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A Resource Guide for Families Dealing with Mental Illness

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This resource guide is provided by:
NAMI Michigan

For more information, please contact us:
921 N. Washington Ave.
Lansing, MI 48906
517.485.4049 800.331.4264 [email protected]

www.namimi.org

Please help NAMI Michigan continue to serve those affected by mental illness by joining or donating to our organization. Fill out and mail the form below or go to www.nami.org and join online.

NAMI Michigan Membership & Donations

Whenever possible, we will refer you to a NAMI affiliate in your community for membership. If you have a preference, please indicate below.

Name_____________________________________________ Address___________________________________________ _________________________________________________ City_________________________ State______ Zip_______ Phone____________________________________________ E‐Mail____________________________________________
Regular Membership $35 _______________________ Includes National, State & Local Affiliate nearest you

Open Door $3 min. Donation
For those with financial hardship All donations are tax deductible. NAMI Michigan is a 501 (c)(3) nonprofit organization

Mail to: NAMI Michigan
921 N. Washington Lansing, MI 48906

THE NAMI MICHIGAN FAMILY RESOURCE GUIDE

Mental Illness: A Family Resource Guide was written for and dedicated to families

who have a relative with mental illness. The first edition, published in 1988, came about through the initiative of Yolanda Alvarado and other members of NAMI Michigan who saw the need to share what they knew with other families. The original manuscript was written by Carol Rees of NAMI Washtenaw County.

Many family members, individuals living with brain disorders and mental health professionals have contributed to revisions over the years with special thanks due to attorney Bradley Geller and Marjorie Hartnett for the section on voluntary and involuntary treatment and to Dr. Larry Alphs for reviewing and updating the manuscript in 2008. The booklet was made available online by NAMI Michigan in 2010. In 2012, Dr. Rachel Glick, Director and John Kettley, Clinical Director of Psychiatric Emergency Services at the University of Michigan Hospital reviewed and updated the text. This edition was made possible by The Broadway Foundation.

Information in this publication is intended for the benefit of our members, readers and the general public. Neither NAMI Michigan nor any of its members assume liability for the contents of this manual.   Individuals should consult with their physicians about their particular situation.   To facilitate easy exchange of its contents, this information is not copyrighted .

Revised September 2012

CONTENTS

I. INTRODUCTION

Purpose of the resource guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . NAMI Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55

II. MAJOR MENTAL ILLNESS

Symptoms of mental illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kinds of mental illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Crisis intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Seeking treatment . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .
67
13 13
Voluntary and involuntary hospitalization . . . . . . . . . . . . . . . . . . . . 14 Guardianship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

  • Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
  • 18

Resources for care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Complaints and grievances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

III. MENTAL ILLNESS AND THE FAMILY

Coping with a relative who has a mental illness . . . . . . . . . . . . . . . 27 Support and advocacy groups for family members . . . . . . . . . . . . 28

IV. INDIVIDUALS WITH MENTAL ILLNESS IN THE COMMUNITY

Community Mental Health Services Programs . . . . . . . . . . . . . . . . 29

  • Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
  • 29

Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Jail and jail diversion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Support groups for consumers . . . . . . . . . . . . . . . . . . . . . . . . . . .
31 31

V. FINANCIAL CONSIDERATIONS

Federal programs: SSI, SSDI, Medicaid, Medicare . . . . . . . . . . . . 32 Conservatorship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Wills and estate planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

VI. WORKING WITH THE SYSTEM:

How to Get the Help You Need.. . . . . . . . . . . . . . . . . . . . . . . . . . . .. .34
APPENDIX A: Books on Mental Illness & Healthy Life Style. . . . . . . . . . 35 APPENDIX B: Acronyms and glossary of terms . . . . . . . . . . . . . . . . . 36 APPENDIX C: Website Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 38 APPENDIX D: Form PCM 201, Petition/Application for Hospitalization. . 39

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I. INTRODUCTION

 Purpose of This Manual

If someone in your family has a mental illness, you are not alone. Members of NAMI Michigan have learned the hard way about mental illness and services available. We have compiled information in this manual that would have been useful to us at the beginning or our journey, in the hope that it will be helpful to others as they find ways to understand and cope with mental illness in their families.

 NAMI Michigan

NAMI Michigan is part of a national organization "dedicated to the eradication of mental illness and to the improvement of the quality of life of those whose lives are affected by these diseases." There are more than a thousand NAMI affiliates in this country, forty of them in Michigan. Members include families and friends of individuals with mental illness, and those who suffer from mental illness. There are also groups in other countries. The national organization is at Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington, VA 22201, phone 703.524.7600 or www.nami.org.

Purposes of NAMI Michigan:

Encouraging and assisting in the organization of local affiliate groups within the state of Michigan composed of families and friends of persons with mental illness. Serving as an information and collection and dissemination center. Monitoring existing health care facilities, staff, and programming for adequacy and accountability.





Promotion of new and remedial legislation. Fostering public education. Pressing for quality institutional and non-institutional treatment of persons with mental illness.

Promotion of community support programs, including appropriate living arrangements linked with supportive social, vocational rehabilitation, and employment programs.



Providing for family support. Supporting and advocating for research into the causes, alleviation, and eradication of mental illness.

Improvement of private and governmental funding for mental health facilities and services, care, and treatment; and for residential and research programs. Liaison with other mental health organizations.



Delineation and enforcement of patient and family rights.

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Most people who join a NAMI affiliate do so because they need information and ways to cope with mental illness of a family member or themselves. They learn by talking with others, by attending educational meetings, and through affiliate newsletters. We encourage you to call the group nearest you and attend its meetings. You can locate local affiliates on the NAMI Michigan website, www.mi.nami.org, or call the state office at 517/485-4049 or 800/331-4264.

II. MAJOR MENTAL ILLNESS

 Symptoms of Mental Illness

Mental illness refers to a group of brain disorders that cause severe disturbances in thinking, feeling, and relating, often resulting in an inability to cope with the ordinary demands of life. They cause great distress to the person affected. Symptoms vary, and every individual is unique. But all persons with mental illness have some of the thought, feeling, or behavioral characteristics listed below. The list was developed by a group of family members from NAMI Arizona. While a single symptom or isolated event is not necessarily a sign of mental illness, professional help should be sought if symptoms increase or persist.

Social withdrawal: Sitting and doing nothing; friendlessness; abnormal self-

centeredness; dropping out of activities; decline in academic or athletic performance. Depression: Loss of interest in once pleasurable activities coming out of nowhere, unrelated to events or circumstances; expressions of hopelessness; excessive fatigue and sleepiness; inability to sleep; pessimism; perceiving the world as "dead"; thinking or talking about suicide.



Thought disorders: Irrational statements; peculiar use of words or language structure; excessive fears or suspiciousness; inability to concentrate or cope with minor problems.

Inappropriate expression of feelings: Hostility from one formerly passive and

compliant; indifference, even in highly important situations; inability to cry; excessive crying; inability to express joy; inappropriate laughter.

Unusual behavior: Hyperactivity or inactivity, or alternating between the two; deterioration in personal hygiene. Noticeable and rapid weight loss; drug or alcohol abuse; forgetfulness and loss of valuable possessions; attempts to escape through geographic change; frequent moves or hitchhiking trips; bizarre behavior (staring, strange posturing); unusual sensitivity to noise, light, clothing.

Often the symptoms of mental illness are cyclic, varying in severity from time to time. The duration of an episode also varies; some persons are affected for a few weeks or months, while for others the illness may last many years or a lifetime.

Accurate diagnosis may take time. The initial diagnosis is often modified later, perhaps several times. It takes time to evaluate response to treatment, a very important piece of information. It may also be difficult to pinpoint the problem because the individual has more

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than one disorder; for example, schizophrenia with an affective disorder, or an anxiety disorder such as obsessive compulsive disorder with depression or a personality disorder. It is important for the psychiatrist to reevaluate the diagnosis from time to time in order to work out the best treatment approach.

In some cases of apparent mental illness, alcohol or drug abuse or an underlying medical disease such as hypothyroidism, use of certain medications in susceptible persons, or a brain tumor is found to be the problem. A thorough physical examination

should be the first step when mental illness is suspected.

 Kinds of Mental Illness

Schizophrenia

The word schizophrenia comes from Greek terms meaning "splitting of the mind." People with schizophrenia, however, do not have a split personality. They have a disorder that affects thinking and judgment, sensory perception, and their ability to interpret and respond to situations appropriately. There usually are drastic changes in behavior and personality. Lack of insight about the illness is one of the most difficult symptoms to treat, and may persist even when other symptoms (e.g., hallucinations and delusions) respond to treatment.

Schizophrenia will affect about 1% of the population at some time during their lifetime. It is usually first diagnosed between the ages of 17 and 25. There may be several psychotic episodes before a definite diagnosis is reached. There may be a genetic component to this disorder, as persons with this disorder have an increased risk of having a close relative with the same condition.

When the disease first appears, the person may feel tense and have difficulty concentrating. He/she may begin to withdraw; school work or work performance may deteriorate; general appearance may deteriorate; and friends may drift away. Parents often think that this is just adolescent behavior gone astray, and even doctors may be uncertain about a diagnosis in the early stages.

Signs and symptoms of schizophrenia include

Alteration of the senses. The senses (sight, hearing, touch and/or smell) may be

intensified and/or or distorted, especially early in the disease.

Inability to process information and respond appropriately (also known as

"thought disorder"). Because individuals with schizophrenia have difficulty processing external sights and sounds, and because they experience internal stimuli that others are not aware of, their responses are often illogical or inappropriate. Their thought patterns are characterized by faulty logic, disorganized or incoherent speech, blocking, and sometimes neologisms (made-up words). They may relate experiences and concepts in a ways that seems illogical to others, but that holds great meaning and significance for themselves.

Delusions. These are basically false ideas that the person believes to be true, but

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which cannot be, and to which the individual firmly adheres despite well-reasoned arguments. However, unusual beliefs may be the product of a person's culture, and can only be evaluated in this context. Two common kinds of delusions are paranoid delusions, characterized by belief that one is being watched, controlled, or persecuted; and grandiose delusions, centered on the belief that one owns wealth or has special power, or is a famous person, often political or religious. Hallucinations. Hallucinations are sensory perceptions with no external stimuli. The most common hallucinations are auditory: hearing "voices" which the person may be unable to distinguish from the voices of real people. Delusions and hallucinations are the result of over acuteness or disruptions of the senses and an inability to synthesize and respond appropriately to stimuli. To the person experiencing them, they are real. Medications can be very helpful in controlling illogical thinking and hallucinations.



Changes in emotions. Early in the illness, the person may feel widely varying,

rapidly fluctuating emotions and exaggerated feelings, particularly guilt and fear. Emotions are often inappropriate to the situation. Later there may be apathy, lack of drive, and loss of interest and ability to enjoy activities.

Changes in behavior. Slowness of movement, inactivity, and withdrawing are

common. Motor abnormalities such as grimacing, posturing, odd mannerisms, or ritualistic behavior are sometimes present. There may also be pacing, rocking, or apathetic immobility.

There is as of now no cure for schizophrenia, but there are many medications are available which can reduce the symptoms. Finding the right medication is a very complex process and demands a working relationship with a doctor that is based on trust. The outcome can be very successful when the individual is treated appropriately with medications and also has access to rehabilitation services and a stable, supportive living environment.

Mood Disorders

Mood disorders or affective disorders include depression and bipolar disorder (manic depression). They are the most common psychiatric problems. The term mood refers to the state of one's emotions. Affect refers to their behavioral expression, especially on the face. A mood disorder is marked by periods of extreme sadness (depression) or excitement (mania) or both (bipolar disorder). If untreated, these episodes tend to recur or persist throughout life. Even when treated, there may be repeated episodes.

Beyond persistent depressed mood, the symptoms of depression include



Loss of interest in daily activities; loss of energy and excessive tiredness Poor appetite and weight loss, or the opposite: increased appetite and weight gain Sleep disturbance: sleeping too little or sleeping too much in an irregular pattern Feelings of hopelessness, worthlessness or guilt that may reach unreasonable

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(delusional) proportions



Recurrent thoughts of death or self-harm; wishing to be dead or attempting suicide Poor concentration

Symptoms of hypomania, or the more severe state of mania, include



Euphoric, expansive mood; or irritable mood Boundless energy, enthusiasm, and activity Decreased need for sleep Rapid, loud, disorganized speech Short temper, argumentativeness Delusional thinking Activities which have painful consequences such as spending sprees or reckless driving, or hyper sexuality

Estimates of the number of people with bipolar disorder vary from about 0.8% to 1.5% of the population. The illness often first appears in childhood or adolescence, although the majority of cases begin in young adulthood. There is believed to be a genetic component to the illness, since depression and bipolar illness often run in families.

Ironically, some of the symptoms of mania lead affected people to believe that they are not sick -- in fact, they may never have felt better. The euphoric mood may continue even in the face of sad or tragic situations. Even when the person continues to feel swept up in a mood of excitement, family and friends may notice serious problems. For example, people with mania often go on spending sprees, become promiscuous, or abuse drugs and alcohol while being unaware of the serious consequences of their behavior. Fortunately, bipolar disorder can be one of the most treatable mental illnesses. Lithium (see section on medications) is effective for 70% of people with bipolar disorder. There are a number of other medications for those who do not respond to lithium or who for some reason cannot take the medication. In addition to medication, many people with bipolar disorder find individual psychotherapy and/or peer support groups helpful.

Since many of the symptoms of mania may also occur in schizophrenia, it is often difficult to diagnose which of these illnesses an individual has, particularly early in the course of these disorders.

Depression in some degree will affect between 10% and 20% of the population at some time during their lives. Severe, recurrent depression will affect between 3% and 5%, some as often as once or twice a year, with episodes that may last longer than six months each. People with the most severe depression find they cannot work or participate in daily activities. They often feel that death would be preferable to a life of such pain. Depression is thought to be the cause of as many as 75% of suicides.

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Probably more than with any other illness, people with depression are blamed for their problems and told to "snap out of it," "pull themselves together," etc. Often others will say a person "has no right" to be depressed. It is critical for family and friends to understand that depression is a serious illness; the person with this illness can no more snap out of it than a person with diabetes can will away that illness.

Depression is often a very treatable illness. Approximately 70% to 75% of people properly diagnosed respond to treatment. There are many types of depression, and each responds somewhat differently to antidepressant medications and psychotherapy.

Schizoaffective Disorder

This illness is a combination of psychotic symptoms such as hallucinations or delusions, and significant mood symptoms, either depression or mania, or both. The psychotic symptoms persist when the mood symptoms resolve.

Other Disorders

Anxiety Disorders include the phobias, panic disorder, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder. Symptoms may be so severe as to be disabling, but these illnesses seldom involve psychosis. Panic attacks come "out of the blue" when there is no reason to be afraid. Symptoms include sweating, shortness of breath, heart palpitations, choking and faintness.

Obsessive Compulsive Disorder (OCD) Obsessions are repeated, intrusive,

unwanted thoughts that cause extreme anxiety. Compulsions are ritual behaviors that a person uses to diminish anxiety. Examples are hand washing, counting, repeated checking, and repeating a word or action. With OCD, the individual may have only obsessions or only compulsions, but most have both.

Personality Disorders such as borderline personality and behavior disorders can also be disabling. The individual may receive some benefit from medications and/or psychotherapy.

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    WHO/MNH/MND/96.9 MENTAL HEALTH CARE LAW: TEN BASIC PRINCIPLES with Annotations Suggesting Selected Actions to Promote their Implementation This is an edited version of a WHO document which lists and describes ten basic principles of mental health care law. It also provides annotations for their implementation in practice. KEY WORDS: health legislation / mental health / mental health care / human rights. This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. Division of Mental Health and Prevention of Substance Abuse World Health Organization Geneva, 1996 TABLE OF CONTENTS Foreword 1. Promotion of Mental Health and Prevention of Mental Disorders 2. Access to Basic Mental Health Care 3. Mental Health Assessments in Accordance with Internationally Accepted Principles 4. Provision of the Least Restrictive Type of Mental Health Care 5. Self-Determination 6. Right to be Assisted in the Exercise of Self-Determination 7. Availability of Review Procedure 8. Automatic Periodical Review Mechanism 9. Qualified Decision-Maker 10. Respect of the Rule of Law FOREWORD This WHO reference document lists and describes ten basic principles of mental health care law. It also provides annotations for their implementation in practice. It is largely inspired from a comparative analysis of national mental health laws in a selection of 45 countries worldwide conducted by WHO in recent years. Also, this selection of principles draws from the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care adopted by UN General Assembly Resolution 46/119 of 17 December 1991 (hereafter referred to as "UN Principles").
  • Incapacitation Through Maiming: Chemical Castration, the Eighth Amendment, and the Denial of Human Dignity John F

    Incapacitation Through Maiming: Chemical Castration, the Eighth Amendment, and the Denial of Human Dignity John F

    University of Florida Levin College of Law UF Law Scholarship Repository Faculty Publications Faculty Scholarship 1-1-2006 Incapacitation Through Maiming: Chemical Castration, the Eighth Amendment, and the Denial of Human Dignity John F. Stinneford University of Florida Levin College of Law, [email protected] Follow this and additional works at: http://scholarship.law.ufl.edu/facultypub Part of the Constitutional Law Commons, Criminal Law Commons, and the Human Rights Law Commons Recommended Citation John F. Stinneford, Incapacitation Through Maiming: Chemical Castration, the Eighth Amendment, and the Denial of Human Dignity, 3 U. St. Thomas L. J. 559 (2006), available at http://scholarship.law.ufl.edu/facultypub/215 This Article is brought to you for free and open access by the Faculty Scholarship at UF Law Scholarship Repository. It has been accepted for inclusion in Faculty Publications by an authorized administrator of UF Law Scholarship Repository. For more information, please contact [email protected]. ARTICLE INCAPACITATION THROUGH MAIMING: CHEMICAL CASTRATION, THE EIGHTH AMENDMENT, AND THEDENIAL OF HUMAN DIGNITY JoHN F. STINNEFORD* There are limits to the extent to which a legislatively represented majority may conduct biological experiments at the expense of the dignity and personality and natural powers of a minority-even those who have been guilty of what the majority define as crimes.' To be 'cured' against one's will and cured of states which we may not regard as disease is to be put on a level with those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles and domestic animals.' INTRODUCTION ..................................................
  • Technical Commentary

    Technical Commentary

    TECHNICAL COMMENTARY Policy and law Introduction some reviews may have been limited by journal guidelines. Mental health laws in many countries limit involuntary hospital admissions to patients who Evidence was graded using the Grading of meet an obligatory dangerousness criterion Recommendations Assessment, Development (ODC) for risk to themselves or others. This and Evaluation (GRADE) Working Group policy approach is in use throughout Australia, approach where high quality evidence such as the USA, and some areas of Canada and that gained from randomised controlled trials Europe. Alternative criteria implemented in the (RCTs) may be downgraded to moderate or low UK and other parts of Canada and Europe if review and study quality is limited, if there is allow involuntary treatment in the absence of inconsistency in results, indirect comparisons, dangerousness, on the grounds of an assessed imprecise or sparse data and high probability of need for treatment if the patient is deemed reporting bias. It may also be downgraded if unable to give consent. risks associated with the intervention or other matter under review are high. Conversely, low Method quality evidence such as that gained from We have included only systematic reviews observational studies may be upgraded if effect (systematic literature search, detailed sizes are large, there is a dose dependent methodology with inclusion/exclusion criteria) response or if results are reasonably published in full text, in English, from the year consistent, precise and direct with low 2000 that report results separately for people associated risks (see end of table for an with a diagnosis of schizophrenia and related explanation of these terms)3.
  • WHO Resource Book on Mental Health, Human Rights and Legislation

    WHO Resource Book on Mental Health, Human Rights and Legislation

    WHO RESOURCE BOOK ON MENTAL HEALTH, HUMAN RIGHTS AND LEGISLATION Stop exclusion, dare to care World Health Organization WHO RESOURCE BOOK ON MENTAL HEALTH, HUMAN RIGHTS AND LEGISLATION Stop exclusion, dare to care WHO Library Cataloguing-in-Publication Data WHO Resource Book on Mental Health, Human Rights and Legislation. 1. Mental health 2. Human rights - legislation 3. Human rights - standards 4. Health policy - legislation 5. International law 6. Guidelines 7. Developing countries I.World Health Organization. ISBN 92 4 156282 X (NLM classification: WM 34) Technical information concerning this publication can be obtained from: Dr Michelle Funk Ms Natalie Drew Mental Health Policy and Service Development Team Department of Mental Health and Substance Dependence Noncommunicable Diseases and Mental Health Cluster World Health Organization CH-1211, Geneva 27 Switzerland Tel: +41 22 791 3855 Fax: +41 22 791 4160 © World Health Organization 2005 E-mail: [email protected] All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to Marketing and Dissemination, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
  • Distinguishing Dementia from Mental Illness and Other Causes of Decline

    Distinguishing Dementia from Mental Illness and Other Causes of Decline

    Distinguishing Dementia from Mental Illness and Other Causes of Decline By Carolyn Reinach Wolf, Jamie A. Rosen, Dorothea Constas and Hindi Mermelstein I. INTRODUCTION Whether an individual suffers from dementia, mental illness or another cause of cognitive impairment, these conditions cause symptoms that worry potential clients, family members and caregivers, to the point of leading them to seek the advice of an attorney with experience in this area. Though there may be several legal questions that arise, in the end, all roads lead to capacity or lack thereof. Attorneys must develop the skill set to assess whether a client (or a client’s family member or loved one) has capacity in a variety of different situations according to various legal standards, and then advise that client as to how to best proceed to achieve his or her legal goal. The attorney must keep in mind his or her ethical obligations in representing a client with potential or actual diminished capacity. In cases where a client may be unable to make decisions on his or her own behalf due to some type of mental impairment (or where the client is a family member or loved one of a mentally impaired individual), that attorney must then develop a plan that may include executing appropriate legal planning documents or seeking intervention through the court system to protect the best interests of the individual. Section II will discuss the common clinical syndromes causing clinical dysfunction, with an emphasis on the similarities and differences between them. Section III will explore the issue of capacity and how these various symptoms affect legal representation from the perspective of a privately retained attorney and from the viewpoint of a Mental Hygiene Legal Service attorney.