Navigating Forced Hospitalization for Bipolar Disorder: A Family's Dilemma

Involuntary hospitalization for bipolar disorder?

My father has suffered from bipolar disorder for many years and has been receiving medication from the Chianan Psychiatric Hospital.
He has been taking his medication regularly, but he often reduces the dosage on his own, which has led to a relapse.
Last year, I tricked him into going to the hospital, but despite his illness, he is still very clever and will not be deceived by the same method this year.

Currently, his condition includes abnormal hyperactivity, frequently claiming to be possessed by a deity.
Last Friday, he cut his own hand with a knife (because my grandmother was injured, he said this would help her hand heal).
He exhibits excessive confidence, exaggerates his abilities, and has even mentioned wanting to "fix" others (similar to killing).
He left home on Thursday, but was found yesterday with the help of the police.
In front of the doctor and police, he behaved well, but once home, he kept saying that if he were sent to the hospital, he would die to show us.
Additionally, a colleague saw him carrying a knife while walking yesterday.

Our family is willing to take him to the hospital, but he insists that he is not sick.
What should we do?

fang, 10~19 year old female. Ask Date: 2017/08/06

Dr. Zhang Fangrong reply Psychiatry

Dear Sir/Madam,
It is common for patients to refuse medical treatment, and I understand that this situation can be very distressing for family members.
Given that your father is exhibiting "extreme agitation and has been attempting to harm himself with a knife," this has reached the criteria for involuntary transport to a medical facility.
I recommend seeking assistance from public health authorities to facilitate his transport.
You can contact the local health center or directly reach out to the fire department for ambulance services to bring your father to our emergency department.
Once he arrives at the emergency department, we will encourage him to accept inpatient treatment.
If he refuses, you may also consider applying for involuntary hospitalization to ensure his physical and mental well-being, which can also provide peace of mind for the family.
Wishing you and your family good health.
Sincerely,
Dr.
Chang Fang-Jung
General Psychiatry
Chianan Psychiatric Hospital

Reply Date: 2017/08/06

More Info

Navigating the complexities of forced hospitalization for a family member with bipolar disorder can be an emotionally charged and challenging experience. Your father's situation, characterized by manic episodes, delusions, and self-harm, indicates a critical need for intervention. Here’s a comprehensive approach to address your concerns and provide guidance on the next steps.

Understanding the Situation
Bipolar disorder is a mental health condition that can lead to extreme mood swings, including emotional highs (mania or hypomania) and lows (depression). During manic episodes, individuals may exhibit behaviors such as increased energy, reduced need for sleep, and impulsive actions, which can sometimes escalate to dangerous situations, as you've described with your father's recent behavior.

The Need for Hospitalization
Given your father's current state—exhibiting signs of mania, self-harm, and threats of violence—hospitalization may be necessary to ensure his safety and the safety of others. In many jurisdictions, mental health laws allow for involuntary hospitalization if a person poses a danger to themselves or others, or if they are unable to care for themselves due to their mental state.

Steps to Take
1. Consult with a Mental Health Professional: Before taking any action, consult with a psychiatrist or a mental health professional who can assess your father's condition. They can provide guidance on whether hospitalization is warranted and the best approach to take.

2. Involuntary Commitment: If your father refuses to go voluntarily and poses a danger to himself or others, you may need to consider involuntary commitment. This process typically involves:
- Emergency Evaluation: Contact local mental health services or emergency services to evaluate your father’s mental state. They can help determine if he meets the criteria for involuntary hospitalization.

- Legal Process: Depending on your location, there may be legal steps required to initiate involuntary commitment. This often involves filing a petition with the court or seeking assistance from law enforcement.

3. Safety First: If your father is carrying a weapon or making threats, prioritize safety. If you feel that he is an immediate danger to himself or others, do not hesitate to call emergency services. They can intervene and ensure he receives the necessary care.

4. Family Support: Engage other family members in the conversation. Having a united front can help in persuading your father to seek treatment voluntarily. Express your concerns calmly and emphasize that your intention is to help him.

5. Educate Yourself: Understanding bipolar disorder and its treatment options can empower you and your family. Familiarize yourself with the signs of mania and depression, and learn about the medications and therapies available.

6. Aftercare Planning: If hospitalization occurs, work with the healthcare team to develop a comprehensive aftercare plan. This should include medication management, therapy options, and support groups to help your father maintain stability after discharge.

Conclusion
Navigating the complexities of mental health care, especially in cases of severe bipolar disorder, requires patience, understanding, and sometimes tough decisions. Your father’s safety and well-being are paramount, and seeking professional help is crucial. Remember that you are not alone in this journey; many families face similar challenges, and there are resources available to support you. By taking proactive steps and engaging with mental health professionals, you can help your father get the care he needs while ensuring the safety of everyone involved.

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