Schizophrenia and forced treatment.

  PHOTO CREDIT:  Arne and Bent Larsen via Wiki Commons

I was hopeful when my son began receiving services with an Assertive Community Treatment (ACT) team, even though the way their relationship came about was not the perfect situation.

My son was in the hospital, having been admitted to the wrong floor.  The inpatient attending physician wasn’t happy to learn that he’d been admitted to her unit over the weekend when she wasn’t working.  The unit was for treating “disorders” such as depression and perhaps bipolar.  The other unit is where a patient went if he or she made reference to or exhibited signs of hearing voices, having hallucinations and/or signs of a cognitive thinking process deemed abnormal or delusional.  

The treating psychiatrist had a poor attitude.  She admitted to me that she had told my son that if he said anything she didn’t like, she would send him to another hospital that was not as desirable as the one he was in.

During a meeting she told my son the only way he could get discharged right away was to agree to sign on with an ACT team, which is what he did.

Before entering the hospital he’d been working with another team of mental healthcare providers that we both liked, but he was rebelling and not conforming to rules, after having been transported from the place we had called home for about six years. 

I felt that the earlier team gave up on him when symptoms of the illness they were treating him for flared, but they said the ACT team could serve him better.

Several years have passed since then.  I can’t be sure the good outweighs the bad in our personal experience of having ACT services.  There were good social workers who my son was very fond of, but they didn’t have much time.

Communication with this ACT team has been frustrating so much of the time.  For extended periods they’ve neglected my son.  They call this being, “engaged observers,” and always have either an excuse, such as too much paper work to get to him, or they blame him for not being easy to find on the downtown streets, which is how they often catch up with their clients.

I communicated with them once that my son needed help.  They agreed.  He was not doing well.  Their approach that time was to suggest that I leave him alone, at least for a couple of weeks or, “however long it takes for him to deteriorate,” his social worker suggested.  I liked the social worker, but I didn’t like the suggestion.

My son was living alone and certainly needed help.  I needed help helping him.  He was not, “sick” enough to be committed to a hospital psychiatric unit at that time.  The idea was to get him some help if he was an inpatient, they said.  I’ve since learned that this means forced medication.

The social worker told me they (his ACT team) believed that me inviting my son to my home, where we would have dinner and spend time with the dogs, one of whom is his, was helping him to stay well or rather, not letting him deteriorate to the point where they could have him involuntarily committed.  They suggested that I stop visiting him or inviting him to my house. 

“Just don’t answer the phone if he calls,”  a social worker told me.

I think this social worker had good intentions, I guess, but he just didn’t get it.  He didn’t have children yet.  None of the social workers on the team had any and many of them are younger than my son is.  We need some elders in these jobs.

ACT teams strive to keep people (consumers or clients) out of hospitals and in the community, but involuntarily commitment remains a common practice for social workers and ACT teams.

We were all in agreement that one of my son’s assets and at that time, probably his only asset was family involvement.  I am his family.  And our two dogs.

Their evidence-based treatment submits that patients who have family support fare better than those who don’t have it.

The ACT team have suggested several actions they believed would help my son since they became my son’s treatment team, a few of which made sense and some of which, I felt that I had no alternative but to agree with. 

I couldn’t go along with what felt to me like abandoning my son so he would get sick enough for a commitment.  I tried it for about a day and a half.  I decided not to go against my gut and my mother’s instinct.  I would not take away the only connection my son had to the outside world so that he would get worse.  Nothing about it makes good sense to me.

“You won’t always be around,” I was also told.

“Well, I’m not dead yet!”  I told the young social worker.  I’m not even a senior citizen yet.  I still have time to help see a difference in the healthcare my son receives, I hope, along with a change in American cultural perceptions about people whose brains work differently than “normal” brains.

The ACT team and I have also had disagreements about whether my son should have had antipsychotics forced on him.  I do not support this treatment for my son.  I think it is against his human and civil rights.

One time he went to the hospital for symptoms of depression.  The ACT team wanted him to be committed for a long-term stay, even though the hospital’s rehabilitation unit was closed at that time.  The hospital said if he stayed he would spend all his time in the day room watching television.  They said he would not receive therapy, but that they could force injections of medication on him.

I prayed.

The inpatient psychiatrist assigned to my son the next day was awesome.  He did not force antipsychotic treatment on his patient.  He said it would be like breaking his spirit. 

He spoke candidly with me about his opinions, which I agreed with and was truly grateful to hear.  He said he could not in his good heart force drugs on my son after having met and talked with him several times.

The doctor said something like… Your son has a free spirit.  He also has a strong adverse opinion about this medication.  He talked about the fact that my son was not a danger to himself or others, that he had not committed a crime or even bothered anyone.  Forcing a medication/drug on him didn’t feel right to the doctor nor myself.

The doctor was kind to speak to me while my son was there.  The only reason my son had to stay more than a few days was because I was trying to get the ACT team to come up and join us in an outpatient treatment planning meeting.  Everyone agreed that we needed a different plan.  The ACT team never showed for a meeting, and the doctor wished me well in pursuing other avenues of healthcare for my son after discharge.

He may not live the life you had expected, the doctor had told me, which I realized, but he has the potential to have a good life, without antipsychotics.  We discussed the fact that sometimes the side-effects of those drugs are worse than the illness, which in my opinion is a rare conversation to have with a psychiatrist.

The ACT team did not like that medication wasn’t forced on my son after he’d stated he did not want it.  They said it was most unfortunate that my son had this particular doctor.  I was aghast.  They said it only enforced my son’s belief that he does not need an antipsychotic drug.  I totally disagree.

I told them that I welcomed the doctor’s honest conversations with me.  I appreciated that he saw my son instead of a number or rather, a diagnosis waiting for a pill or an injection.

The ACT team’s psychiatrist told me this scenario (my son having access to a listening and caring psychiatrist) wouldn’t happen again.  She said she had many contacts at that hospital.   She said the next time my son needed medical attention that she could make sure he would be assigned to a psychiatrist whom she was acquainted with.  I didn’t think this was a good thing, and I would discover, eventually, that I had been correct.

“The next chance I have, I want you to know that I will advocate for a long-term commitment with forced medication for your son,” the psychiatrist told me in an angry tone.

I told her she should not act out of anger or frustration when it came to my son’s care.  He should not be committed because she was/is angry that things didn’t go her way or that the inpatient psychiatrist did not agree with what she wanted.  And most certainly, a commitment should not be planned for an indefinite time, before one is even needed.  That’s like a threat.  No, actually, it was a threat.

I’ve never had the same amount of trust in ACT services as I had before that conversation with their psychiatrist.

Thank you for visiting Dogkisses’s blog.  Please see link above for photo credit and copyright information for the beautiful orchid via Wiki Commons. 

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