What should you do in an emergency?
(Source: NAMI San Francisco)
Control Yourself – don't shout
into the phone or at arriving officers or medical professionals.
They can't understand you if you shout.
On the phone: Be ready to give
concrete examples of the dangerous behaviors and to support your
contention that the person is mentally ill. For example, say,
"My daughter pulled a knife" as opposed to "My daughter wants to
State over the phone the following information and be ready to
repeat it to arriving police officers and/or medical
Family member's name.
That the person is mentally ill and give the diagnosis.
State whether medications are being used, whether it was
stopped and when was the last time the meds were taken.
Describe what your family member is doing now.
Say whether you feel threatened.
Say whether your family member is hearing voices or fears
Say whether a weapon is in the house --- to minimize further
agitation, remove any guns from the house before the police
Say where inside the house is your family member
Say whether there is a history
Until professionals arrive, you
must STAY CALM and:
Be polite, respectful,
reassuring, low-key and direct with your family member.
Maintain on-going communication directly with the person and
do not include others in side conversations.
Do not try to trick or deceive your family member.
Avoid immediately moving in close or touching the person
Remove all objects with which a
person may do harm to self or others.
When professionals arrive:
Have all the lights on inside
Carry nothing in your hands especially coming outside to meet
them, in which case walk, don't run to meet them.
Be prepared to repeat the information you gave over the phone.
State whether there is a history of suicide attempts.
State whether your family member is violent or delusional.
Have treating psychiatrist's
phone number handy.
Ask the Physician
(Source: NAMI San Francisco)
The following are questions to ask the treating physician about
your family member which don't conflict with confidentiality
laws in some states. If you fail to learn anything from the
treating physician, try another doctor at the program or
hospital where your family member is getting treatment
- What is your diagnosis? What
is the nature of this illness from a medical point of view?
- What is known about the
cause of this particular illness?
- How certain are you of this
diagnosis? If you are not certain, what other possibilities do
you consider most likely and why?
- Did the physical examination
include a neurological exam? If so, how extensive was it, and
what were the results?
- Are there any additional
tests or exams that you would recommend at this point?
- Would you advise an
independent opinion from another psychiatrist at this point?
- What program of treatment do
you think could be most helpful? How will it be helpful?
- Will this program involve
services by other specialists ( i.e. neurologist,
psychologist, allied health professionals. )? If so, who will
be responsible for coordinating these services?
- Who will be able to answer
our questions at times when you are not available?
- What kind of therapy do you
plan to use, and what will be the contribution of the
psychiatrist to the overall program of treatment?
- What do you expect this
program to accomplish? About how long will it take, and how
frequently will you and the other specialists be seeing the
- What will be the best
evidence that the patient is responding to the program, and
how soon will it be before these appear?
- What do you see as the
family's role in this program of treatment? In particular, how
much access will the family have to the individuals who are
providing the treatment?
- If your current evaluation
is a preliminary one, how soon will it be before you will be
able to provide a more definite evaluation of the patient's
- What medication do you
propose to use? ( Ask for name and dosage level and write it
down.) What is the biological effect of this medication, and
what do you expect it to accomplish? What are the risks
associated with the medication? How soon will we be able to
tell if the medication is effective, and how will we know?
- Are there other medications
that might be appropriate? If so, why do you prefer the one
you have chosen?
- Are you currently treating
other patients with this illness?
(Psychiatrists vary in their level of experience with severe
or long-term mental illnesses, and it is helpful to know how
involved the psychiatrist is with treatment of the kind of
problem your relative has.)
- When are the best times and
what are the most dependable ways for getting in touch with
- How do you monitor
medications and what symptoms indicate that they should be
raised, lowered or changed?
- How familiar are you with
the activities of the NAMI-Yolo or NAMI-California?
Rights of Families
Don't get lost in the shuffle
Families are not to blame
Find out what you have to do for your family
Keep a list of questions to ask the
Know your rights. Protect your family.
A variety of factors -
primarily the confidentiality laws regarding mental health treatment and the
historical blaming of families for mental illness - contribute to families
being shut out of the treatment process. Families are often shut out even
when people who have mental illness sign waivers enabling clinicians to
communicate details of illness and treatment and the following information
is helpful whether or not a waiver has been signed. If your family member
regularly signs waivers, make sure your family member signs a new waiver
each time they enter a new facility. Most waivers need renewing each
Here are few things to do:
- If a family member does not sign a
confidentiality waiver, mental health professionals can't talk with you
about your family member's situation. However, you can talk with
them or send them information.
- If you know or suspect
your family member is in a specific facility and a waiver has not been
signed, you can send the clinicians letters detailing your relative's
history and different characteristics you have noted about your
relative's illness. You may also call the clinicians and give them
information over the phone, but limited resources in the mental health
system may make them difficult to reach in person. You should do this
even if your relative has signed a waiver enabling the treatment
professionals to communicate with you. Your historical memory of the
illness and your relative is valuable to treatment and you should be
keeping a diary.
- If your relative has not signed a
waiver, you can ask the treating psychiatrist questions about
- "patients with symptoms similar to your
- how families can help in situations
where patients are ________.
These types of questions do not conflict with most confidentiality laws.
If the treating psychiatrist is not helpful, ask questions of another
psychiatrist on the treatment staff.
Family Rights - HIPAA Privacy Rules & Sharing Information
related to Mental Health
HIPAA (Health Insurance Portability and Accountability
Act) is often used by mental health providers who don't fully
understand its purpose and limitations to completely block
communication with family members. These U.S. Department
of Health & Human Services guidelines clarify and give examples
of sharing mental health information with family members.
This document can be used as a basis to open a dialog with
providers about when and what information can be shared using
HIPAA as it's meant to be applied.
Rights of Families - Statutory Rights and Guidelines
The following is a summary of current California Law
prepared by NAMI-California.
Statutory Rights & Guidelines
I. Statement of Policy
Families of clients in mental health facilities should be
encouraged to participate in the assessment, treatment and
aftercare planning process for each client, consistent with the
best interests and wish of the client.
II. Rights of Family Members
The right [of a spouse, parent, child, or sibling] to be given
notification of the client's presence in a 24-hour facility,
unless the client requests that this information not be
provided. [Cal. Welf. & Inst. Code 5328.1]
The right to be given information regarding the diagnosis,
prognosis, prescribed medication and side effects, and progress
of the client, if authorized by the client. If the client is
initially unable to authorize the release of this information,
daily efforts shall be made to secure the client's consent or
refusal of authorization.
[Cal. Welf. & Inst. Code 5328.1]
The right to have the family make reasonable attempts to notify
the immediate family of the client's admission, release,
transfer, serious illness, injury or death, unless the client
requests that the information not be provided.
[Cal. Welf. & Inst. Code 5328.1(b)]
The right to see and receive copies of information and records
regarding the client, with the consent of the client and
approval of the treating physician, psychologist or social
worker. [Cal. Welf. & Inst. Code 5328(b)]
The right to a copy of the written aftercare plan when the
client is discharged from an inpatient psychiatric facility,
when designated by the client. (effective January 1998)
[Cal. Welf. & Inst. Code 5622, 5768.5]
The right to have removed from the client's record any
information provided in confidence by the family, prior to
release. [Cal. Welf. & Inst. Code 5328(b)(d)(j)(k), 5543]
The right to be given required information concerning the
administration of convulsive treatment or psychosurgery, if
authorized by the client. [Cal. Welf. & Inst. Code 5326.6(b),
The right to receive copies of public information, including
licensing and other reports. [Cal. Gov't Doc 6250 et seq.]
The right to visit the client every day, if desired by the
client. [Cal. Welf. & Inst. Code 5325(c)]
The right to have confidential phone calls with the client and
to mail and receive unopened correspondence, if desired by the
client. [Cal. Welf. & Inst. Code 5325(d)&(e)]
The right to provide clothing, personal possession and a
reasonable sum of money to the client for us in the facility, if
desired by the client. [Cal. Welf. & Inst. code
The right to participate in the treatment and rehabilitation
planning of the client, as a source of information and support.
Included in the participation is the identification of service
needs, and advocating for, and coordinating the provision of
these services, as appropriate.
[Cal. Welf. & Inst. Code 5600.2(a), 5600.4(c)]
The right to be advised of the time and place of certification
review hearings, judicial review, conservatorship proceedings,
unless the client requests that this information not be
provided. [Cal. Welf. & Inst. Code 5256.4(c), 5276,
The right to be appointed conservator or to nominate a
conservator subject to the priorities and preferences in the
Probate Court. [Cal. Probate Code 1810-1813]
The right to have the first priority for conservatee placement
be a facility as close as possible to the conservatee's home or
home of a relative.
[Cal. Welf. & Inst. Code 5358(c)]
The right to submit a complain regarding abuse, unreasonable
denial or punitive withholding of rights concerning a resident
in a license health or community care facility to a clients'
rights advocate for investigation. [Cal. Welf. & Inst.
The right (unless found not to be acting in good faith) to be
immune from civil or criminal liability, penalty, sanction or
restriction for participating in the filing a complaint of
providing information to the patients' rights advocate.
[Cal. Welf. & Inst. Code 5550(a)]
The right to be informed of the telephone number by the facility
of where to file complaints with the Department of Health
Services, Licensing and Certification Program. [Cal.
Health and Safety Code 1288.4]
Profession licensing boards and other regulatory and enforcement
agencies may also be contacted to register complaints about the
facility or personnel
The right to not have the client discriminated or retaliated
against for the family members' participation in any advocacy
activity. [Cal. Welf. & Inst. Code 5550(c)]
- Cal. Government Code, Cal.
- Code, Cal. Welf & Inst.
Code, Title 22
- Cal. Code of Regs., Joint
Commission on Accreditation of Healthcare
Organization Standards, California
- Association of Hospitals and
Systems Consent Manual.
This is a synopsis of current California Law. For additional
information, refer to the statues cited, or consult an attorney.
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