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Treatment for an extreme case of Bipolar I, PLEASE HELP.
I will try to keep this post as short as possible.
My brother has been diagnosed with Bipolar I disorder. He seems to have no one who wants to help him except myself (he has lost most of his family and friends). His disorder usually manifests in its mania (rather than depressive) phase. His symptoms are textbook but on a higher level, violent behavior including but not limited to: self-mutilation, suicide threats, death threats, physical altercations, destruction of personal/ public property, drug abuse - marijuana (daily), cocaine (monthly), spending sprees (very excessive), et cetera.
All of his previous therapists have told him that his case of the disease is very extreme and have since refused him treatment. Although he has been given referrals, no doctors have accepted him, minus a psychopharmacologist who seems to be more concerned with upping his prescription and getting him out of her office. He has health care, but NYC is a little different than most places. Competent doctors do not like patients who have to rely on insurance and prefer clientele who can pay upfront in cash. He was previously supported by a family patron who is no longer helping him.
Although I have researched the topic heavily, due to the extremity of his situation, I am at a blank. I returned to the States after a long bout abroad and will be leaving the country again in a few weeks. I won't have the opportunity to return for a long period for at least another year and a half. I want to put together as much stuff possible for him before I leave.
The situation is as follows:
- He takes his meds (I do not know if they are correct meds, because I have no background in medicine).
- He does not have access to a competent therapist.
- He has no outputs for his anger.
- He refuses to try anything new.
- He refuses to see old friends or try to make new ones.
- He has no one besides myself who is willing to help him (Besides myself, he has a deep resentment for our direct family members).
- Out of habit, he has a poor diet and has difficulty eating without first smoking marijuana, thus he is severely underweight.
- He has no interest in exercising.
- However, he has on occasion in his rare depressive stage told me that he would be willing to go into a sanitarium for this problem.
The reason for most of his refusals come from his educational background is in psychology. Albeit he has a developed understanding of his illness, unfortunately, he is more interested in using his knowledge of the disease as a route to escape any responsibility to help himself. I am tired of getting into semantic debates with him and listening to quotes from obscure medical articles, but at the same time I love him. I am starting to think the only feasible option is to have him legally restrained and forced into a mental asylum. I strongly believe that he is a threat to himself and others.
However, he also has told me personally that he knows the psychological evaluation test well that he would be given provided anyone calls 911, and that he could beat it any day of the weak. This was followed by his assurance that, provided he was detained he would do anything he could to to provoke an officer to kill or hurt him.
This is very difficult situation. Sometimes I wish I could redo my educational path and study medicine so that I could personally develop treatment on the situation. Sorry that this statement is long and unorganized, but if you made it this far, please give me any advice you can offer.
My brother has been diagnosed with Bipolar I disorder. He seems to have no one who wants to help him except myself (he has lost most of his family and friends). His disorder usually manifests in its mania (rather than depressive) phase. His symptoms are textbook but on a higher level, violent behavior including but not limited to: self-mutilation, suicide threats, death threats, physical altercations, destruction of personal/ public property, drug abuse - marijuana (daily), cocaine (monthly), spending sprees (very excessive), et cetera.
All of his previous therapists have told him that his case of the disease is very extreme and have since refused him treatment. Although he has been given referrals, no doctors have accepted him, minus a psychopharmacologist who seems to be more concerned with upping his prescription and getting him out of her office. He has health care, but NYC is a little different than most places. Competent doctors do not like patients who have to rely on insurance and prefer clientele who can pay upfront in cash. He was previously supported by a family patron who is no longer helping him.
Although I have researched the topic heavily, due to the extremity of his situation, I am at a blank. I returned to the States after a long bout abroad and will be leaving the country again in a few weeks. I won't have the opportunity to return for a long period for at least another year and a half. I want to put together as much stuff possible for him before I leave.
The situation is as follows:
- He takes his meds (I do not know if they are correct meds, because I have no background in medicine).
- He does not have access to a competent therapist.
- He has no outputs for his anger.
- He refuses to try anything new.
- He refuses to see old friends or try to make new ones.
- He has no one besides myself who is willing to help him (Besides myself, he has a deep resentment for our direct family members).
- Out of habit, he has a poor diet and has difficulty eating without first smoking marijuana, thus he is severely underweight.
- He has no interest in exercising.
- However, he has on occasion in his rare depressive stage told me that he would be willing to go into a sanitarium for this problem.
The reason for most of his refusals come from his educational background is in psychology. Albeit he has a developed understanding of his illness, unfortunately, he is more interested in using his knowledge of the disease as a route to escape any responsibility to help himself. I am tired of getting into semantic debates with him and listening to quotes from obscure medical articles, but at the same time I love him. I am starting to think the only feasible option is to have him legally restrained and forced into a mental asylum. I strongly believe that he is a threat to himself and others.
However, he also has told me personally that he knows the psychological evaluation test well that he would be given provided anyone calls 911, and that he could beat it any day of the weak. This was followed by his assurance that, provided he was detained he would do anything he could to to provoke an officer to kill or hurt him.
This is very difficult situation. Sometimes I wish I could redo my educational path and study medicine so that I could personally develop treatment on the situation. Sorry that this statement is long and unorganized, but if you made it this far, please give me any advice you can offer.
He needs medication adjustment, a case manager to coordinate services and recovery for issues with substance abuse. He needs better forms of coverage (Medicaid, Medicare if he could be eligible for SSDI but he needs to apply first and can't if he's currently using substances). That's a lot but it starts by connecting him with services. I know what N.Y.C. is like. I live here. I would suggest going to your local independent living center and asking them for resources to coordinate all this. Then as that is resolved, his treatment could be adjusted. He could live in supported housing for people with psychiatric disabilities. He could be on SSI or SSDI if eligible. Try that. Its all a lot of steps but your local independent living center can help. Here's a link.
http://www.ilru.org/html/publications/directory/index.html
There's one in every county/boro of every state. And as a volunteer if that doesn't work out I could perhaps do some advocacy from the non profit I am a part of. If other things don't work out pm me and I'll see what I can do. Those agencies and the one I volunteer for are not clinical but they could (better than myself I am homebound but do research info. and do appeals representation for SSI and have extensive benefits knowledge) address getting the clinical services coordinated and then it could be addressed from there.
http://www.ilru.org/html/publications/directory/index.html
There's one in every county/boro of every state. And as a volunteer if that doesn't work out I could perhaps do some advocacy from the non profit I am a part of. If other things don't work out pm me and I'll see what I can do. Those agencies and the one I volunteer for are not clinical but they could (better than myself I am homebound but do research info. and do appeals representation for SSI and have extensive benefits knowledge) address getting the clinical services coordinated and then it could be addressed from there.
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