Early this year, The New York Times ran a powerful guest essay, “I Am the Last Barrier Between My Sister and New York City.” Authored by a writer whose sister has schizoaffective disorder and who, because of her illness, lacks all insight into her condition, the article details the enormous challenges the writer has faced in her efforts to ensure her sibling has access to housing, medical and mental health care, and basic living needs.
The piece is all too true, although not surprising to those of us in the mental health field. The author seems to have navigated many of the challenges in the system fairly well—or as well as our broken mental health and supported housing system make possible. Crucially, she sought help from expert practitioners, including specialized attorneys, to ensure her sister received the financial and other benefits to which she was legally entitled, and successfully petitioned for guardianship, a beneficial legal intervention in many of these situations.
Navigating the complex world of mental illness
The writer’s testimony points to the necessity of knowing exactly which professionals can best assist when a loved one is suffering from serious mental health issues. Fundamentally, families should ensure those they frequent and retain have real training and experience in the complex world of mental illness and the options available in the mental health, legal, and clinical systems.
Oftentimes, this isn’t completely straightforward, as mental health issues can, and often do, trigger and/or exacerbate other challenges, including academic, behavioral, and drug- and alcohol-related ones. As a result, families often find themselves speaking with consultants and other professionals who might be well-versed in these ancillary issues but do not have comprehensive mental health expertise.
This often leads individuals with mental illness and their families down a wrong or misguided path as they follow guidance that doesn’t take into account the realities of living with serious mental illness. This can drain precious time, energy, and resources as families up-end their lives to try to make their loved one’s situation better.
Mental health and legal options
It is inevitably more effective to first consider the various mental health/legal options at families’ disposal for providing meaningful help to loved ones, part of what my legal practice refers to as its “Mental Health Legal Toolkit,” specifically:
- Psychiatric Intervention. A team (psychiatrist, case manager, security, mental health attorney) meets with the family members and then the individual with the goal of bringing him/her to the hospital and/or arranging for private psychiatric care, case management, or other outpatient services.
- Psychiatric Hospitalization. An individual can be hospitalized voluntarily or involuntarily if an episode occurs in which the individual poses a substantial risk of harm to self and/or others. Hospitalization would allow for a psychiatrist and/or another mental health professional to evaluate any medical and mental health issues and establish a diagnosis and treatment plan, if any.
- Assisted Outpatient Treatment (AOT). A valuable tool for individuals who are non-compliant with treatment or services in the community and are frequently hospitalized, AOT is a court-ordered treatment for an individual’s mental illness and supervision in the community with the goal of preventing “a relapse or deterioration,” the proverbial “revolving door.” To be eligible for AOT, the person must be 18 or older; suffering from a mental illness; unlikely to survive safely in the community without supervision; have a history of lack of compliance with treatment for mental illness; and, most important, have had two hospitalizations in the past 36 months or one incident of violence to self or others in the past 48 months, which must be due to non-compliance with treatment.
- Guardianship. This legal proceeding authorizes the court to appoint and oversee a legal decision-maker for another adult, who, due to incapacity or other disability, and “functional limitations” is unable to manage his/her own affairs. The court can appoint a personal needs guardian to make decisions regarding medical care, residence, travel, etc., and/or a property management guardian to make financial decisions, apply for benefits, etc.
- Mental Health Warrants. This proceeding involves petitioning the court to issue a civil warrant to bring the individual to Court for a hearing. The individual is appointed counsel. At the hearing, the Court determines if he/she currently poses an imminent danger to self or others and should be remanded to a psychiatric emergency room for immediate evaluation and possible admission for treatment.
- Advance Directives. These legal documents, executed while the individual has the requisite mental capacity, contain an individual’s prior expressed wishes regarding medical treatment or financial affairs. They include healthcare proxy and power of attorney.
- HIPAA and State-Specific Release Forms. This authorization allows treatment providers to release information pertaining to patients/clients to family members or other designated individuals. This makes it possible for families to communicate with treatment teams and best understand diagnoses and medical or psychiatric treatment records. It is also extremely helpful in allowing families to participate in “family meetings” and/or discharge planning, all of which are key to ongoing mental health stability and functioning in the community.
Of course, legal approaches are not required for all persons experiencing mental health issues. But, among those with serious mental illness—including individuals like The New York Times guest essay writer’s sister—they are foundational for helping families best preserve and protect their loved one’s overall well-being.
