Tensions often exist between individual rights and liberties and those of a family, neighborhood or community. No where does this delicate balance seem to get tested more than in the areas of mental health and cognitive impairment. The latter of which is most often seen in cases involving Alzheimer's and other dementia.
Clinicians and other healthcare professionals have learned through trial and error to walk the fine line of respect for the individual's wishes and safety of others. Legislation creates a framework and the setting of clear expectations helps set the boundaries for interactions.
But, what about families and friends. How do they know where the line between acceptable and unacceptable behavior lies if their lens is clouded by love, guilt, shock, disbelief, confusion, frustration or being fatigued from compassion. How can they begin to see more clearly to make the decisions that respect the desires of their loved one, without jeopardizing the safety of others or oneself.
Prior blog posts have touched on access to firearms, the role of Adult Protective Services , the importance of self-care. and even a guest post on making executive decisions for aging parents. This post will focus on resources to help you make more objective decisions relating to those whom you care. In California, it is commonly referred to as a "psychiatric hold", "5150" or The Lanterman-Petris-Short (LPS) Act; but similar legislation and safeguards are in place around the US.
The goal is to arm family caregivers with knowledge and help them to think more "clinically" about the behaviors that are exhibited by their loved one. In doing so, family/caregivers/neighbors can make better decisions to protect the safety of their self, family, neighborhood and community. This includes the decision to place their an individual in a facility better equipped to care for their needs and protect the safety of others.
A detention for evaluation and treatment of a mental disorder is appropriate when an individual potentially fits into one of the three categories below. Peace officers, authorized professionals at a 5150 designated facility or others designated by the local county/parish can write the legal document that authorizes holding a person against their will at a designated facility or emergency department. Once this occurs, emergency and mental health professionals can stabilize the crisis and provide the psychiatric treatment needed.
Danger to Self - A person who is suicidal, expresses significant harm to self, or engages in dangerous behavior that puts him/her safety at risk (intentional or unintentional). This can include a person who has thoughts to commit suicide or inflict bodily harm on self and when a person refuses to accept or is unwilling or unable to obtain a psychiatric evaluation/treatment voluntarily.
Danger to Others - The person expresses harm to others or demonstrates behavior that puts the safety of others at risk of serious harm. Dangerous or violent behaviors can be unintentional or intentional; including thoughts of causing bodily harm to another person or people or irrational, impulsive or reckless behaviors, such as misuse of a vehicle as to put others directly in danger or harm.
Gravely Disabled - A person who is unable, due to a mental disorder, to provide or utilize food, clothing or shelter; or otherwise unable to care for him/her self. Signs can include loss of weight, dehydration, little or no food in the house, failure to wear clothing, inappropriate clothing for the climate/conditions, refuses to use their shelter, sleeping in dangerous conditions, no plan for obtaining meals/clothing/shelter and refusing assistance from family/friends/others.
The situations that are most commonly being expressed by family caregivers and causing the most frustration are:
- The display of faults in comprehension or judgment, but insisting or actually using a firearm/driving or participating in other potentially dangerous activities.
- Making physical threats against others or exhibiting abusive or violent behaviors.
- Refusing assistance from others, but unable to survive safely without involuntary detention.
The bottom line is that it doesn't hurt family or neighbors to call and ask for an evaluation. Reach out to the individual's health team for guidance, if possible. However, if an active threat of harm or dire and unsafe situation is present call 911.
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