Can I sign my brother into a mental health facility?

My brother has been diagnosed with paranoid schizophrenia and has not been taking his medication. He's been using methamphetamine and alcohol and was found sleeping naked in my step mom driveway in 12 degree weather.

I was adopted in by his dad (who just passed) and his mother will not Get involved because she's afraid of financial responsibility.

Do I have the rights to be able to sign my brother into mentalhealth facility?

Lauren Ostrowski, MA, LPC, NCC, DCC, CCTP
Lauren Ostrowski, MA, LPC, NCC, DCC, CCTP
I tailor my therapeutic approach to each client's strengths and goals

I'm sorry to hear that your brother has been having such a rough time. He's lucky to have you on his side (although he may not always see it that way).

As far as whether you can sign him in, that depends on a lot of different things.

I would suggest that you Google the state and county that you live in as well as some phrase similar to "crisis hotline." They can tell you how it works in that county. My guess is that you could sign him in as long as he met the criteria for admission at that moment, but I can't  be entirely sure. 

You could also ask the person on the phone about financial responsibility. I have not heard of that being a problem, but I guess it would depend on insurance.

If you have trouble finding a local  hotline, consider calling the national crisis number (800-273-8255) and ask them to help you find someone local.

The information above is intended as general information...  (more)The information above is intended as general information based on minimal information, and does not constitute health care advice. This information does not constitute communication with a counselor/therapist nor does it create a therapist-client relationship nor any of the privileges that relationship may provide. If you are currently feeling suicidal, as if you want to hurt or kill yourself or someone else, or are in crisis, call 800-273-8255 (24 hours a day, 7 days a week), call 911, or proceed to your local emergency room.
Eric Ström, JD, MA, LMHC
Eric Ström, JD, MA, LMHC
Attorney & Licensed Mental Health Counselor

Thanks for asking this question. I know it can be really difficult to deal with issues like this.

To answer your question, you might be able to get you brother some mental health help, even if he doesn't recognize that he needs it. In most states, an individual can request a mental health evaluation of a family member if that family member poses a danger to themselves or someone else, or if they are unable to take care of their own basic needs.

You can always call 911 if you are concerned about his immediate safety (for example if you find him sleeping outside in below freezing weather.  As an alternative to calling 911, you might also be able to request an evaluation from an authorized mental health provider.  The deatsils of who you would contact vary from state to state. Here's a link with some additional resources:

http://www.treatmentadvocacycenter.org/someone-i-know-is-in-crisis

He's lucky to have a brother who cares for his wellbeing as much as you do.

The information above is intended as general information...  (more)The information above is intended as general information based on minimal information, and does not constitute health care nor legal advice. This information does not constitute communication with a counselor/therapist/attorney nor does it create a therapist-client nor attorney-client relationship nor any of the privileges that relationship may provide. If you are currently feeling suicidal or are in crisis, call 911 or proceed to your local emergency room.
Sherry Katz, LCSW
Sherry Katz, LCSW
Couples and Family Therapist, LCSW

The answer depends on what State you live.

Since the description you write here is that your brother may be a serious risk to himself and others, it is worth contacting a mental health hotline or one of your local area hospitals and talk to a social worker or other professional level person in their psychiatry department.  

Ask the same question you posted here.   Your question is a good one and merits serious follow through.

The information above is intended as general information...  (more)The information above is intended as general information based on minimal information, and does not constitute health care advice. This information does not constitute communication with a counselor/therapist nor does it create a therapist-client relationship nor any of the privileges that relationship may provide. If you are currently feeling suicidal or are in crisis, call 911 or proceed to your local emergency room.
Karen Keys, LMHC, CASAC, NCC
Karen Keys, LMHC, CASAC, NCC
Recovery and Wellness Expertise

Hello, My heart goes out to you, your brother, and your family, dealing with a very painful and difficult situation. 

In New York, you can't institutionalize someone else directly. You can, however, call the police or EMS. If they agree that he would benefit from hospitalization (and it sounds like they would), he can be held in the hospital for up to 72 hours, whether he agrees or not. Some hospitals will not hold a person that long, in spite of what we might want. I have seen many patients in and out of hospitals countless times, and it has been my experience that it can be extremely difficult to hold a person long enough to achieve good stability and an appropriate after-care plan. Hospitals in NYC tend to take a "patch and release" approach more often than I would like. 

It's been my experience that family makes a difference. Assertive, knowledgeable, persistent family can improve the quality of your loved one's care. Hospitals are highly pressured to discharge people quickly but they can not discharge a homeless person without someplace to go. If your family is willing to accept your brother, that will be the path of least resistance for the hospital. If the family refuses, they will be forced to find another path for him. You can also pressure the hospital to refer to rehab after psychiatrically stablized (which may only take a few days) and that may give your brother more time to begin making clear-headed decisions. 

If your brother has a psychiatrist, that person should be actively involved. I had a patient patched-and-released three times, in spite of my advocacy and him literally begging to remain and stop his voices. We finally got a 90 day hospitalization because I strong-armed his psychiatrist into demanding that the hospital stabilize his patient.  

If your brother has a history of non--compliance with oral medications, you can push the hospital for injection, which again will help your brother stay stable for longer. 

Best wishes to you and your family. 

The information above is intended as general information...  (more)The information above is intended as general information based on minimal information, and does not constitute health care advice. This information does not constitute communication with a counselor/therapist nor does it create a therapist-client relationship nor any of the privileges that relationship may provide. If you are currently feeling suicidal or are in crisis, call 911 or proceed to your local emergency room.
Kristi King-Morgan, LMSW
Kristi King-Morgan, LMSW
Social Worker, Psychotherapist

Family members sometimes get Power of Attorney over vulnerable adults. If you had this, you could do something like that. I'm assuming that you don't, though. There are steps family members can take through the court system to get someone involuntarily committed, but it is a long process. 

I deal with situations like this everyday on the job. The only time an adult can be committed against their will is if they are deemed by the doctor (such as at an emergency room) to be a threat to self or others. For instance, if he had suicidal thoughts and a plan to carry out the action, or if he had homicidal thoughts against someone else and a plan to carry it out, he could be placed on a short hold, but these holds only last for a few days. This still isn't a long-term solution. 

An adult has the right to refuse treatment and the right to make their own choices, no matter how bad those choices are. If you have a way to get him to an ER whenever things like that happen, such as being found sleeping outside in 12 degree weather, it will help a lot. They may or may not do a short term commitment for treatment based on the situation that brings him to the ER, but it's a start. They can help set him up with appointments for psych and he can get on medications. You can help by taking him to appointments and making sure his medications get filled. However, you can't force him to take the meds, so this may be something that happens a lot. With enough of a paper trail of many ER visits and that sort of thing, you'll stand a better chance of getting a court appointed psych ward stay. 

Some tips about ER visits: Don't send him alone. Always go with him or have someone go with him, because you will be able to give the treatment team better insight into what's going on than he will. He may say everything's fine and he wants to leave, so they won't have any reason to keep him if that is the case. Go with him. 

If you do get Power of Attorney, take the paperwork with you when you go to the ER and to doctor's appointments because they aren't just going to take your word. They need to see the actual paperwork. Having it on file in their system isn't good enough because paperwork expires, etc. Take it with you at all times. You can also compile his medical records and that sort of thing to take with you so they can see a full history of what's going on.

Keep in mind that if you do get Power of Attorney, this makes you his guardian and you have to take care of him. Otherwise, you can get reported for vulnerable adult abuse and neglect. In fact, your mom ignoring and not helping may already put her at risk of that because she is willingly doing nothing to help someone who clearly needs the help. She won't be financially responsible for the hospital or doctor bills, but should be held responsible for his safety. Someone should. There are group homes for people with schizophrenia. " Being responsible" for someone doesn't mean you have to pay their bills, it just means you are going to make sure they get the care they need. That care may be placement in a long-term care facility like a group home or a nursing home. Psych inpatient hospitals aren't long-term, so you do need to look into other long-term options. Psych inpatient stays are temporary and are to stabilize him, they're not where someone stays forever.

Good luck, and keep up the good attitude! Work with his treatment team. Ask for a social worker. If they see family that is wanting to do the right thing and wanting to help, they'll help you even if it does take a while to get things sorted out. The worst thing any of you can do is NOT go to appointments and that sort of thing. 

The information above is intended as general information...  (more)The information above is intended as general information based on minimal information, and does not constitute health care advice. This information does not constitute communication with a counselor/therapist nor does it create a therapist-client relationship nor any of the privileges that relationship may provide. If you are currently feeling suicidal or are in crisis, call 911 or proceed to your local emergency room.

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