Mental-health courts can take away the rights of an individual if clinicians can prove a person is not capable of making good decisions on their own. Instead, the court finds someone else who is willing to make good decisions for them. Often, the person entrusted to make the right decisions is a relative of the patient. When a parent or sibling wants to help, the legal system automatically gives them that right. This is done without questioning that family member’s own ability to act in the best interests of their loved one.
Last year, one of us worked with a patient in his 40s at an outpatient behavioral health hospital in San Diego. This patient was very disabled because of his mental illness. He saw and heard things that weren’t there, made very poor decisions and thought that people were out to get him. He claimed that his mother abused him when he was a child and that she was insane. He accused his mother and her boyfriend of using drugs and blamed them for making his problems worse.
Regardless of the validity of those claims, the focus here is that he had no choice but to live with his mother because she was his conservator. She was in control of his life and could have had him hospitalized if she thought he was out of control. The patient’s mother was automatically entrusted with her son’s rights without any check on her own ability to make sound decisions. In fact, during several conversations, it was not clear whether or not she was making the best decisions for her son.
It seems like this particular patient would have done better if he was not living with his mother while he was in treatment. True, he could not have lived on his own, but there were other options for him. He could stay at other places where he would be looked after. A more neutral person could have been assigned to look out for his best interest. Even if his mother really did have his best interest in mind, it didn’t help his situation because he thought that she was making his problems worse.
This created a conflict situation. These dynamics made it difficult to make progress toward dealing with the patient’s mental-health needs. Eventually, the patient dropped out of the hospital’s program because he couldn’t move out of his mother’s house and the mother agreed to pull him from the program because she couldn’t get him hospitalized whenever she thought he was not listening to her or did not follow her directions.
Family can play a huge role in helping someone get better when they are mentally ill. However, sometimes family can make it harder for someone to get better. We all have family members who annoy us and make us wish that they were not in our lives. If you had a mother who constantly criticized you, made you feel bad about yourself and everything you do, would you really want her to be in control of your life? Is she the best person out there to keep your money, tell you where you can live, and make decisions for you?
Don’t get us wrong. We are not saying that family members shouldn’t be the ones to help. Lots of families can take very good care of relatives who can’t take care of themselves. It just makes more sense if we have something in place to check for these things. A suggestion to policymakers is to include a screening process for potential familial conservators. A central aspect would be to explore whether or not the individual with mental illness wants a family member as their conservator and to investigate any concerns they may voice. Further, an assessment of the family member could also be included in order to screen for issues such as their own mental illness or substance abuse that might compromise their ability to best care for their loved one. If we are going to take away someone’s rights and give them to someone else, we really need to make sure that the person in charge is able to make the best decisions.
Linda Wu and Shayna Kelleher are graduate social-work students at San Diego State University, where they are specializing in mental health.