Families should act promptly when it comes to mental health for elders
The Anniston Star - 1/20/2019
Jan. 20--When John Langston was beaten almost to death in a Calhoun County Jail cell in December, he didn't have an Alzheimer's diagnosis, but his mother and her seven sisters had all died of the disease, and that's enough to convince his sister, Linda Langston, that he had what she called "the cruel gene."
"John had an appointment with the psychiatrist to be diagnosed with Alzheimer's but was arrested before that could happen," Linda said. "He is still given psych medication in the hospital now, that they say is for bipolar disorder."
If that appointment had come a few days earlier, the diagnosis might have helped keep him out of the jail, especially if his sisters had been granted powers of attorney and guardianship over John. According to mental health experts in Calhoun County, though, families often wait until behavior is erratic and unsafe to take action.
John lived in Anniston with his other sister, Lorraine Langston, but she had trouble keeping him in her home. Linda called it the "sundowning" effect, an Alzheimer's and dementia symptom in which the person has confusion that worsens throughout the day. She said that's what led him to disappear from Lorraine's house one night.
"They rode all over town trying to find him, and the police called her and told her that he was in jail for shoplifting in Oxford. He was in jail there for three days and went to court on that charge," Linda said. "He was out on parole for a year, but he broke parole when he was arrested there. They released him on Dec. 4 but the county was there to pick him up right after."
Four days later, on Dec. 8, Langston was attacked by another inmate, which left him with broken ribs and a broken skull, and serious brain injuries. Now Langston is in stable condition, but nothing like good shape: He barely recognizes family members, he's fighting and angry, cursing at his nurses when he's awake -- something Linda noted is out of character for the man, whom she said has always been a flirt with nurses -- and has to be kept in a "posey bed," a sleeping space constructed like a toddler's playpen with a roof on the top.
"It's like he's in a cage," Linda said.
Having an official diagnosis might not have kept Langston out of jail -- he's had a long relationship with the Calhoun County court system -- but it might have made a difference long before he was arrested.
According to the National Institute of Mental Health, about 42,000 people in Alabama are schizophrenic, and 83,000 have bipolar disorder. Alzheimer's was the sixth leading cause of death in the state in 2016, according to the Centers for Disease Control and Prevention, with 2,507 deaths attributed to the disease that year.
The issue of mental health is a pressing one for families caring for an elderly adult who is either incapacitated or incompetent -- the terminology used in the county Probate Court. These families have to make choices early if they want to maintain power of attorney for their loved ones.
The two options
John Garlick, chief deputy of the Calhoun County Sheriff's Office and the county's mental health officer, said that there are two routes for families to take when they're caring for a relative with mental health issues which might make them a danger to themselves or others.
"The first option, that doesn't cost anything, is to file an involuntary petition for commitment," Garlick said.
He said that contact has to be made with a mental health service to start the process, and the person in question has to meet the criteria for commitment. Those criteria include being a clear danger to themselves or others, that mental distress and suffering will continue without intervention, and that the person is incapable of making a rational decision about treatment. If the case meets the criteria, the probate judge can issue an order for the Sheriff's Office to take the person in question to a facility controlled by the Alabama Department of Mental Health.
"The other option is pretty involved," Garlick said. It involves families contacting a mental health service to obtain a diagnosis of any mental health conditions, which can then be used to petition for guardianship, according to Calhoun County Probate Judge Alice Martin.
"We all know that family members can't watch someone 24-7, and a guardianship and conservatorship case can provide a family member with authority to get that loved one into a facility where they can have 24-7 care, in the event they will not agree to go," Martin said.
When to make choices
It's not easy to admit when it's time to get help, according to Garlick.
"There's a certain degree of hesitancy when the problem is still in its infant stages. I wish people would catch these things earlier, and by earlier, I mean when they first notice something is going on," he explained.
Family members might notice when their loved ones start showing symptoms of mental illness, or seem to stop taking medication for known conditions, but they don't tend to confront the problem until problem behaviors are impossible to ignore, Garlick said.
"When they're really doing something to hurt someone or themselves, that's when people typically react," he stated.
He said that it's possible to react too early. Someone who stops taking medication or going to counseling doesn't qualify for involuntary commitment. But "once we have an overt act, and it can be small, particularly if they have a history," he explained, authorities can intervene and provide help.
Martin said her 85-year-old mother is sharp-minded -- "she's probably healthier than me," she quipped -- but because of her age, Martin and her sister have their mother's power of attorney, which she voluntarily gave to her daughters.
"It's sufficient to cover medical and financial matters, so we can take care of her if she becomes incapacitated," she said. "Once you're incapacitated, you don't have the ability to give power of attorney."
She said that she understands why families are reluctant to discuss issues as serious as severe mental health problems, but she believes it's worth the discomfort to discuss them.
"I think people need to think about this. Nobody likes to think about getting sick or mortality, but it's reality, and we need to think about it and we need to have a plan," Martin said.
Assistant Metro Editor Ben Nunnally: 256-235-3560.
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