Ways to Help Someone with Mental Health Issues

If someone falls, you can help them stand up, again. You can assist them to a place of comfort to clean up the wound and put a bandage on, and the person would probably be appreciative.

If there is a serious medical emergency with broken bones, bleeding or a heart attack, we know to call 9-1-1. People are trained to call for help immediately.

But what if there was pain and discomfort that isn’t as easy to name? We all want to reach out when someone is struggling, and when someone’s mental health needs care, knowing where to start isn’t always easy.

“For the majority of (mental health) conditions, such as paranoia or depression, people don’t understand that their experience is affecting them,” Arianne Zimmerman, MA, LPC, Director, Clinical Operations for Behavioral Health Services at Penn Highlands DuBois, said. “That can make it difficult for family or friends to intervene…Many, many families call us, they don’t know what to do.”

Staff at PHH Behavioral Health Services explain that there are options for help, depending upon the severity of the situation.

Encourage your loved one to seek help by making an appointment at an outpatient clinic. If the situation is more serious and needs addressed immediately, encourage your loved one to go to the closest Emergency Department, or ED.
For the person who is already seeing someone – a therapist, psychologist or psychiatrist – a family member or friend can share their concerns with the provider. Even if it seems minor, it is helpful for staff to know because patients are often not forthcoming about their experience. For the person who isn’t seeking therapy, if the person is seeing their primary care physician, a similar call may be made.

Keep in mind that for both types of offices – therapy and primary care physician - the personnel will never confirm or deny this person is a patient. Staff answering will only politely listen and will pass the information along when appropriate. The office staff actions are consistent to protect the privacy of the patients.

But there are times that a person’s condition is more serious - maybe they are paranoid, hearing voices or severely depressed. “The person’s insight can be impaired. They don’t understand how their experience is affecting them,” Zimmerman said. “This can make it very difficult to intervene with people.”

What else can you do? “There are options,” she said. Pennsylvania law has an act known commonly as “302.”

This law says that whenever a person is “severely mentally ill and in need of immediate treatment, he may be made subject to involuntary emergency examination and treatment. A person is severely mentally disabled when, as a result of mental illness, his capacity to exercise self-control, judgment and discretion in the conduct of his affairs and social relations or to care for his own personal needs is so lessened that he poses a clear and present danger of harm to others or to himself.”

Zimmerman broke this down into three simple parts:
1. Is the person showing he or she is a clear and present danger to himself or others. Is he inflicting bodily harm, threatening to hurt you or others – or himself - within the last 30 days?
2. Is the person unable to handle personal situations or their medical care within the last 30 days? Did they quit taking all of their medications? Did they start increasing drug or alcohol use? Is there a probability of death within 30 days without adequate care?
3. Is there a reasonable chance that a person will commit or attempt suicide? Is there an expressed intention?

“If a person says he/she is going to kill himself, you need to listen and get as much information as possible,” Zimmerman said. “Ask someone if he or she is having thoughts of killing themselves. People are afraid or worried to ask someone about suicidal thoughts, but it is critical in preventing a suicide attempt or completion.”

To help, keep track of what is happening to your friend or loved one. It could be needed in the future. Listen for details of paranoia and erratic behavior. A person may be able to appear that he/she is not experiencing mental health symptoms long enough to fool those who may be trying to help – such as a therapist or a doctor. These professionals don’t have the advantage of spending a longer time with someone to see all aspects of a patient’s life.

“If the situation comes to the point where the patient needs to be hospitalized, staff will need specifics.” Zimmerman said. “You will need to demonstrate that the person’s situation is leading to imminent risk. Is the person nailing doors or windows shut? Are they not caring for themselves? Hasn’t left the house in months? These are things you want to pay attention to.”

The process for petitioning for a patient to be involuntarily evaluated starts with a phone call to the county crisis intervention representative. Each county has a contracted and designated group. Locally, they are:
• Clearfield and Jefferson County: 1-800-341-5040
• Elk and Cameron County: 1-800-652-0562
• Clarion County: 814-226-7223
• Centre County: 1-800-643-5432

This county delegate will gather information from the person who calls and the patient. If there is enough information, a warrant is issued for the local police to pick up the patient within 30 days to take to the local Emergency Department for evaluation by a mental health therapist.

If the delegate does not have enough information, the petition can be denied. This is why having detailed information is very important.

At the Emergency Department, a therapist provides a mental health assessment and talks with family or friends to obtain more information. “We recommend that someone is present with the patient while in the ED to provide additional information,” Zimmerman said. “It can take time in an inpatient unit or weeks of therapy appointments before a person feels comfortable enough to admit there is a problem on their own and it can be very difficult to obtain information from a person in crisis.”

After the therapist assesses the patient, he or she contacts a psychiatrist and coordinates with the ED physician who determines if a patient should stay an allotted 120 hours (five days). If the patient is willing to come in for treatment, they may be offered the opportunity to complete a voluntary commitment, also known as a 201.

If there are further concerns with a patient while inpatient, the law allows for an extended involuntary stay of another 20 days. This is known as a 303.

A 303 commitment only occurs after a hearing which involves a mental health review officer and public defender for the patient. Every county is different, but locally most hearings are done over the phone or at the facility instead of the courthouse.

If more time beyond a 303 is needed, a part of the mental health law, part 304 can be enacted with the court’s approval up to 120 days. “Often by then, we know if the patient will need longer term care,” Zimmerman said.

Reaching out to get help for someone can be hard to do. Do what you can to be present, supportive, and encouraging. “People don’t want their loved one to be angry at them for taking steps to get them help. If you are concerned that your loved one may be angry or defensive, consider the alternative of them continuing down the same path which could lead to a more severe outcome.”

For more information about Penn Highlands Behavioral Health Services, go to www.phhealthcare.org. PHH has services throughout the region that offer help.