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Caring for someone whose mental state poses a danger

Drawing of a man brooming inside an head

You think that the mental state of someone you are caring for poses a danger to them or to you. Something must be done.

How do you assess this danger? Do you feel that you are mistaken? How do you deal with your feeling of helplessness? How can you get support in this difficult and delicate situation? Here are some tips and advice.

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The mental state of the person you are caring for is a danger

Are you afraid of making a mistake when you think that the person you are caring for is a danger to themselves, to others, to you? Do you feel troubled by the idea of going against their wishes?

Jean-Pierre, whose son suffers from schizophrenia, gives a poignant testimony in this regard.

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How do you gauge the level of danger at the heart of the situation while providing the best possible support for the person you are caring for? L’Appui pour les proches aidants would like to give you concrete examples, rooted in the experience of the Caregiver Support counselors. The goal is to help you find your way in your own situation and with regard to a difficult and delicate situation.

Case studies

Examples

Serious and immediate danger

The brother of a caregiver is depressed. He confides in her that he has suicidal thoughts but will not act on them because he does not want to hurt his family.

The caregiver prepares for the eventuality that the situation changes, for example, if the brother says that he has a concrete plan to commit suicide with a firearm and expresses the desire to carry it out within the next 24 hours. If this situation arises, the caregiver plans to contact 911, as there is a serious and immediate danger to themselves.

Serious and imminent danger

The daughter of the caregiver is 20 years old and experiences her first psychotic episode. She is plagued by paranoid ideas. She feels that the government is watching her through the monitors. She prepares to defend herself against government agents with knives. She thinks she is invincible.

The caregiver consults their caregiver association to help them file a petition for interim custody, as her daughter is a serious and imminent danger to others.

No serious or imminent danger

The caregiver’s mother has bipolar disorder. She has recently stopped her medication and is in a manic phase. She hardly sleeps at all and is constantly working on a new business venture, a venture that is the result of a delusion. The mother is spending huge amounts of money on this project, which is not going to work.

The caregiver tries to convince her mother to undergo treatment, but the mother refuses. Since her mother is not in immediate/imminent danger, the caregiver cannot force her mother to receive treatment or to undergo an assessment. In this case, the right to autonomy of the cared-for person is protected by law. The caregiver contacts the Caregiver Support Helpline or her caregiver association for support in feeling powerless and for strategies to encourage the person being cared for to consent to an assessment or treatment.

Eight tips for safely navigating the situation

  1. You may feel guilt, stress, discouragement, helplessness or be overwhelmed. Feeling these emotions is normal in this situation;
  2. If you feel the need, seek mental health assistance, contact Info-Social 811 or the telephone helplines;
  3. Learn as much as you can about mental health and mental disorders, how to support someone with depression and how to support someone with a mental disorder;
  4. Do not hesitate to use resources and references intended to provide guidance to caregivers;
  5. There are services adapted to your specific needs as a caregiver;
  6. If you want to request a psychological examination for the person you are caring for, community centres and organizations can accompany and support you in this process;
  7. Support and self-help groups are there to share knowledge and experiences with other caregivers;
  8. The person you are caring for is taking up a lot of your energy these days. Think about yourself. Here are some practical tips for preserving and caring for yourself.

Questions and possible solutions

Why use an agency in the process of applying for a psychiatric assessment?

The agency can help you write the application, accompany you to the police station, or assist you in preparing the application.

My father is a senior citizen with a substance abuse disorder. His home is unsanitary and he falls frequently. His last fall resulted in a broken hip. The medical team suggests a move to a CHSLD but he categorically refuses…

In this case, the healthcare institution may decide to go to court and apply for a court care order.

I have heard of the P-38 law. What is it?

This is the Act respecting the protection of persons whose mental state presents a danger to themselves or others. In certain cases and contexts, the mental state of the person being cared for represents a danger to themselves, to others, and to you as the caregiver. In these exceptional cases, Quebec civil law allows the person to be placed in temporary custody in a healthcare institution. This procedure is governed by Act P-38. Here are some details (in French only).

The person I am caring for is in temporary custody. What is the next step from here?

Twenty-four hours after the person you are caring for has been taken into care, a psychiatrist will carry out a psychiatric assessment. A diagram shows the process (p. 14, in French only).

I have a thousand questions running through my mind…

Here are some frequently asked questions (in French only) developed by the Réseau Avant de craquer network: psychiatric assessment orders, interim custody, hospitalizations, levels of dangerousness, etc.

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