Hello LovingMom,

I know you are a LovingMom.

My Mom loved me and this is what she did when I went off my meds:

Though I wasn't psychotic, she drove me to the hospital and was able to convince the staff I needed to be admitted.  I had escaped from her house and ran to the bus stop to leave after having my Aunt Rose drive me to my mother's house.  I was not in the right frame of mind.  My mother and father pulled up to the bus stop in their car and luckily I got in the car and followed them out of the car and into the emergency room, where I began to pace up and down the hall as if I would run away.

The point being: it is never too early to seek help if someone has discontinued his or her medication.  The longer you wait, the worse it will get.  Consensus among leaders in the psychiatric field is that the longer a person goes without medication, the more severe the illness will become.  Repeated drug holidays cause what is called "the kindling effect" observed in bipolar yet also possible with schizophrenia.  This means that after each repeated episode, a person will not recover to the level he was before the episode.  He will start to get sensitized and set off by lesser stressors which will cause symptoms.

Carolyn is right: your son needs to understand that "cause-and-effect" is at work here: not taking the meds will cause the effect of him not achieving life goals.  Have you talked to him about this before by talking about what his goals are and how medication can help him achieve them?  A book that outlines techniques for talking to a loved one who does not want to take meds has been useful for many family members:  Xavier Amador, PhD's I Am Not Sick, I Don't Need Help (2007 edition, Vida Press).

The problem with merely talking with him is that he may say he'll take the meds and you have to take it on faith that he's taking them.

In some states, a person can be legally required to take medication for schizophrenia if he is non-compliant.  I know of one person who was hospitalized 85 times and was unable to link not taking the meds to winding up in the hospital.  It seems like it would not be possible for him to miss this connection when it is so obvious to others.

You're walking a fine line because you say he's not a danger to himself or others.

My question is: do you want to wait until it gets to that point?  Can he really be functioning at his best when he is off the medication?

Also: you have to be honest about exactly how many times he's gone off his meds.

He may not be a danger to others, but your use of the words "gravely impaired" impliies that in ways that matter he is a danger to himself.

I would consider having him what's called "Baker Act"ed in some states.  I would see how he can be legally required to take his medication.  If you do not want to go that route, I would take him to the hospital and there is one thing you can do to insure he is admitted: Have his psychiatrist call ahead to alert the staff, "Steve Adams [or whatever your son's name is] is a patient of mine and I'm sending him to the emergency room.  I do not want you to release him, he is to be admitted."

This is what a "NAMI mommy" recommended when I interviewed her here.

If you take a wait-and-see approach I'm sure you'll see that down the road you will have to do exactly this-if not now, then in the future.

If you would also like advice from other NAMI mothers who have been in your shoes, call (800) 950-NAMI (6264) and ask for the name and number of the local affiliate in your city or twon.   The local affiliate will have weekly or monthly family support meetings.

The question you may ask and rightly so is this: what would happen if you exaggerate the threat he is to himself to be able to get him into the hospital?

Alas, this criteria for admission applies in many states in the U.S.

Carolyn is right about the revolving-door phenomenon.  You could get him admitted and when he's released he could gradually stop taking the meds.  He could have anosognosia, a symptom of schizophrenia that is the lack of awareness that you have an illness.   After all, if you weren't sick, why would you take meds?  This is exactly the problem addressed in the Xavier Amador book I mentioned above.

To wrap up, you may want to do these things:

See if a psychiatrist or social worker can make a house call.

Take him to the hospital and have his doctor call ahead to inform the staff to keep him.

Get your son into Assertive Community Treatment / ACT so that he is legally required to take medication.

Contact NAMI mothers for other suggestions, and for support for whatever decision you make.

As well, we will always support you at this website so feel free to write in as often as you'd like.

Regards,

Christina