Dear Jenna, you may only have a few options in this situation. Your mother has schizophrenia, she’s clearly out of control, she’s constantly interacting with the police and hospital, she needs to be watched 24/7 and she refuses to take her medication. This essentially leaves her to remain psychotic and probably you and your sister feeling helpless. You and your sister work five jobs between the both of you and it’s barely enough to pay the bills. The two options I see for you in the situation are 1) that you and your sister work together to create a plan in which you coerce your mother into taking her medication; or 2) move her into a group home or residential living facility in which she could be constantly monitored and given her medication by medical and psychiatric staff.
Let’s examine the first option which is that you and your sister create a plan that focuses on your mother taking her medication. I’m essentially suggesting you create rules for her based on the premise that if she wants to remain in your home she must take her medication. To make certain she does take the medicine you and your sister could take turns administering the medication each day. For instance, you would be responsible for Monday, Wednesday and Friday and she would be responsible for Tuesday, Thursday, Saturday and Sunday or vice versa. You can choose whatever days or times work best for you and your sister based on your work schedules.
Each time you or your sister gives her the medicine do a “mouth check” (i.e. ask that she open her mouth to prove she swallowed it). This may be difficult to enforce because she could “cheek” the pill. “Cheeking” the pill means she hides it underneath her cheek or tongue and pretends as though she swallowed it. You want to check for this. If she believes that she doesn’t need the medicine because she “feels better,” then she may be trying to act as though she took it.
If you choose this method I would also advise you to keep the medication in your possession. That way, she cannot say that she has already taken it for the day. If it’s in your possession, you’ll know if and when you gave it to her.
It also might be a challenge to keep a consistent medication administration schedule between you and your sister if the both of you are working odd or late hours. If coordinated correctly, and if you and your sister make a commitment to administering the medication every single day, this may be a way that she could continue to live with you and not constantly be in and out of the hospital.
You may also want to offer her rewards for taking the medication. For instance, if she complies with taking the medication for a month perhaps you and your sister could take her out for dinner or to a movie. This may create a positive association in her mind between taking medication and the getting to spend time with her daughters.
This method also ensures that she doesn’t have to continually experience psychotic episodes. There is some evidence that with each psychotic episode it takes longer for an individual to “come out” of that episode. There is also evidence that with each psychotic episode it is difficult for the individual to fully return to their previous state of psychological functioning. This is called stepwise decompensation. For these reasons, it is important to prevent reoccurring psychotic episodes with medication. Medication is the best method to prevent these episodes.
Also anticipate the possibility that your mother may not be open to the idea of her daughters administering her medication. She may feel that she is being treated like a child. She may feel this way at first but that feeling may fade with time. I can understand why she may feel that way but the problem is she is not willing to stay on her medication even though each time she stops taking it she has another psychotic episode that lands her in the hospital or involvement with the police.
Unfortunately, she needs help and she’s not able to care for herself at this time. There may come a time in the future when she is able to consistently take her medication on her own and remain symptom-free but at this time, she has a track record of not being able to do so.
A variation of this option would be to stipulate that in order for her to continue living with you and your sister she must accept an injectable form of medication. Currently, there are several antipsychotic medications that can be administered as an injection. Risperdal Consta, for instance, is an injection that can be given in the arm, upper thigh, or buttocks. It’s typically given twice a month. The injection is administered by a psychiatric nurse or a doctor. In many communities, there are services that come to the home to give the injection. If your mother took an injectable form of medication this might give you peace of mind. It could prevent her from having a relapse and it would keep her out of the hospital.
There’s also the added issue of her substance abuse. You could also stipulate that in order for her to remain in your home she must abstain from alcohol or drugs (unless she has a beer in your presence as you allow her to occasionally). If she does not refrain from these substances then there should be some type of consequence for this behavior. She needs to know that she cannot live in your home and engage in behavior that is unacceptable to you.
I would also advise you to check with the social worker or someone from the hospital to see what services are available to your family. I mentioned the service in which a nurse or a doctor could come to the home and give her an injection. There may be other services that can assist you and your sister to more effectively care for your mother.
The second option is the possibility of having to move your mother to a personal care home or a residential living facility. This, of course, would be extremely difficult for her and I’m sure for you and your sister. Nobody wants to place their family member in a personal care home or other care facility. But in some situations, such as when individuals cannot care for themselves or put themselves or others in danger, this difficult step may be necessary. Your mother is a danger to herself if she is not supervised.
I recognize that both of these options are difficult and challenging. You are dealing with a very complicated situation. I’ve worked with many families dealing with similar situations. They’re often faced with many of the same issues you’ve written about. Basically, the options with regard to dealing with these issues come down to the two I’ve presented to you.
With regard to Social Security Disability benefits, it is very common to be rejected the first time you apply. I would encourage you to hire an attorney to appeal the decision. In some states, it could take up to three years to receive a decision on an appeal. An attorney can expedite this process and increase the odds that the appeal will be granted. Generally, an attorney will not charge a fee if they don’t win the case. If your mother won the appeal the attorney would most likely only take a small portion of the Social Security Disability back benefits. I would strongly recommend you consider an attorney.
It’s clear you care about your mother and that you and your sister want do what is best for her. To the best of your ability you want to prevent this uncontrolled illness from majorly disrupting her life and yours. To accomplish this sometimes means you have to make difficult choices. It’s important to do what is best for your mother but also what is best for you and your sister. You can’t let this problem interrupt your life to the point where you can no longer hold a job or function normally because you’re constantly dealing with your mother’s problems. I am under no illusion that this is a difficult challenge but your quality of life has to matter and be a priority.
Your current living situation is unsustainable. Something needs to change. I understand the challenge of your situation and I hope that these suggestions will help you. If you have further questions please do not hesitate to contact me. I will be glad to help.