Can we avert disaster? (mental-illness-legal-issues filter)

• My adult brother with various mental health issues (living at home with my parents in the Chicago area – near north suburbs) keeps going off and doing self-destructive...and illegal stuff. It’s getting worse, and it can’t go on. We’re clueless and scared. Help us, HiveMind! So much Ah, me…where to begin? My baby brother (mid-30’s) has always carried a host of developmental disabilities -- learning problems, inability to socialize, etc. Not classically autistic, but possibly Asperger’s-like, and he was diagnosed nearly a decade ago with schizophrenia (of the negative symptom variety). Since then he’s been on a host of meds in an attempt to control a whole soup of this and other mental health problems, including compulsive tendencies, depression, etc. It is the compulsive behavior that is causing the greatest issues. Over the past several years my bro has engaged in a series of problematic activities that share the features that (1) he clearly lacks both control of and good judgment over them; and (2) they’ve been about trying to get/make money. Highlights of the downward spiral: - (6-7 yrs ago): obsessive purchase/collection of videos…which at some point, having spent all his money on them, he decided to sell on ebay (probably making back 1/10 of what he spent, but I imagine “feeling” like he was making money) - (1.5 - 5 years ago): Working in a low-level office job and blowing much of his earned income on impulse purchases. Discovers online gambling, gets into that, blows the rest of his money and more. Starts being a “bad” ebay seller, trying to sell stuff he doesn’t have on hand and then stuff he doesn’t have at all. Discovers the power of the internets to provide just about anyone with a credit card at predatory terms, and blows money he doesn’t have at said terms. Debt racks up. - (about 1.5 years ago): Brother gets caught after signing a client check over to himself. Police are involved, but no charges are pressed – it’s obvious to all that he’s no criminal mastermind, just a messed up guy and somewhat lost soul. He is fired from job, though. - Since then, it’s been too much free time to get into trouble, and the obsession with money (and stunted legitimate avenues to get it) remains. Nearly a year ago it was discovered that he’d stolen my mom’s identity (both their names are on a bank account, since she has requested control of his SSI checks) to open other credit and rack up a few thousand dollars in charges there. After some frustrating failed efforts to get the credit card company to negate the charges (which might have been more successful if they’d been willing to send my brother to jail), they decided to just try to gradually pay it off. They got my brother connected to a program where a psychiatric social worker came to the house weekly; no one knows much about what actually was accomplished during these sessions, but a few weeks ago my brother told the SW to stop coming, and he did. Now, the other day my grandfather mentions offhand that money has been mysteriously flowing out of his own bank account. After some investigation, our fears that my brother is at it again are confirmed. I’m fuzzy on the exact details of what and how, but I understand it involves another fraudulent account using the fact that my grandfather and mom have a joint account together. We’re talking about $10K here. My grandfather is understandably upset but compassionate about the situation. My parents are heartbroken and at their wits’ end. Prior to this last straw, my parents’ approach has been to figure out how to get things just out of crisis mode, see that things seem calmed down, normalize the new state of affairs, and then hope and pray that the underlying problem has gone away. They’re good, loving folks and intelligent people, but life has thrown one setback after another at them, and so they have tended to tread water, moving from one crisis to the next. The situation is simply no longer tenable, either from a short-term or long-term standpoint. Short term: at this rate, the kid will land himself in jail! Believe me, he wouldn’t make it there. In addition, this pattern is clearly only getting worse, my brother has led himself to financial ruin, and he’s taking the family with him. My parents are in their early 60’s, earn only a modest income, and have I’m sure a slew of financial worries that go well beyond this. Perhaps most importantly, it's obvious that he's just not getting the kind of care that he needs. My parents can feed him, clothe him, and house him...but that's clearly not all that's needed here. Long term: no one’s getting younger, and my parents now acknowledge that the (co)dependent situation they have enabled with my brother is unfair to me and my new family. What will become of him when they are gone? I love my brother and my family very much, but I need to love him from a protected distance, knowing that he’s reasonably well cared for -- I’ve worked hard to escape the chaos of my family of origin, and I don’t want my own life, marriage, etc. to be hijacked by inheriting his unmanaged issues as my responsibility. That might make me seem like an unkind or ungenerous person, but I do know myself and what I am and am not equipped to handle. At this point, my immediate goals for the situation are to (1) identify any/all options and resources I can that can help my family figure out the best strategies, decisions, etc. for the highest good of all concerned; and (2) find ways to be supportive of my family, given that I do not live near them and am very limited in my ability to get back “home” and help out in person. I would love to hear any advice or recommendations from anyone who has been or knows someone who has been in a similar family situation, or simply any MeFi social-worker types who can point the way to how one goes about finding a path through this kind of mire. I’ve found paulsc’s wonderful comments on previous posts but wonder if there’s more or more specific advice available for my family’s situation. I’ve referred my parents to get in touch with the local chapter of NAMI for starters. What else? - short-term – What are the options for handling the immediate fiscal/legal issues created here? What kind of supports should my family be recruiting, and what’s the best way to find them? Are there good practical options for helping to keep my brother out of trouble with this sort of activity while we try to deal with the underlying issues? - near-to-long-term – What kinds of supervised living arrangements might be available and appropriate for my brother? What would those situations be like? What do we need to do to prepare as a family for that sort of thing? Chicago-area-specific suggestions, referrals, etc. are most especially welcome.

• Answer:

  shelbaroo, I wish you luck in finding a way to "out source" your brother's care, but unless you are willing to spend 5 figures a year to make it happen, I doubt that you'll be successful, in the long run. The kinds of facilities you are looking for don't really exist any more, for middle class and working class families. Statistically, if your brother can't shelter with family for the rest of his life, and can't learn to live independently or in the rare community based group living facilities that have a long term spot, it's very, very likely he is either going to the streets (where many schizophrenics wind up in America), or to jail. Tens of thousands of people with similar mental health issues are out on the streets in America tonight, and thousands more are in our jails and prisons, having run afoul of the law. You are right in thinking that your brother would not do well in such situations; few people could, even without the mental and perceptual problems having mental illness creates and/or exacerbates. I wonder about your understanding of your brother's diagnosis, and about his treatment. Schizophrenia is sometimes best thought of as being a spectrum of dysfunction, but people that have both classic schizophrenic disorders and autism/Asberger's issues aren't common, in my experience. A lot of schizophrenics have more negative affects (flatten emotional response, difficulty socializing, difficulty with communication, etc.) than positive ones (psychotic symptoms, "voices," hallucinations, paranoia). If there is any good news in the treatment of schizophrenia, it is that new atypical anti-psychotic medications continue to be developed, and although many continue to have serious side effects, they are no where near as debilitating as the conventional anti-psychotic medications of even 20 years ago. Other than the SW you mention making home visits, you don't speak of any psychiatrists or other medical professionals being in charge of your brother's case, insofar as medication management, and prescriptions are concerned. From your description of your family's financial arrangements, it sounds like your parents have your brother set up with Social Security for SSI, which will also normally qualify him to receive certian health benefits, including psychiatric supervision and medications, through Medicaid. Yet, if he does not take his meds, or go to his psychiatric appointments, he will not remain medication compliant, and this is a common problem with schizophrenic people. Step 1 for your family is to be in touch with any persons in charge of your brother's case managment, to alert them to these problems, and perhaps, to inquire as to alternate therapies. Many anti-psychotic drugs quit working for reasons we don't really understand, and if this is happening with your brother, he may need a short term committment for stress reduction and changes to meds, to get his base problems in reasonable control. Until he's essentially medication compliant, on meds that actual control his anxiety, psychosis and other symptoms, he is in danger, in many ways. Turning to the issues of your responsibility and roles for your brother's future care, if any, let me just say that I understand, because I've been through http://ask.metafilter.com/48027/Aspergers-diagnosis-late-in-life There's a fair amount of our history contained in many other AskMe responses I've made to similar questions in the last couple of years, but like your brother, my brother lived with my parents for over 28 years of his adult life, until they died in 2005. He was first diagnosed during a visit to my home after he got out of the Army over 30 years ago, and he returned to live with my parents at their insistence, through a long series of hospitalizations and attempts at independent living, that never worked out. When my parents died, I became my brother's primary caretaker. It's something I knew all along would come to pass, when our parents died. As a younger person, it was something that I expected to be difficult, but having come to it, let me say that it has been easier than I had hoped, primarily because my brother has accepted my help with managing his disease with a great deal of grace, and because he and I work on keeping him medication compliant, and in good physical and emotional health, as much as we can. Regularity of schedule, including basics such as mealtimes, are important in keeping oral meds working as well as they can. Weight control, physical fitness, stress avoidance, sleep management, and socialization are all important in keeping my brother on his meds. I also go with him to his monthly psychiatric appointments and blood work appointments, which keep him on his anti-psychotic meds dispensing protocols. It's a constant, daily balancing act, which is not particularly onerous, but which is darned near impossible to hire out. But it wouldn't be fair to simply leave this topic by saying that caring for my brother has turned out not to suck as much as I thought it might, when I was younger. Because, truth be told, his life and his well being have added immeasurably to mine. He has a certian goofy sense of humor that is endearing, and a genuine concern for others I sometimes lack. And his example of quiet courage in bearing for all of his adult life a disease that has cost him any semblance of a normal life, for which he once might have hoped, is down right inspirational. You say "I don’t want my own life, marriage, etc. to be hijacked by inheriting his unmanaged issues as my responsibility." I understand. Really, I do. And yet, when it comes to it, that may not be how things play out. It's possible to adapt. Rewards, and understanding often come, unbidden, just as they are needed. But immediately, your family needs to be in touch with whoever is medically responsible for his psychiatric care. In contrast with other posters to this thread, I can't endorse abandoning him to run-ins with the legal system, if you and your family can reasonably still help him avoid it. The potential for violence is too great, and the possibility for effective case management in the system is nearly nil. In particular, the correctional system itself will work hard to shed responsibility for non-violent mentally ill persons, in nearly every jurisdiction in the U.S., with a vigor that is born from the desperation of correctional officials in trying to manage the portion of their populations with mental illness who are so dangerous and who have extant criminal histories serious enough that they must be segregated from society. You say your brother wouldn't do well in jail, but you make no mention of how little the detention system would be interested in having your brother as an inmate. If you've never visited the lockdown facilities of a major urban jail, or a involuntary commitment facility in a major American city, let me just confirm they are no place for a frightened, confused, non-predatory person to be, even for a matter of hours. And unless your brother becomes threatening delusional, or truly violent, they are going to be little more than very short term way stations for him, until he becomes a victim of someone more predatory than he is. Get in touch with his treating psychiatrist. Discuss what you know of his symptoms, and his issues with treatment supervision with the SW, and with meds. Take advice regarding personal involvement, so as to use any travel or personal time to best advantage. Be in touch with your parents and grandparents. This is not likely to be a situation with which you can positively assist, at arms length, indefinitely. Since you can't change the disease, and you can't probably change your parents, work on changing what you do have power to change, which is generally your own attitude and thinking about this situation.