Q. My husband was recently diagnosed with schizoaffective disorder, in addition to bipolar disorder and anxiety disorder. He also has Crohn’s disease, ADD, and idiopathic hypoventilation syndrome (asthma). All diagnoses, except ADD, were discovered over the past year. He also has opioid and benzodiazepine dependence.
I have known him for two years. We were married two months ago. He has been in and out of the hospital for all of the medical issues he has currently.
At the end of January 2008, he started taking methadone for the opioid dependency. He is very protective of his methadone. The doctors at the adult psychiatry unit in the hospital have tried to make changes to his dosage, but he becomes very upset. He is constantly drowsy and groggy. He is unable to stay awake, and drools all over.
The medications he takes are methadone, seroquel, depakote, singulair, and pentasa. He started taking seroquel last week. Depakote was started at the beginning of May.
I spoke with one of his doctor’s today. She told me he hasn’t made any effort for follow-up appointments. He is being discharged from the hospital today. He is no longer having hallucinations. The doctor stated he’s made the decision to be this way.
I don’t know what to do anymore. I know of two other places he could possibly go, but they will not take him right now. One will not admit him because of the dosage of methadone. The other only takes patients without insurance. He used heroin in the past also. Do you have any suggestions? I’m afraid to bring him home.
It seems like they may be releasing your husband too soon. He seems barely able to function but as long as he is no longer hallucinating the doctors may feel that he is stable enough to leave. What also complicates this matter is that he is still using methadone and, according to his doctors, he is unwilling or unable to make the needed effort to attend his follow-up appointments. His reluctance to allow them to change his methadone dose and his past noncompliance may have played a part in why he is being released. Perhaps his doctors feel that there is little else they can do for him by keeping him in the hospital. All of these matters make this situation very difficult.
He may also be overmedicated. The medication prescribed in the hospital is often higher than what a doctor might prescribe for an individual being treated on an outpatient basis. Usually, the hospital staff will schedule follow-up psychiatry appointments for their patients soon after he or she leaves the hospital and it is at these subsequent appointments that the medication dose is usually decreased or altered. To know if he is overmedicated would require him to attend the follow-up appointments and based on your letter he may not be willing to comply.
It’s a complicated situation but I do have a few suggestions. You can ask the hospital about an outpatient commitment. Most states have laws in place that allow hospital psychiatrists the ability to assign an individual leaving a psychiatric facility an outpatient commitment. The outpatient commitment stipulates that a patient will follow a set of predetermined treatment plan recommendations (e.g. attending follow-up appointments to the psychiatrist or the therapist, taking the prescribed medication) or risk being readmitted to the hospital. Few states enforce outpatient commitments and rarely are individuals ever readmitted for noncompliance but they are often used as leverage to ensure that individuals comply with their doctor’s orders.
Another suggestion is to either ask the hospital staff or call local residential living facilities to see if there is a bed available for a dually diagnosed individual (addiction and mental health) who is leaving the hospital but who is still relatively unstable. Your husband might be better served at a facility that can manage and treat his addiction and mental health issues. He seems unable to handle these issues on his own and there may be little that you can do to help him at this point in time, when he is so unwilling or unable to help himself.
You can also ask the hospital staff about other services such as intensive case management or mobile treatment teams comprised of doctors, therapists and nurses. Many communities have such services. As his primary caregiver, these services may help ease your work and provide you with needed support and information about how to best treat and care for your husband.
Your husband is lucky to have you. Many individuals with serious mental illness are not as fortunate. Many do not have family members ready, willing and able to care for them and to help them to become stabilized. But I also know that caring for an individual with a serious mental illness can be challenging. In the near future, you should consider contacting your local National Alliance for the Mentally Ill (NAMI) office for support for the ongoing care of your husband. In my experience, NAMI members are extremely helpful and often have an in-depth understanding of serious mental illness and the mental health system.
Thanks for writing and I wish you luck. Please write again if you have further questions.