Shay Jacobson, RN MA NMG LNCC CNLCP
Linda was inclined to making impulsive, reckless decisions.
She spontaneously informed her landlord she would be moving out of her apartment without making a plan for a new residence. She was also involved in a car accident in which she was the driver, however she had no recollection of the event.
Even more alarmingly, it was reported that Linda boarded a private aircraft bound for Italy without any plan or means by which to return home.
Linda had a history of bipolar disorder and schizoaffective disorder, both of which had been under control for some years. Her father’s death, followed by the dissolution of a 10-year relationship and an estrangement from her mother, had caused Linda’s issues to re-assert themselves.
When she contacted her attorney from Italy seeking help in getting home, he made those arrangements and then called us to talk about guardianship.
A Place for Linda
Freshly back from a humiliating overseas excursion and now living in a homeless shelter, Linda was open to the idea of intervention, even if it did take the form of guardianship. Linda had no support system and no suitable family candidates to act as guardian. It was agreed by all that Linda’s attorney would act as Conservator and Lifecare Guardianship would act as Guardian of the Person.
A temporary guardianship was established due to the urgent need for housing, enabling us to set to work on stabilizing Linda’s situation quickly.
Linda felt certain she could live successfully in an apartment, as she had in the past, particularly with the guidance and oversight of her guardianship team. The least restrictive environment is always the goal in a guardianship, so we carefully considered this possibility and took steps to find a suitable apartment for Linda.
Linda’s status deteriorated, however, circumventing this plan rather quickly. Linda expressed many delusional ideas, including her belief that others could “read her thoughts” and were talking about her. She was also convinced she was pregnant despite the fact that she was approaching 50 years of age and had long ago had a hysterectomy.
The worsening of Linda’s delusional thoughts led to a hospitalization during which she could be stabilized and her medications reevaluated.
Thereafter, Linda was discharged to a rehabilitation center where she could receive intensive therapy and significant support in remaining medication compliant.
Out the Door
The next chapter in Linda’s story features several instances of elopement. She was quite skilled in the art of leaving the facility undetected, and in making poor decisions on her “outings”. Linda was discovered by police near the airport, barefoot, walking in the rain and fully disoriented. On another occasion, she slipped out of the facility and managed to purchase both a puppy and a car (both were promptly returned). She was also known to engage in prostitution when such opportunities presented themselves, and it was widely believed that this was the impetus behind the ill-fated private plane trip to Italy.
Linda’s propensity for risky behaviors and impulsive outings led to yet another hospitalization. It was determined that she needed to live in a secured environment where her ability to elope would be severely limited.
On the very day of Linda’s initial placement in a secured facility, she held a sharp pencil to the neck of a social worker there and made a number of verbal threats in the process.
Once again, Linda was hospitalized on a psychiatric unit.
A New Direction
Linda had burned a few bridges with respect to placement options. With the goals of long-term stabilization, counseling and a strong emphasis on medication compliance, we found another community where Linda could be treated safely.
Perhaps owing to fatigue surrounding this cycle of placement, upheaval, hospitalization and then placement again, Linda finally gave her medications a chance. She remained compliant for a period of time, and also attended counseling sessions and participated in facility activities. This combination of behaviors, in tandem with our consistent support and advocacy, enabled Linda to gain some insight into her illness and to understand that an end to the cycle was within reach, and something she could strive toward.
Linda remained compliant over 90 days and was thus awarded the privilege of leaving the facility for 30 minutes on her own twice weekly. This reward was a strong motivator, and Linda complied with the rules and returned promptly each time. She did so well over time, in fact, that we began exploring the possibility to a group home placement where she would be supervised but far less restricted.
It was during this period that Linda began to rebuild her relationship with her mother. They spoke on the phone regularly, and Linda was eventually allowed to go to Florida to spend a full week with her mother and siblings. The visit was a huge success, and yet another reason for her to continue on the path of stability.
While waiting for a group home placement to become available, Linda continued to improve. She was recommended for an assessment for independent living through the William vs. Quinn settlement, a class action suit challenging the legality of preventing 4500 mentally ill plaintiffs from seeking treatment in less restrictive settings. The assessment supported much more independence for Linda, and LCG worked with a number of organizations to make this transition possible. Linda had proven to all concerned that she was once again capable of living in her own apartment.
Though no longer living in a therapeutic environment, Linda regularly attends a bipolar support group, cognitive behavioral therapy, a beading group and a meditation class. She has lunch with friends, goes to the movies, and periodically visits her mother in Florida.
The Judge presiding over Linda’s guardianship heard our argument for restoration. She had done everything possible to facilitate her own recovery and it was with great pride and pleasure that we saw Linda’s rights restored.
Linda was under our care for many years. Having seen the depths of her instability, we are especially impressed with how far she has come, and how long she has worked at sustaining this period of wellness. We could never have brought about such an outcome without Linda’s concentrated efforts on her own recovery.
Though supported and encouraged in every way possible, it was Linda who pulled herself up and who stands on her own now as a woman whose mental illness is a small sidebar to a story of growth and tenacity.
© Lifecare Innovations