One heartbreaking aspect of loving someone who is struggling with a mental illness is not knowing if his treatment team is seeing the whole picture. Is your loved one able to accurately report his symptoms? (To simplify this discussion, I am going to refer to the doctor or therapist as "she" and the patient (your loved one) as "he.")
Doctors and therapists are bound by strict confidentiality rules, which is why you have to sign those "HIPPA" forms when you go to any medical person, including mental health professionals. So what's a mother (spouse, friend, etc.) to do when there are serious concerns about a loved one's mental health?
Here's a tip: Confidentiality only prevents the doc from giving information to you. It doesn't prevent her from receiving information from you. So, here are some options.
1. Go to the appointment with him. Ask your loved one if it would be OK. It's his decision.
2. Ask if he will sign a release form so you can talk with the doctor or therapist. Release forms usually last from three to six months.
3. See if your loved one would prefer someone other than you to communicate with his doctor. Is there someone both of you trust who might be more acceptable to your loved one?
4. Write a letter to the doctor or therapist (or send a copy to all members of the treatment team). Or call--but in that case you will probably be giving the information to a staff person, who in turn will transmit it second-hand to the doctor. Your letter will probably get through to the doctor without a go-between interpreting it.
If you do write, you have two options:
Option A.--Be up front about it.
Tell the patient what you are doing and why. You might want to give the patient a copy of the letter before the appointment so he can see for himself what your concerns are.
I hear you saying, "He knows perfectly well what my concerns are and he thinks I'm full of it." A succinct letter can help him to better see the big picture from your point of view. Be brief, but be clear and specific, and avoid judgment, blame and shame. Just the facts, ma'am, such as:
"He seems confused and often cannot finish a thought" or "His conversation rapidly flits from one topic to another" (not "he jabbers incessantly").
Point out any changes in his behavior, thought patterns, or moods:
"For the last month, he has been bathing about once a week and hasn't been combing his hair. This is unlike him. Normally, he bathes regularly and is well-groomed." That is clearer and less confrontational than, "I tell him over and over he needs a bath, but he won't listen when I tell him he stinks to high heaven." (And if you are talking that way, your anger is understandable, but talking to him disrespectfully will probably make things worse.)
Re-write your letter, perhaps several times, to make it as clear and helpful as possible.
Option B.--Write the letter without telling him.
If you think your sending a letter will agitate him or exacerbate symptoms like paranoia, explain in your letter why you would prefer the doctor or therapist not disclose that you wrote. But be prepared--there's no guarantee the doc will not tell her patient that you wrote the letter. On the other hand, she isn't required to do so; it's a judgment call.
You will have to balance the risk of agitation against the risk that if you don't give the doc more information, she will be hampered in making the most accurate diagnosis or offering the most effective treatment.
Bless those of you who are making these hard decisions about how to be helpful. I wish every person who experiences depression or another mental illness had someone like you watching over them! Call MHA, (740) 522-1341, or visit our website, www.MHALC.org, if you'd like to learn more about mental illness, violence prevention and recovery, parenting, or volunteering.
--Judith Allee
Parent Support Coordinator
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