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Bipolar – Involuntary Commitment

answered 07:03 PM EST, Mon June 06, 2011
My 26 year old brother has rapid cycling bipolar disorder and about 2 years ago he attempted suicide. After his suicide try, he was sort of stabilized on medications and he stayed on them for a while, but I can tell now that he’s off them again and he seems to be using crack or meth or something as well. I’m really scared for him but he says he’s fine and doesn’t need or want any help, of any kind – and he gets so aggressive when anyone pushes the issue that everyone in the family is scared to bring it up anymore. A few days ago he was acting crazy and smashing his stuff up in front of the room he rents (my parents pay the rent) and the police came and he calmed down so they didn’t press any charges. We explained the situation and asked if they’d take him in for his own good to get him some help but they said they can’t unless he’s obviously just about to hurt himself or someone else. He’s acting just like he did before his last suicide attempt so we think he is about to hurt himself but he won’t listen to us and he won’t take his medication. Is there any way we can get him hospitalized for his own safety, even though he doesn’t want to go?

Dr. David Sack Says...

The rules about civil commitment vary from state to state. Over the last 30 years the civil rights of the identified patient have been given much more weight in the equation. So it has made it much harder to put them into treatment on an involuntary basis. In general, psychiatric patients can only be detained for very short periods of time, 72-96 hours, for the purposes of assessment. If they are deemed to be an imminent threat to themselves or other people involuntary treatment can be provided.

In general, the courts have been reluctant to keep patients in involuntary treatment who state they are willing to accept treatment and have a place to go to. The problem you are encountering with your brother is all too common across the United States today. Some jurisdictions have enacted outpatient civil commitment to ensure the individual stays in treatment after they are released from the facility – but this is the exception rather than the rule.

If you can be present when the police are called to your brother’s house there is a much greater likelihood that they will be willing to detain him and bring him to treatment. However, this is often not possible or feasible. 

Many patients who are stable in their bipolar disorder will become unstable or psychotic even after very brief exposure to crack or methamphetamines. It is critical your brother receive treatment not only for his bipolar disorder, but for his substance abuse, if there is any chance for him to stabilize long term. In many cases where treatment appears to not be working, the person shows dramatic improvement if they stop using illicit drugs or alcohol.

One treatment, lithium, has been shown to significantly decrease suicidal risk in bipolar patients with this clinical picture.

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