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Selah R, M.S. LPC
Selah R, M.S. LPC, Therapist
Category: Mental Health
Satisfied Customers: 582
Experience:  Licensed Professional Counselor; over 13+ yrs exp working with adults, teens, & families/couples.
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My sister has Bipolar Disorder I. Lately, it has been getting

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My sister has Bipolar Disorder I. Lately, it has been getting worse and she is getting to the point where it is out of control. Her behavior is eradic and borderline psychotic. Her husband is her primary caretaker and I help, but I am not sure how long this can go on. Her doctors tell us there is nothing we can do but deal with it. Is there something we can do to get control of this? Her only stress in life was work, so we put her on disability; now she is angry because we will not give her the car keys because she is seeing things and she has tried to commit suicide 8 times. The doctors keep giving her meds but they are not working. She was diagnosed 10 years ago. It has been like this and going downhill for about 3 months. Should we consider putting her in a hospital for a few months? If so, which ones and what are the costs like? We are not rich, but of lower middle income.
Submitted: 6 years ago.
Category: Mental Health
Expert:  Selah R, M.S. LPC replied 6 years ago.
Thank you for trusting JustAnswer with your important question.

Mental health treatment, especially hospitals, have changed a great deal over the past years. We used to be able to send a patient in for 1-2 months to help them stabilize on medications, monitor their symptoms, and help them learn new coping skills. With rising costs and lower insurance coverage, most psychiatric hospitals have become crisis centers where the average stay is about a week. The few hospitals that still do extended treatment (2-4 weeks) are usually specializing in a specific niche like drug rehab, trauma survivors, or dual-diagnosis (mental illness + substance abuse). These centers can easily cost $1,000/day and higher. The last option is to have her committed to a state-run hospital, where longer treatments (6-8 weeks and longer being normal). The costs on these hospitals are usually much less, and she might qualify for free care based on the family income level and if she has Medicare or Medicaid as part of her disability.

Your best bet would be to talk to her psychiatrist about what your options are that s/he will support. You can also call 211 to find out if there is a "mobile mental health crisis team" in your area who can come out and evaluate her when she is in a psychotic state. They can help get her in to hospitals and will usually know how to best work the hospital scene. Once she has been admitted to a hospital for crisis care, it's time for the family to step up and ask about long-term treatment due to the severity of her condition and the fatigue of her caregiver.

Some local community-based mental health centers also offer case managers who come out to the home to work with chronically mentally ill people. These services might help take some of the strain off her spouse. If she has Medicare or Medicaid, she might also qualify for home healthcare visits from nurses. Many families use those services in order to have respite time for themselves (a few hours they can get away, run errands, or otherwise step back from the primary caregiver role). This might be worth looking at.

The current standard treatment for her condition is still going to be medications (mostly mood stabilizers and antipsychotic medications) to manage her symptoms, with no expectation of cure but rather symptom management. Some people are finding Cognitive Behavioral Therapy to be beneficial in working with people with Bipolar, but any form of psychotherapy is going to be difficult when she is in a psychotic state. Still, having a bond with a skilled therapist, learning how to be more aware of her own symptoms and the need for symptom management, may help her make better decisions regarding her moods and reactions.

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