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The Handbook:
Table of Contents
Introduction
Brain Disorders
Coping in Crisis
Medications
Resources for Care
Effects on the Family
Public Health Services
Financial Resources
Working with the System
Appendices:
NAMI Phone Numbers
DuPage Health Services
Chicago Area Hospitals
Community Resources
Legal Resources
Books, Videos, Journals
Hospitalization Form
Judicial Admission Form
Declaration of Treatment
Drug Reimbursement
An Affiliate of the National Alliance on Mental Illness
Coping with Brain Disorders in Crisis
If the mentally ill family member:
- is in danger of physical injury,
- is out of control,
- is talking about suicide,
- is posing a threat to the safety of other persons,
you need to know what steps to take.
Consult ahead of time with a mental health professional or with the Behavioral and Mental Health Services of the DuPage County Health Department (Access and Crisis Center: (630) 627-1700) so that you will know how to obtain services when you need them. Make a list of important information and keep it by the telephone.
Occasionally, everyone has a bad day. If you sense deterioration in a relative's mental condition, try to find out what is going on. There are usually early warning signs that signal problems, such as changes in sleep or social activities, increasing hostility or suspiciousness. Try to get the mentally ill family member to see a psychiatrist or social worker. The objective is to avert a crisis.
If you should need to phone for help, have with you written information about the family member's diagnosis, medications, and the specific event or behavior that caused you concern. It may be useful to have several copies to give to the police and to mental health professionals.
Family members may be at a loss as to how to react when someone they love is in crisis. Remember that the illness is no one's fault, nor is it the fault of the person who is in crisis. Most mental illnesses are considered to be biochemical disorders of the brain diagnosed by their symptoms. Some things that you can do in a crisis are:
Evaluate the situation. If you feel there is a danger to any person, either call the Access and Crisis Center (627-1700) for help in assessing the seriousness of the situation or seek assistance from local law enforcement officers. Plan for voluntary hospitalization or involuntary hospitalization. Call your local NAMI support group for assistance with taking these steps.
Be supportive. If your relative is seeing, hearing or feeling things that are not real, do not argue, deny or reason with him at this time. Instead, assure him that you love him, understand that what he is experiencing is real to him, and that you want to help him.
Always be honest. Your relative needs to know that you can be trusted. Discuss the need for hospitalization with him if this is a possibility.
Voluntary Hospitalization
If your family member willingly accepts his need for hospitalization and is admitted to an appropriate psychiatric facility, accept the fact that he is getting the care he needs.
You will be eager to follow his progress. However, in order to receive information from the staff caring for him, he will have to sign a Release of Information Authorization that is provided by the hospital. This is required because there is an issue of confidentiality in which the hospital is prohibited from disseminating information about its adult patients without their consent.
At times, involuntary hospitalization becomes necessary. If at all possible, voluntary hospitalization is always better. However, often the reasoning ability of a mentally ill person in crisis is impaired, and it is not always possible to convince him of the need for inpatient treatment.
Consequently, a person may be seriously ill, but if he refuses treatment, he cannot be committed to a hospital against his will unless he meets all of the following criteria:
- he/she must have a mental illness,
- his/her behavior and actions must be driven by or be a consequence of this mental illness,
- because of his/her behavior, there must be a reasonable expectation that serious physical harm to self or others will occur in the near future.
Also one of the following three conditions must be present:
- there is an imminent threat that the person will harm himself or herself,
- there is an imminent threat that the person will cause serious physical harm to someone else, or
- the person is not able to provide for his or her basic physical needs so as to guard against serious harm.
For the courts to take the serious step of depriving someone of his civil liberties, there must be clear and convincing evidence of the above criteria. This can be frustrating to family members or professionals working with the client in that a person may really be in need of treatment but be unable to meet all legal criteria for commitment. The Mental Health and Developmental Disabilities Code protects the basic liberties and freedom of all citizens, and thus the courts have made the grounds for involuntary hospitalization as narrow and strict as possible.
The first step a concerned relative or friend should take in regard to exploring the need for involuntary hospitalization is to contact those professionals who are treating the client. If the client is not in active treatment or if the therapist is not available, contact the DuPage County Health Department Access and Crisis Center at (630) 627-1700. The Access and Crisis Center staff must first assess all persons who might qualify for admission to public psychiatric hospitals and who reside in DuPage County. For DuPage County residents, the state facility for adults is Elgin Mental Health Center in Elgin, Illinois. For children and adolescents under age 18, treatment is provided by the Behavioral and Mental Health Services at private local hospitals with separate children and adolescent units which have been contracted by the State of Illinois to provide services.
Adolescents and children who are at risk of hospitalization at one of the hospitals under state contract must be screened by the Screening, Assessment and Support Services (SASS) Team, accessed through the DuPage County Health Department Access & Crisis Center. The SASS Team screens the youth to make a determination about which hospital program or community-based program can best meet the needs of the child or adolescent. It is further noted that the hospitalization of children and adolescents is never considered involuntary since the approval of the parent or guardian is required for admission and provides the permission for treatment.
If the Access and Crisis Center Staff determines that the person is in need of involuntary hospitalization, a certificate will be issued (see Appendix G). Only a physician, clinical psychologist or qualified examiner may issue a certificate for involuntary hospitalization. A petition also needs to be filled out, and this form can be completed by any adult citizen (see Appendix H).
The certificate is a mental health professional's formal evaluation of the client's clinical condition based on an interview and the reports in the petition. The petition is a report of someone's observations of the client's behavior.
The certificate and petition allow authorities to transport the client, against his will if necessary, to the hospital for further evaluation of the need for involuntary hospitalization. Often the client will sign himself into the hospital voluntarily. If hospitalized involuntarily, the court may appoint counsel for him and shall set a hearing date within five working days after admission to the health facility. At that time, the judge will decide if the client should continue to be hospitalized. If the judge so decides, subsequent judicial reviews of the case will be conducted in order to protect the client's civil rights.
Another route to involuntary hospitalization is through the State's Attorney Office. A judicial hearing will be arranged, and if warranted, the judge will issue a writ of detention and examination. The Sheriff's Department will then take the client to a mental health facility for evaluation. Thereafter, the certification process continues as for all other involuntary cases.
Even if this option is the only choice, the best first step to take for DuPage County residents is to contact the Access and Crisis Center. The professional staff will be able to assist you and help sort out all the options. The Access and Crisis Center has gone through the process of involuntary hospitalization many times, and the staff is there to help family members cope with all the issues as well as to help clients receive whatever treatment seems appropriate.
For more detailed information on involuntary hospitalization or involuntary medication, see Mental Health and Developmental Disabilities Code, 1992, or call Assistant State's Attorney, Civil Division, at (630) 682-7056 or 682-7535, or write 505 County Farm Road, Wheaton, IL 60187.
If a person resides in DuPage County, the Access and Crisis Center of the DuPage County Health Department, Behavioral and Mental Health Services must assess persons who might qualify for admission to public psychiatric hospitals.
Research, education and cooperation hold promise for a better quality of life for the mentally ill and their families.
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