Keeping Our Loved Ones Safe and Getting Them Well

Families for Depression Awareness

FDA_logo_greenAs family caregivers and caring friends of people living with mood disorders or other mental health conditions, we want to help our loved ones by

  • keeping them safe
  • getting them care to get well; and
  • preventing suicides.

Sometimes people are in a state of mind that prevents them from making sound decisions. There are mental states (e.g., experiencing psychosis) and physical conditions (e.g., effects from a stroke) that can adversely affect a person’s usual good judgment. We agree with DBSA and others that, ideally, a person with a mental health condition will engage family members and friends as partners in wellness and in crisis. There will be a written plan and the legal documents necessary to ensure that care is pursued and provided according to the individual’s wishes as expressed when he or she was well. Mental health practitioners can make sure that families get information about this and should strongly encourage patients to bring a family member to at least the first appointment.

The Reality

In our experience, all too often these conversations and pre-planning have not occurred, and the family member must navigate the complex medical, insurance, and legal systems to get emergency care for their loved one.

Family members are frequently excluded from mental health care decisions, despite being the ones who often have the most pertinent knowledge and the greatest motivation to get someone the care they need to get well.

Here’s an example from Nancy: her adult son was taken to the emergency room while experiencing a psychotic break. That hospital informed Nancy that he would be transferred to one of two particular hospitals, but they didn’t know which. After he was moved, Nancy was not able to get information from either hospital about whether he had been admitted. Even worse, the hospital would not take information from her about his current medication and psychiatrist, which she sought to provide in case he was at that hospital.

Finding a Solution

What do we do when there isn’t a prior plan in place? How do we find workable, fair alternatives to our flawed system of providing care to people whose mental state prevents them from making decisions in the way that they would if they were well? We need to include the variety of voices and stakeholders, including families, in this process.

If someone is suicidal, thinking of hurting themselves or others, or having cognitive impairment (e.g., in a psychotic state), then families should be able to

  • learn the whereabouts and condition of their loved one from medical facilities and practitioners and
  • interact with practitioners and staff to keep their loved ones safe, facilitate treatment and recovery, and get them well.

The laws of involuntary hospitalization, involuntary treatment, and patient privacy too often create barriers to securing medical care for loved ones who, due to cognitive impairment or mental state, are not in a position to make sound decisions at the time. We need to encourage the creation and implementation of mental health crisis plans, and we all need to participate in finding workable alternatives to these problems. Family members are ready, willing, and able to pitch in and resolve these issues.

Your Turn

Be sure to read the companion posts by Dr. Lloyd Sederer and the Depression and Bipolar Support Alliance (DBSA).

Tell us about your experiences! Comment below, and fill out our survey so we can better understand the scope of the problem.

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Take from above post: "There will be a written plan and the legal documents necessary to ensure that care is pursued and provided according to the individual’s wishes as expressed when he or she was well."

In a previous post, I had said in over 40 years, I have never been offered a plan to work with or the legal documents necessary to provide information to a mental health facility if I had a relapse of my symptoms.   In the early stages of symptoms,  my judgement may be lacking. I might typically travel far from home before  I required emergency treatment. This resulted at times being given medications that I reacted to with severe side effects. The horror of the experiences hindered me from seeking help in times of crisis.  Last week I met with my psychiatrist.  He has several psychiatrists within his association.  He said that they had never provided or worked with clients on a written plan, much less "legal documents" to assure correct treatment in accordance to a plan put in effect with input from a client.  He was interested about a template or "legal documents" if I found any.  After speaking with other mental health consumers, this seems to be the norm and not the exception.  It makes sense me that a "plan" should be a part of every treatment plan.   Where are these documents available? How do we get them in the hands of consumers and health providers?


As excerpted from Living with Someone who is Living with Bipolar Disorder, Chelsea Lowe, Bruce M Cohen, MD, PhD:“ A bipolar person might not see his or her viewpoints as the right one, so much as the only one.You might find sometimes to your frustration, that your feelings, opinions, wishes and conversation hardly seem to matter.Your partner might also misunderstand things you or others do or say, or give such convoluted rationales for his own actions or thoughts as to leave you shaking your head…” “Even more frustrating for their partners, people who have bipolar disorder often don’t believe that their extreme moods and unusual behaviors are part of an illness – or even abnormal.”

Couple the above insights with the reality that some experts say it can take up to two years to recover from a serious mental health crises, it is no wonder loved ones are reluctant to discuss pre-planning with theirbipolar family member.Having just gotten to a place of relative stability in the family and improved communications, we are weary of “rocking the boat” by bringing up the topic:“How would you like us to respond in your best interest should there be another mental health crisis.”

There are many reasons why this conversation is uncomfortable.Will our loved one think we are insinuating that we don’t have faith in their wellness plan – that we actually think there might be a “next time’?As healthy, mature adults all of us in the conversation have to face up to this uncomfortable reality.“Yes, there might be a next time, and I want to be sure I am there to support you and have your best interests and wishes taken into consideration, should the need arise.”

This pro-active step does not indicate lack of faith in a loved-one’s wellness plan, but rather demonstrates the deep love, care and concern we have for our bipolar loved one.There are ways to initiate the conversation that are not hurtful.Choose the time wisely.Right after a trigger or stressful event would not be a good time to have this discussion, for example.

Showing that you believe in your loved one’s wellness plan by opening the conversation with “I am so proud of how well you have been taking care of yourself.It really shows,” could be a great entre into a more serious discussion on pre-planning.

Erasing stigma means owning up to the disorder and treating it matter-of-factly.After all, if we are not willing to accept the realities of the disorder and deal with them just like we would any other disorder such as cancer or diabetes, how can we expect the general public to do so as well.


@MrJoeHermanIt’s unfortunate that so few people know about this empowering tool, which is part of why we’re making so much noise about it!

We encourage you to share the National Resource Center on Psychiatric Advance Directives with your clinicians, family, and fellow consumers. This resource answers frequently asked questions and links you to all the state-specific forms that you need to create an advance directive. It has guides geared toward consumers, family members, and clinicians. Check it out and spread the word:

Also, DBSA has a sample advance directive on our website: