Question: My mother is 48 years old and exhibiting what appear to be early symptoms of schizophrenia. She is paranoid, delusional, disorganized and irrational. How can I convince her to seek psychiatric help? Every time I try, she attacks me and views me as an enemy.
Dr. Ballas: I am sorry to hear about the problems you are facing. The issue is almost as old as psychiatry: what's to be done with someone with serious mental illness that doesn't want help. This topic is highly controversial, and the history of psychiatry is checkered with instances of serious civil liberties violations. On the other hand, some mental illnesses, including extreme cases of mania or psychosis make it very difficult to convince a person that they need help, because their ability to think rationally has been affected.
Most states have psychiatric commitment laws that attempt to balance the need to protect civil liberties with the need to get people with severe mental illness the treatment that they need. Involuntary commitment is intended to provide a way to get psychiatric care for someone who is severely mentally disabled to such a degree that they pose an imminent danger to themselves or others. As with every aspect of this issue, what is considered by law to be an imminent danger to others varies state to state. Usually, if a person has done some sort of bodily harm to themselves or others because of their mental illness they are considered to be in clear or present danger. The bottom line is that most states allow you to force someone into a hospital, against their will, at any time, as long as you can show that they are an immediate danger to themselves or others in some way.
If someone is suicidal, homicidal, or highly disorganized to the point that they cannot safely function in society, most states have some sort of recourse for friends, family members and other concerned parties to get the person treatment. If you think someone needs to be involuntarily committed to a hospital, one option is to call the Office of Mental Health and explain to them what is going on. If you can't find the number for your local crisis center or Office of Mental Health, another option is to call the police or bring them to the nearest emergency room. If the person refuses to go to the hospital on their own, the police may have to escort him or her to an emergency room or crisis response center where a physician can assess the person for involuntary commitment.
Typically a friend or family member is involved in making this decision, and the person begins treatment in a psychiatric institution. Commitment is a complicated and sensitive issue in which most relatives feel confused as to whether it is the right thing to do. The truth is, many times in schizophrenia and bipolar disorder, an involuntary commitment is the first step towards a person getting healthy. Family members may be worried about starting an involuntary commitment for fears of being blamed, feeling guilty, or not being trusted by their family member in the future. Keep in mind that once you ask the police or hospital for help, a doctor will become involved and give you advice as to what to do next. Remember, you are asking for help for your loved one.