Helping those who refuse help

THE PHONE RINGS.

It's my friend - I'll call her Liza - calling from the West Coast. She's frantic about her mentally ill brother "Kenny," who lives in the Philadelphia area.

Kenny, who has bipolar disorder, stopped taking his meds. The last time this happened, he went AWOL for a year, living on the streets while his wife and kids worried sick about him. He eventually made his way back home, resumed psychiatric treatment and got his life back.

By last fall, things were going well and Kenny so brimmed with confidence that he decided he didn't need medication any more.

This happens often to people like Kenny: They become convinced that their illness is something to get over, like the flu. So they quit treatment once they're "better," often because they dislike the side effects of the meds that hold their delusions and hallucinations at bay.

Thus began Kenny's latest fall into hell - never a solo tumble, since it pulls his family with him.

This time, Kenny quit his job and casually mentioned the word "suicide," which allowed his wife to commit him to in-patient psychiatric care. He left treatment early and became erratic. When he got into a neighborhood confrontation, he was arrested. His frightened family got a protection from abuse order.

Within days Kenny violated the order - he left a plastic water bottle on the back steps of the house - so now he's locked up in county jail. He won't be released unless he has a place to live, but his family won't take him back unless he agrees to get help. Which he won't do because his illness tells him he doesn't need it.

At Kenny's status hearing this week, the judge noted that Kenny seemed more haggard and agitated than he did when he was locked up a month ago. Psychiatric evaluations were ordered and everyone's awaiting the results before they figure out what to do with him.

Kenny has no money, and none in his dwindling circle of loved ones will post his $30,000 bail. He's so unhinged they fear he'll go AWOL the moment he steps outside the prison.

"This is hell," says Liza, crying, when she calls for advice. "He doesn't need jail. He needs treatment."

Liza's lament reminds me of a talk I once heard by Elyn Saks, a brilliant lawyer, professor and psychiatrist who has schizophrenia. Her searing memoir, The Center Cannot Hold: My Journey Through Madness, helped me understand why she says that those with mental illness have "both the right to refuse care and the right to be rescued."

People like Kenny and Saks are not their diagnoses; they are human beings who have diagnoses, and they deserve the dignity of choosing or refusing care the way any of us do when we get sick. But when their lives have fallen apart because their mental health has crashed and burned, they also have the right to be rescued from consequences they'd never have chosen if they were of sound mind.

At this point, Kenny's right to be rescued needs to trump his right to refuse care.

Liza believes with her whole heart that Kenny - the stable, medicated Kenny - would be shattered to know that the erratic unmedicated Kenny is gravely ill and causing heartache.

But Kenny, when he was of sound mind, never put into writing what he would permit a designated loved one - like Liza - to do for him if he ever lost his grip on sanity. This is called a psychiatric advanced directive and it functions in much the same way as a medical advanced directive does. It lets everyone know your treatment wishes and preferences should you be unable to make them clear in the midst of a crisis.

Liza didn't know such a directive was even possible until I told her about it. Her goal now is to try, from afar, to convince her brother he needs treatment. As soon as she can afford it, she will fly here to support him as his mental health improves.

Then she'll talk with him about the treatment he'd like her to obtain for him the next time - because there will probably be a next time - he spirals into madness. She hopes he will agree to draw up the documents that will support his best wishes for himself, the ones he can't summon when when his bullying mental illness overtakes him.

I end my conversation with Liza with the promise to put her in touch with mental-health agencies in the Delaware Valley that can help her advocate for Kenny from 3,000 miles away. I tell her I will ask Kenny, in a letter to the prison, to put me on his visitor list so I can tell him in person how much Liza loves him and how eager she is to help him, if only he'll let her.

I'm pretty sure that the stable, medicated Kenny would allow me to see him, in a heartbeat. I don't know what the unmedicated, erratic Kenny will decide.

Like Liza's, my fingers are crossed.

Phone: 215-854-2217

On Twitter: @RonniePhilly

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