Table of Contents:

Page 1:
HARDEST EXPERIENCE OF YOUR LIFE
REALITY ABOUT WHAT THE MENTAL HEALTH SYSTEM CAN DO
WHAT CAN YOU GET FROM THE SYSTEM?
GET ENTITLEMENTS FOR YOUR LOVED ONES

Page 2:
HOW CAN YOU ACCESS THE SYSTEM?
HOW TO SUCCEED WITH MENTAL HEALTH PROFESSIONALS
EDUCATE YOURSELF

Page 3:
DEMYSTIFYING MEDICATION
YOUR LOVED ONE DOESN'T TAKE THE MEDICATION
NEGATIVE AND POSITIVE SYMPTOMS
DISCHARGE PLANNING

Page 4
HOW TO SUCCEED WITH YOUR MENTALLY ILL LOVED ONE
PROTECTIONS AND OPPORTUNITIES FOR YOUR LOVED ONE
LOOK AFTER YOURSELF AND YOUR FAMILY

DEMYSTIFYING MEDICATION
The mentally ill have a biological disorder or chemical imbalance. Medication will either remit, reduce or eliminate the symptoms. Medications stabilize the way in which your loved one experiences her/himself and the world. They may also enable the loved one to make use of other clinical interventions, such as therapy. Medication compliance is the key to your loved ones' recovery process. Although medications don't cure, they reduce symptoms, enabling your loved one to use treatment and achieve some recovery. Be prepared, it can take from three to six months for some medications to stabilize the individual, depending on the medication and how it may interact with other medications. Case-by-case, medications must be introduced slowly and monitored closely, and the family must be carefully informed of side effects so you all know what to look for.

YOUR LOVED ONE DOESN'T TAKE THE MEDICATION THAT KEEPS THEM STABLE?
Severe lack of awareness that one is ill is part of the brain chemistry disorder. Psychologist Xavier Amador, who has made a study of this phenomenon, counsels to "externalize the illness by Listening, Emphasizing, Agreeing and finding Partnership or L E A P. 'Leap' is a way of connecting and getting out of the battle. to find a common ground to allow them to find their own reasons for becoming compliant. You can't use logic and expect insight when someone is delusional; the brain dysfunction is the enemy, not the patient." Dr. Amador's book I am Not Sick, I Don't Need Help (Vida Press) addresses this problem.

If a loved one is a family member over 18 who won't take the medications, has been hospitalized two or more times in the past three years, and may be at risk of being dangerous to him- or herself or others, then you might consider petitioning for Assisted Outpatient Treatment (see AOT). This is meant to be a last resort, when nothing else will work. Call you local mental health department, ask for whoever is responsible for the AOT program, and tell that person you would like to file a petition under "Kendra's Law." The program must investigate the condition and situation of the person you are concerned about in a timely fashion. Under "Kendra's Law," a court is able to assign a PACT team or case manager to assist people in getting treatment whether or not they want such assistance, but often, after the case is investigated, agreements can be made and services provided to keep people out of danger without going to court. Petitions are most easily filed while your loved one is in the hospital. You may ask the hospital for a petition to be implemented before discharge.

NEGATIVE AND POSITIVE SYMPTOMS AND HOW TO TREAT THEM
It's important for families to understand the difference between negative and positive symptoms.

- Positive means the presence of something undesirable. Positive symptoms respond directly to medication therapy: e.g. auditory hallucinations, visual hallucinations, psychotic thinking, delusional beliefs.

- Negative means the absence of something desirable. Negative symptoms are social withdrawal and inability to initiate and maintain interpersonal interactions. These symptoms are addressed by the newer anti-psychotic medications and can also be aided over time by the family and loved one attending psychoeducation groups, the patient attending a psychiatric day treatment (PDT) program or participating in a clubhouse. The clubhouse model that's been copied worldwide is "Fountain House." Founded by mental health care consumers, "members" put the emphasis on "mainstreaming" with a job and a home, in a supportive, attractive, home-like social environment.

DISCHARGE PLANNING: THE KEY TO THE FUTURE:
Discharge planning begins on the day of admission to the hospital when discussions regarding housing placement and aftercare should begin. It takes focus, motivation and time to design and implement an appropriate discharge plan, so this must receive top priority. This can be difficult if your loved one is not stable and not able to participate in discussions. However, if they have been living at home or independently, and if you feel they may need a supervised living situation, you should tell the staff immediately. This way they can begin the housing application process, which starts with completion of the "HRA 1995." Family involvement in planning is crucial because there are different types of housing available. It is important that you be proactive about doing your own research. The resource for learning about the various types of housing and where there are openings is www.cucs.org/vacancy You can exercise your legal rights to a complete discharge planning process (analysis of needs, medication, aftercare services, assistance in finding employment, identification of residence, listing of resource services and evaluation of eligibility for public benefits) by invoking Mental Hygiene Law Section 29.15 and the OMH Official Policy Manual PC-400. If you feel the hospital is planning an inadequate discharge, call the Urban Justice Center's Discharge Program 646-602-5600, which advocates for patients' rights and can intercede and provide assistance.

The other critical part of discharge is aftercare. If your loved one is unable to work due to their illness, it will be beneficial for her/him to attend a structured rehabilitation program. Examples are: Continuing Day Treatment, psychosocial clubs, Individual Psychiatric Rehabilitation Treatment (IPRT) or vocational programs. Again, be proactive in your research to assure that you are exploring all possible options.

Some experts, such as Dr. Fuller Torrey, feel with some mental disorders living at home creates an atmosphere of unpredictability and tension. Many families feel they are not qualified to give the necessary care. Since there is no one right answer, the question should be asked at the earliest point so there is time to implement alternative options.

The Discharge Plan should be tailor-made for your loved one:

- A consumer with mental illness who has had several hospitalizations within two years meets the criteria for getting a PACT/ACT (Assertive Community Treatment) team. This multidisciplinary team works with them at home or in the community and is strongly recommended for patients who have a severe and unstable course of illness, as the team can follow the person through all phases of the illness (see PACT).

- Another option for someone who has a history of non-compliance, as mentioned, is Assisted Outpatient Treatment (AOT) or "Kendra's Law."

- The person with mental illness who has had a first "break" in the middle of adulthood may have had a good social and educational history. In such a situation, services might focus on psychoeducation about the illness and medication and possible referral to either a "clubhouse" for transitional employment or to an IPRT (Individual Psychiatric Rehabilitation Treatment) for an opportunity to work on transitional vocational rehabilitation counseling.

- A high proportion of persons with mental illness "self-medicate," using various substances. Drug or alcohol abuse complicates the treatment picture. However, in the case of a "dual diagnosis" of substance abuse and mental illness, parents and loved ones need to know about programs and services targeted for this group which are known as MICA programs.

- Upon discharge, your loved one may be entitled to an Intensive Case Manager or Supportive Case Manager to help with everyday issues of housing, compliance, getting to programs, money management and the like, so be sure to ask.

Many families have found a one-page "Behavioral Contract" which is signed by the psychiatrist and social worker before a consumer leaves the hospital is invaluable to spell out, for the family and the team, formalized boundaries about the family's and the loved one's responsibilities and obligations.

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