Challenges in Compulsory Treatment for Patients with Bipolar Disorder

Q: Challenges in Compulsory Treatment for Patients with Bipolar Disorder

Hello： There may be some resistance to the involuntary treatment of patients with mental illness in practice, but as long as there is good communication and coordination, it should not be difficult. <br>Please remain calm and proactive. <br>Here are some suggested steps： 1. <br>T

Patients with moderate bipolar disorder who lack insight into their condition and cannot be compelled to seek treatment?

Hello, I would like to ask Dr.
Chiu: My mother is a patient with moderate bipolar disorder, and she has entered a manic phase again this year (this is her fourth episode).
The problem is that she still lacks insight into her condition and often stops taking her medication on her own.
She engages in many reckless and dangerous behaviors.
Despite seeking help from the health bureau, doctors, and the police to force her into treatment and hospitalization to accept medication and stabilize her condition, we have tried various methods but have been unable to compel her to seek medical care.
When we called the police during incidents where she physically assaulted family members, they stated there were no third-party witnesses and advised us to handle it ourselves.
The health bureau said they could not assist, but after a neighbor reported being threatened, they called us asking why we hadn't taken her to the hospital.
The long-term doctor always insists that we bring her to the hospital for registration before any diagnosis, but she refuses to see a doctor, adamantly claiming she is not ill.
There is a lot of passing the responsibility among the parties involved, and as family members, we want to help her recover but feel helpless.

What methods are available to compel her to receive medical treatment and care? We have tried reasoning and comforting her, but she has lost trust in us and has even verbally and physically assaulted us.
Furthermore, she is very intelligent, and the same tactics are no longer effective.
We are from Hsinchu, and we love our mother dearly.
We truly do not want to pay the price of her health (in previous episodes, she even had to undergo surgery to remove damaged organs) or risk a life-threatening situation before the health bureau or medical system can address this issue.
For the sake of our mother's illness, we have read numerous books on bipolar disorder, trying repeatedly to bring her back to reality, but the current system leaves us feeling desperate.
Dr.
Chiu, could you please advise us on any ways to help? Thank you!

Kuài yào juéwàng de jiāshǔ, 50~59 year old female. Ask Date: 2013/10/19

Dr. Qiu Junda reply Psychiatry

Hello: There may be some resistance to the involuntary treatment of patients with mental illness in practice, but as long as there is good communication and coordination, it should not be difficult.
Please remain calm and proactive.
Here are some suggested steps: 1.
The mother's condition should already be registered with the health bureau, so you can first request assistance from the health bureau personnel.
If emergency hospitalization is needed, find out which nearby hospitals can provide treatment (including inpatient care) — ideally, the original hospital where she was treated should be able to admit her.
This way, when it's time to seek medical care, you can quickly decide which hospital to go to.
2.
If the mother exhibits violent or agitated behavior, you can contact emergency services (119) to transport the patient for medical care while simultaneously reaching out to the health bureau for assistance in coordinating between the hospital and emergency services.
This should facilitate a smooth transfer for the patient to receive treatment.
Thank you!

Reply Date: 2013/10/19

More Info

Dealing with patients who have bipolar disorder, particularly during manic episodes, poses significant challenges, especially when the patient lacks insight into their condition. Your situation with your mother, who has moderate bipolar disorder and is currently experiencing her fourth manic episode, is indeed complex and distressing for the family.
Firstly, it’s important to understand that bipolar disorder is characterized by extreme mood swings, including manic highs and depressive lows. During manic episodes, individuals may exhibit behaviors that are impulsive, risky, and sometimes dangerous. This can include substance abuse, reckless driving, or even aggression towards family members. The lack of insight, or anosognosia, is common in manic episodes, making it difficult for the patient to recognize that they are unwell and in need of treatment.

In your case, the repeated episodes and your mother’s refusal to acknowledge her condition complicate the situation further. You mentioned attempts to seek help from various authorities, including the health bureau and police, but faced obstacles due to the lack of third-party witnesses or evidence of immediate danger. This highlights a significant challenge in the mental health system, where involuntary treatment often requires clear evidence of danger to oneself or others.

Here are some potential strategies to consider:
1. Crisis Intervention: If your mother poses an immediate threat to herself or others, calling emergency services may be necessary. In many jurisdictions, police can intervene if they believe someone is in danger, even without a third-party witness. It may be beneficial to document specific incidents of dangerous behavior to present to authorities.

2. Involuntary Commitment: Each state has its own laws regarding involuntary commitment for mental health treatment. If your mother’s behavior is severely endangering her health or safety, you may want to consult with a mental health attorney or advocate who can guide you through the process of seeking a court order for involuntary treatment.

3. Engaging a Mental Health Professional: If possible, try to involve a psychiatrist or psychologist who can assess your mother’s condition and advocate for her treatment. Sometimes, having a professional involved can lend credibility to your concerns and may help persuade her to accept treatment voluntarily.

4. Family Support and Education: Continue educating yourself and your family about bipolar disorder. Understanding the condition can help you communicate more effectively with your mother when she is stable. Support groups for families of individuals with bipolar disorder can also provide valuable resources and emotional support.

5. Medication Management: Once your mother is stabilized, medication adherence is crucial. Discuss with her psychiatrist about long-acting injectable medications that can help ensure she receives her treatment even when she is resistant to taking oral medications.

6. Crisis Plans: Work with her healthcare providers to develop a crisis plan that outlines steps to take when she begins to show signs of mania. This plan can include emergency contacts, preferred hospitals, and specific interventions that have worked in the past.

7. Therapeutic Alliance: Building a trusting relationship with her healthcare providers can be beneficial. If she feels comfortable with her psychiatrist or therapist, she may be more likely to accept treatment.

8. Legal and Community Resources: Investigate local mental health resources, including advocacy groups that can assist families in navigating the mental health system. They may have specific programs or contacts that can help in your situation.

In conclusion, while the current system may feel frustrating and inadequate, there are pathways to seek help for your mother. It’s essential to remain persistent and to advocate for her needs, while also taking care of your own emotional well-being during this challenging time. Your love and concern for her health are evident, and with the right support and interventions, there is hope for stabilization and recovery.

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