How to Handle a Reluctant Bipolar Patient: Seeking Help for My Brother

My brother has bipolar disorder and is not cooperating with treatment. What should I do?

Hello Dr.
Wu, my brother has bipolar disorder and was discharged from Luton Hospital on July 9th.
After his discharge, he started selectively taking medication, only the ones that help him sleep, and he is not taking the others.
My brother has always had difficulty communicating, and his condition has worsened since he became ill.
He does not listen to any advice and now goes to his workplace (he is a mechanic) and occupies the space to work on his own car.
His boss hopes we can take him back to the hospital, but we are unable to persuade him.
Given this situation, can he be involuntarily committed for treatment?

Mandy, 20~29 year old female. Ask Date: 2011/07/12

Dr. Wu Peijun reply Psychiatry

Hello, based on the description of the situation, it seems that "involuntary hospitalization" is intended to send your brother back to the hospital.
If that is the case, the principle for involuntary hospitalization requires a risk of harm to others or self-harm, and it appears that your brother's condition may not meet that criterion yet.
I'm not sure if his last hospitalization at Luton Hospital was voluntary.
Currently, if he is willing to return for outpatient care, you can contact the outpatient physician in advance and ask them to find a way to persuade him to be hospitalized.
If he refuses to return for a follow-up, it is advisable to discuss the possibility of readmission with his attending physician from the last hospitalization, as they would be the most familiar with his condition.

Reply Date: 2011/07/12

More Info

Handling a reluctant bipolar patient, especially a family member, can be a challenging and sensitive situation. Your brother's recent discharge from the hospital and his selective adherence to medication indicate that he may be struggling with his condition and the treatment process. Here are some steps and considerations that may help you navigate this difficult situation.

Understanding Bipolar Disorder
Bipolar disorder is a mental health condition characterized by extreme mood swings, including emotional highs (mania or hypomania) and lows (depression). Patients often experience periods of intense energy, euphoria, or irritability during manic phases, followed by depressive episodes where they may feel hopeless or lethargic. Treatment typically involves a combination of medication, therapy, and lifestyle changes.

Importance of Medication
It is crucial for individuals with bipolar disorder to adhere to their prescribed medication regimen. Mood stabilizers, antipsychotics, and antidepressants can help manage symptoms and prevent episodes. Your brother's choice to only take sleep medication may indicate a lack of understanding of the importance of comprehensive treatment.

Communication Strategies
1. Empathy and Understanding: Approach your brother with empathy. Acknowledge his feelings and frustrations about his condition and treatment. This can help build trust and open lines of communication.

2. Educate: Sometimes, patients may not fully understand their condition or the importance of their treatment. Providing educational resources about bipolar disorder and its management can help him see the value in adhering to his medication.

3. Involve Professionals: If possible, involve a mental health professional who can communicate with your brother. Sometimes, hearing advice from a trusted therapist or psychiatrist can have a more significant impact than family members.

4. Set Boundaries: While it’s essential to be supportive, it’s also important to set boundaries regarding his behavior, especially if it affects others. Let him know that you care about him but are concerned about his well-being and the impact of his actions.

Seeking Help
If your brother’s behavior poses a risk to himself or others, or if he is unable to care for himself, it may be necessary to consider involuntary treatment options. In many jurisdictions, there are laws that allow for involuntary hospitalization if a person is deemed a danger to themselves or others, or if they are unable to provide for their basic needs due to their mental illness.

1. Consult with Professionals: Before taking any action, consult with a mental health professional or a legal expert to understand the options available in your area. They can provide guidance on how to approach the situation and the legal implications of involuntary treatment.

2. Emergency Services: If your brother becomes a danger to himself or others, you may need to call emergency services. They can assess the situation and determine if hospitalization is necessary.

3. Support Groups: Consider joining a support group for families of individuals with bipolar disorder. These groups can provide valuable insights, coping strategies, and emotional support.

Conclusion
Dealing with a reluctant bipolar patient requires patience, understanding, and sometimes tough decisions. It’s essential to prioritize your brother’s safety and well-being while also respecting his autonomy. Open communication, education, and professional involvement can help facilitate a more productive dialogue about his treatment. If necessary, do not hesitate to seek emergency assistance to ensure he receives the care he needs. Remember, you are not alone in this journey, and there are resources available to support both you and your brother.

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