himself or herself physically, is suicidal, is physically threatening, or is out of control to the point of causing a serious accident (driving too fast, playing with fire, etc.), they’re obliged to have the person admitted to a hospital or mental healthcare facility, with or without the permission of the person or their friends or family members.
Until a medical or mental health professional deems the person “a danger,” the person remains free to be verbally abusive, to overspend or gamble away the family savings, to be sexually promiscuous, and so forth. They can even be psychotic as long as the psychosis does not create dangerous behavior. Of course, family and friends are likely to interpret such behaviors as the person posing “a danger to themselves and others,” but by law, professionals and the courts must analyze it differently.
So, the question is, what can you do as a friend or relative when your loved one is in the throes of a manic episode and really does need to be hospitalized? Here are some suggestions:
- Call your loved one’s doctor or therapist and report what’s going on. Due to privacy issues, the doctor or therapist can’t give you any information, but there’s no law preventing them from listening to what you have to say.
- If your loved one is obviously talking and behaving irrationally, offer to drive them to their doctor’s office or hospital for something to calm them down. The doctor’s evaluation could lead to a mandatory hospitalization. But be careful – driving with an irrational person in the car can be a risky endeavor.
- Call the police or dial 911 and ask for help. (We provide some specifics on what to say later in this post.)
- Contact your local mental health “crisis team” if one exists. These are mobile teams that will come to you to assess your loved one for safety and the need for care. Be sure that you have the phone number for the team posted several places in your home. You may want to contact the team when there isn’t an emergency to give all the basic information so that in a crisis all of the basic paperwork has already been done. If your loved one is willing to meet with the team before an emergency situation occurs, all the better.
If you cannot access a specialized mental health crisis team, then the police will be the first responders, but they will be unlikely to show up if you simply report that you think you’re loved one is experiencing a manic episode and you’re worried about them. Be specific:
- Report a “violent EDP” or “suicidal EDP.” EDP stands for emotionally disturbed person.
- Describe exactly what your loved one did or said to make you think the person is a danger to himself or others. Did he or she threaten suicide? Did your loved one threaten you or someone else? Is the person driving erratically?
- When the police show up, make a solid case for why you believe your loved one is a potential danger to himself or others. If others have witnessed the incidents, have them back you up. Point out any damage your loved one may have caused. The police don’t want to take your loved one to the ER for an evaluation, so you have to give them good reason.
- Be clear that your loved one has been diagnosed with a mental illness. You want the police to be aware that this is not just someone behaving badly or someone who is intoxicated. Use the term “mental illness” in everything you tell them.
I’m not recommending that you do this, but some people have reported turning over furniture before the police arrive to stage a violent scene. When the police witness the chaos, they’re a little more likely to conclude that your loved one really is in a violent state. Again be careful – police departments vary dramatically in their mental health savvy and level of training for working with those in a mental health crisis. You want to avoid a dangerous confrontation between your loved one and the officers as this could cause another set of problems.
If the mental health emergency team or police take your loved one to a hospital, be sure to follow up with the healthcare team to make sure your friend or relative has everything they need – perhaps most importantly, their medications. Bringing clothes, pajamas, and other “comforts of home” can also help make your loved one’s stay more comfortable, but call the facility beforehand to find out what’s allowed and what’s not.