Fruitless Advocacy

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It has been almost two months since our horrible experience with the hospital. And as has usually been the case for too many years now, another crisis came right on the heels of the previous one. This time, it took the form of my mom and uncle having to leave the house in which they were renting a room in on short notice. Unexpectedly, they were told by the owner that the house was going into foreclosure and that they had to leave in two weeks. They had never signed a lease, so had no rights to exercise. With nowhere else to go, my mom and uncle began staying in a motel when the two weeks expired.

This took place in the context of her health being poor and compromised from the lung infection that she was hospitalized for. Just walking was an immense struggle for her. I knew that the added stress of trying to find new housing wouldn’t be good for her, either. My concern and frustration were exacerbated by typical unresponsiveness from the county.

A day after my mom was unethically wheeled out of the hospital, I had called and talked to the Deputy Director of the Kern County Mental Health Department to inform him about what happened and to ask for assistance with my mom. Specifically, I asked about a new program the county had recently approved called Assisted Outpatient Treatment (AOT). Basically, it’s court-ordered outpatient care.  I’ve read about it and know there are mixed opinions and evidence about its effectiveness. I also know there are serious ethical concerns about the coercion aspect. I sympathize with some of them, but I also know from experience that a degree of coercion can work with my mom.

The message from the court/county basically would be “Take your medication and adhere to treatment or you’ll end up being involuntarily hospitalized.” I happen to believe that my mom partly takes her diabetic medication, due, in part, to her past experience of being involuntary hospitalized for high glucose. She knows that a lower glucose number keeps the authorities away. Her being in the program would also take the focus off of me as “the bad guy” responsible for trying to get her to treat her serious mental illness. We could then form a partnership around the goal of keeping her out of the hospital, instead.

The bureaucracy reared its ugly head almost immediately, however. I received a call the next day from someone with the county, the Family Advocacy Office, who didn’t seem thrilled I had talked to the Deputy Director. It was as if as she couldn’t be bothered. She asked me how I learned about the AOT program. Kern County isn’t actively publicizing it. I just knew it was approved by the county last October, by doing a Google search, and called the Director to see where it was in the implementation process. It can take some inveigling or persuasiveness, but I learned a long time ago that it’s just best to talk to the Directors when you want some solid information and assistance.  While she might not have liked my persistence, she did her job and took information down for what she explained was the beginning of the process for getting someone in the program. She also explained what seems pretty typical for AOT programs, regardless of where they are being utilized, at least in California. Initially, they give the person who is being considered for the program thirty days to voluntarily seek and adhere to outpatient treatment. If the person fails to find and adhere to treatment at that time, the case goes before a judge for potential mandating of service.

I was of course hoping that the process could be expedited, given my mom’s situation and condition. I knew she could easily end up back in a hospital relatively soon again, given her poor condition. As far as I was concerned, I thought my mom’s condition and the situation were such that she should be involuntarily hospitalized for her psychiatric condition. While I knew I could request an assessment, like I wanted done at the hospital, I also knew that they probably wouldn’t 51/50 her. The criterion she would have to fit was that of “gravely disabled.” Basically, that refers to someone who isn’t able to adequately provide shelter, clothing, and/or medical care for themselves, as a result of their psychiatric illness. It’s interpreted very narrowly, though. As multiple police officers have told me–as if they’re reading from the same department memo–a person essentially has to be lying down naked on railroad tracks, covered in their own excrement. I decided to spare my mom the indignation of an assessment by and potential conflict with the police.

About two days later, a supervisor called me from an Adult Aging department and told me they were sending out a field team to meet with my mom. After some questioning, I found out that this was part of the initial thirty-day assessment. He didn’t tell me that right away, for some reason. I was confused and thought the plan was changed. The lack of information government workers and bureaucrats can give about mental health options and processes never ceases to amaze me. Too many govt. workers just go through the motions.  Anyways, the team, consisting of a counselor and social worker, were set to meet with my mom to assess her and try to convince her to see a psychiatrist. It turned out that it was the same team who had been in contact with my mom before, around six months prior, just after one of her many prior hospitalizations.

To no surprise to me, when talking to the counselor on the phone after their home visitation, the counselor expressed that my mother, in her view, was borderline “gravely disabled.” After informing her of my mom’s precarious living situation, she said it’d probably make the most sense to try to convince my mom to admit herself into a hospital, and from there, to try and get her into some kind of assisted living situation. I agreed with her, at least in the short-term. I conveyed to her if we ever got to that point, my mom would eventually leave the facility of her own accord. As has been explained to me various times in the past, and as the counselor knew, no assisted living facility would try to keep her there against her will, if they aren’t legally obligated to do so.

Two weeks passed, and the counselor stopped returning my phone calls. It was similar with the supervisor and  Deputy Director. On the advice of a representative from the Family Advocacy office, I went in person to the Department of Mental Health to find out what was going on. She suspected they had stopped talking to me, due to patient’s privacy laws. It turned out that wasn’t the case. My mom, of her own accord, listed me as someone they could share information with when she was being seen by them previously.

As it turned out, the counselor had taken a medical leave of absence. Nobody was following up with her messages and/or cases, apparently, and for some reason, the supervisor and Director couldn’t be bothered.  Another counselor I ended up meeting with was nice enough and assured me that they would follow through with my mom. We agreed on a tentative plan to try and get my mom to see a psychiatrist again. Around three weeks have passed since that visit/conversation, and my mom has received little follow up. Without my constant advocacy, I seriously doubt the county would follow through with getting her into AOT at all. Given this, I’ve decided to move my mother in with me in Modesto, CA. The county, Stanislaus, doesn’t have AOT, but their services seem OK. They make home visits and integrate medical and psychiatric care. That’s uncommon. Thus, a new chapter in our lives begins….