Home Treatment for Family Members with Mental Illness

Q: Home Treatment for Family Members with Mental Illness

Hello： The "home treatment" covered by health insurance is indeed only applicable to patients who have been definitively diagnosed and issued a "serious illness card." It seems that your mother is currently unable to attend a consultation, and we cannot confirm a diagnosis based

Mental illness in the family?

Hello, my mother has been observed to have issues with schizophrenia and delusional disorder for a long time, but she does not perceive herself as ill.
Therefore, I am hesitant to take her to see a doctor, fearing that if I bring it up, she might suddenly become agitated.
Previously, I inquired at a hospital about the possibility of home treatment, but they mentioned that it seems to require a major illness card.
I'm not sure if that's true.
She also mentioned that we could contact a public nurse for a home visit, and she bought a bottle of Haloperidol liquid medication, which I have been mixing into her food.
However, it seems to have no effect, not even side effects.
I wonder if her condition is too severe for it to show any results.
The doctor advised me to mix it into her food, and the nurse said that her mood would be more stable during visits.
Is that correct? I'm concerned that if a nurse comes for a visit unexpectedly, she might find it strange and become resistant.
When she has episodes, she often writes down her feelings of being persecuted.
Sometimes she keeps them to herself, but she frequently posts these notes on the mailbox downstairs to let everyone know.
At that moment, I feel at a loss about what to do.
If I take them down, she might become agitated, but leaving them up is embarrassing since we live in an apartment and all the residents can see them.

Could you please tell me what conditions are necessary for home treatment? Is the Haloperidol liquid that the doctor recommended effective? It seems to have no noticeable effect on her.
I also saw that there might be a second-generation low-dose version available online, which is said to be better.
Is that true?

Xiao Gou, 20~29 year old female. Ask Date: 2007/01/06

Dr. Sun Xiaoru reply Psychiatry

Hello: The "home treatment" covered by health insurance is indeed only applicable to patients who have been definitively diagnosed and issued a "serious illness card." It seems that your mother is currently unable to attend a consultation, and we cannot confirm a diagnosis based solely on her "victim mentality." In other words, home treatment is not suitable for your mother's situation at this time.
Here are a few suggestions:
1.
Use a reason that your mother can accept to seek medical attention: For example, common mental health issues often include complaints of "insomnia," or middle-aged and elderly women frequently report "headaches," "body aches," or "chest tightness." You could take her to a general hospital's psychiatry department (which is actually the mental health department, such as the Taoyuan City Hospital).
By using these discomforts that she may be more concerned about as a reason, you can convey to her that she can seek help, allowing her to feel the family's concern and be willing to seek medical care, while also avoiding the struggle of administering medication in her food.
We usually try to explain the patient's condition in terms they can accept during consultations.
2.
Contact the public health nurse at the health station: Public health nurses typically discuss the situation with you first before deciding whether to visit your mother; they will not go without prior discussion.
If your mother remains adamantly opposed to treatment, you can connect with the public health nurse and the home care nurse at our hospital to discuss subsequent treatment arrangements.
Currently, the towns and cities cooperating with our hospital include: Taoyuan, Zhongli, Bade, Yangmei, Luzhu, Guishan, and Pingzhen.
Additionally, some health station doctors in Taoyuan County also provide preliminary psychiatric diagnoses and medication treatment, so "visiting the health station" might be a more acceptable option.
3.
If none of the above options work and you must resort to administering drops, please discuss the dosage with the physician who recommended the drops, as effective treatment often requires dosage adjustments during the course of treatment.
If you go this route, you will also need to find an acceptable reason to bring her in for a consultation when she is somewhat stable (as mentioned in point 1).
However, since your mother's diagnosis is not yet fully confirmed, the decision to continue using drops should be made with caution.
Caring for a family member with mental illness is a very challenging process, and I encourage you to communicate these suggestions with other family members.
Once you decide to take her for medical care, it is essential for the family's attitude to be consistent to ensure she continues to accept treatment.
I hope this information is helpful to you.

Reply Date: 2007/01/06

More Info

When it comes to understanding home treatment for family members with mental illness, particularly in the context of schizophrenia and delusional disorders, there are several important considerations to keep in mind. Your situation is complex, and it’s clear that you are deeply concerned about your mother’s mental health. Here’s a comprehensive overview of how to approach this issue.

Understanding the Condition
Schizophrenia and delusional disorders can manifest in various ways, including hallucinations, delusions, disorganized thinking, and impaired functioning. One of the most challenging aspects of these conditions is that individuals often lack insight into their illness, which can make them resistant to seeking help. This lack of awareness can lead to significant distress not only for the individual but also for their family members.

Home Treatment Considerations
1. Professional Assessment: While you mentioned that your mother does not recognize her condition, it is crucial to have a professional assessment. If she is unwilling to visit a doctor, consider reaching out to mental health professionals who specialize in home visits. Some community mental health services offer outreach programs where professionals can assess and provide support in the home environment.

2. Home Treatment Conditions: For home treatment to be effective, certain conditions must be met:
- Safety: Ensure that the home environment is safe for both your mother and others. If there are any risks of harm, it may be necessary to consider hospitalization.

- Support System: A strong support system is essential. This includes family members who can provide emotional support and help monitor her condition.

- Medication Management: If medication is prescribed, it is crucial to ensure adherence. You mentioned using Haloperidol (哈柏度液) in food, which can be a strategy, but it’s essential to consult with a healthcare provider about the appropriate dosage and method of administration.

3. Monitoring and Communication: Regularly monitor her behavior and mood. Open communication is vital, but it should be approached delicately. Avoid confrontational discussions about her mental health; instead, focus on expressing concern and love.

4. Community Resources: Utilize community resources such as public health nurses or social workers who can provide support and guidance. They can help facilitate home visits and offer strategies for managing her condition.

5. Crisis Management: Be prepared for potential crises. If your mother exhibits severe symptoms or poses a danger to herself or others, it may be necessary to seek emergency assistance. Familiarize yourself with local mental health crisis services.

Medication Considerations
Regarding Haloperidol, it is an antipsychotic medication commonly used to treat schizophrenia and acute psychosis. However, its effectiveness can vary from person to person. If you are not observing any changes in your mother’s behavior or mood, it’s essential to discuss this with her healthcare provider. They may need to adjust the dosage or consider alternative medications.

Addressing Delusions and Behavior
When your mother expresses delusional thoughts or behaviors, it’s important to respond with empathy rather than confrontation. Acknowledge her feelings without validating the delusions. For example, you might say, “I understand that you feel this way, and it must be very distressing for you.” This approach can help maintain a connection without escalating her distress.

Conclusion
Navigating the complexities of mental illness within a family setting is undoubtedly challenging. It’s essential to prioritize both your mother’s well-being and your own mental health. Seeking professional help, utilizing community resources, and maintaining open lines of communication can significantly impact the effectiveness of home treatment. Remember, you are not alone in this journey, and there are resources available to support both you and your mother.

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