Navigating Referral Processes for Mental Health Rehabilitation in Taiwan - Psychiatry

Regarding the issuance of a referral form to a rehabilitation center during the initial consultation, thank you for taking the time to review this, and I would appreciate your assistance?

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Dear Dr.
Wu,
My brother was diagnosed with schizophrenia in May 2019.
Prior to his diagnosis, he had been consuming excessive amounts of non-psychiatric prescribed sedatives and sleeping pills provided by himself and our parents, and he had not been receiving long-term treatment from a psychiatric or mental health specialist.
His previous consultations were all in the Taipei metropolitan area.
Last August, due to my mother immigrating abroad, my 88-year-old grandmother in Taipei was unable to provide care, and I was asked to arrange for ongoing care.
However, after my brother was discharged from Songde Hospital, he had access to sedatives at home and did not return for follow-up for 21 months.
He began exhibiting signs of irritability and withdrawal symptoms from the medication.
On July 10, he violently attacked my mother, pushing her down after a physical altercation, which was only stopped when my grandmother intervened.
On August 27, after I took my brother to visit his original attending physician, Dr.
Liu, at Songde Hospital to discuss the incident with my mother, he became uncontrollably angry late that night when reminded of an appointment the next day.
He charged at me like a bull, and with no way to retreat, he started to attack me.
At that moment, I asked my grandmother to call the police to initiate involuntary hospitalization procedures.
After three days at Songde Hospital, his CPK levels reached over 46,000, indicating rhabdomyolysis, which raised concerns about potential kidney failure, leading to his transfer to the nephrology department at the United Hospital System - Zhongxiao Branch for 48 days of treatment.
He was preparing to return to Songde to continue addressing his original substance abuse issues, but during the transfer, he took advantage of a moment when the nursing staff was distracted and left the hospital without notice.
After searching the ward and being unable to contact him, I reported him missing at the nearby police station.
This was the second time I had to report him missing.
A few hours later, my grandmother informed me that he had returned home but had asked her for sleeping pills, which she refused to give him.
When I returned home, I insisted that he come back to Songde with me since he was currently classified as a missing person, and under police pressure, he finally agreed to return with me.
However, upon arrival at the emergency room, his CPK levels were again over 1,700, prompting me to transfer him to a comprehensive hospital for better treatment.
I found Shin Kong Hospital, which has both psychiatric and nephrology departments, and he was admitted there for 40 days.
Since they only had an acute psychiatric ward and no chronic ward, my brother expressed a desire to return to Songde for chronic care or to transfer to Shin Kong's chronic ward.
However, Songde indicated that due to internal medicine issues and the lack of a referral process, they could not arrange a bed immediately and recommended he go to a comprehensive hospital instead.
Subsequently, I found Tucheng Chang Gung Memorial Hospital, which has a chronic psychiatric ward, but my brother's willingness to be admitted fluctuated.
Upon re-admission, he stated he did not want to sign the hospitalization consent form, which puzzled the attending physician, who remarked, "You should still be at Shin Kong; how could you be referred here? If you don’t sign, we will have to initiate a 60-day hospitalization process." Under the pressure of the 60-day requirement, my brother signed the hospitalization agreement.
During his stay, the chronic ward needed to clear out patients before the new year, and due to my brother's low willingness to transfer to the chronic ward at Taoyuan Chang Gung, we discussed that he would be willing to go to a rehabilitation home.
Before his discharge, he mentioned whether he could wait until after a physical examination to ensure continuity of rehabilitation treatment, as he might not follow my instructions once back home.
The medical team did not accept my suggestion, believing my brother was highly motivated and improving daily, and thus set a discharge date.

On the first day back home on January 11, he began to behave abnormally, refusing to eat from morning until night, only drinking a lot of water.
He also showed reluctance to visit the planned daytime rehabilitation facility and for the scheduled physical examination before going to the rehabilitation home.
That evening, he complained of discomfort and refused medical attention.
Noticing his pale complexion and concerning symptoms, I called 119.
At St.
Paul’s Hospital, his CPK level was 2,544, confirming rhabdomyolysis.
Only then did he agree to undergo the physical examination before going to the rehabilitation home in Neili, with results expected around Wednesday, January 26.
The rehabilitation home indicated that they had a referral form that needed to be submitted within 14 days of admission, which was urgent.
I am unsure if it is possible to indicate on the form that the case originated from the initial diagnosis.
We plan to continue seeking treatment here.
Thank you for your assistance with the initial consultation, and I will attach the medical records.
Best regards.

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Andon Lin, 30~39 year old female. Ask Date: 2022/01/24