Family member with psychosis

[Anotherthink]

My brother had an episode of psychosis 4 years ago. He had been depressed for some time and was put on lithium and several other medications when we sought medical attention. Things got better but he has remained depressed since.

He lives with my parents and has absolutely no drive to get better. He refuses talking therapy, lies to the doctor about how he's doing, binge drinks and has awful sleeping patterns. He barely left the house before lockdown other than to go to the pub.

There have been several ocassions that I've thought the psychosis has returned. I'm now finding out that he has been violent to another family member (our brother) and believes that he has gangs after him. This is bollocks so clearly he has psychosis again. He was extremely drunk when this happened but once sober he maintained he had done nothing wrong.

I'm really concerned now. I worry about my parents, my brother does not treat them well and I'm concerned that they could be next, although they aren't. He focussed on my dad massively when he had the first episode years ago.

Most of the time he presents as normal, he would not be sectioned if they tried. He isn't seeking the correct medical help and now with covid couldn't get it even if he wanted it.

What the fuck can I do to help anyone here? Everyone is just going along business as usual.

Hi, first of all I'm so sorry to hear this

I have some questions...

Does your brother have a diagnosis, and is he under the care of a psychiatrist?
If so, who is the nearest relative responsible for his care?
Has he been referred to a community mental health team?

I find the MIND webpages are very helpful for carers/friends.

Thank you for replying user I'll try to keep it brief but I tend to ramble!

He was under the early intervention team but then they moved house to a different area and it reached an end I think due to the length of time he had been under their care rather than due to a significant improvement.

He was diagnosed with severe depression which was the cause of psychosis. He was later diagnosed with ptsd which was seen as a big breakthrough but he's largely the same.

He's still under the mental health team but it is much more hands off and he hasn't built the same rapport with them. I feel like he's being treated for a life long illness rather than being on a path to recovery if you know what I mean. It's very sad that his life is wasted and for my parents who he lives with are kind of 'this is it' and bad behaviour is minimised because it's become normal. They leave things a few days to cool off when it's bad but by then it's too awkward to deal with head on.

I'm going to speak with my mum and give her the number for the crisis team (I assume she has all these already but as brother is always present these details can't be discussed freely) and tell her how important it is to contact as soon as there are concerns rather than trying to deal with it between them. I'm thinking of reminding her that if he had a physical illness that got very bad she would be straight on to doctors, and that this is the same. Is this a bad thing to say? They know all this already, and I'm not that involved with the day to day I don't want to be insensitive as I know they are under immense pressure.

That all sounds very sensible to me. I don't think it's a bad thing to say, mental health issues are just as serious as physical health issues.
Good luck!

Hi, that sounds really tough.

Not sure how helpful but wanted to share my experience. My DB was sectioned with psychosis and dx with schizophrenia. Came back to live with parents. Side effects of medication (up all night, binge eating) plus weed habit caused friction. His first social worker was crap but it was agreed that moving out would be best, as he wanted freedom too (he had lived on his own before getting unwell).

Got a flat, got into drugs, I rescued him a few times (literally, I think he would he dead). Eventually got a decent social worker who moved him somewhere better. Today - still unable to work but does have hobbies, things that keep him 'sane', a few friends. Still takes drugs sometimes and is bad with money. Calls on parent a lot for things a 40 year old should really be able to do (lifts, food, ten pounds here and there).

There is a mental health service that he can refer himself into when he needs support which he does once a year or so, usually when he has fallen out with a girl. He has an annual double appointment with his GP to check health, liver, cholestrol etc. I am glad as there is a strong correlation b/ween mental health and risk of diabetes, liver problems etc. DB has high cholestrol at 40 :(

One thing that was helpful for him was doing Recovery College. He trained as a peer support worker and did a few sessions, it gave him a lot of confidence at the time.

I don't know what to suggest in your situation. I only get really involved with DB if its life threatening now e.g. risk of homelessness (such as cleaning his flat to secure his tenancy for 5 years) or violence (involving the police not me directly), for my sanity really (i.e. not getting too involved in his problems- he actually stole from me when I was closer to him which, asides from the money, traumatised me emotionally and dented my trust in people, all of which came to the surface for me recently under lockdown) and for my parents peace of mind.

Rethink run a support group for siblings. The cycle is FOG, fear, obligation, guilt but remember its not your responsibility, ultimately they have to take responsbility. All the info, referrals mean nothing if they don't have the motivation. Be strong in yourself and you can be at your best X

That is really helpful thank you swim

Can I ask how long it took for your db to get a schizophrenia dx? I'm concerned by these recurrences of psychosis. I do wonder whether the voices have ever gone and if it's more the case that it gets out of control and he can no longer sense that they are not real when it's 'bad'.

I don't think he has ever had a social worker. Is this something that came with the schizophrenia dx? He had an amazing mental health nurse who he confided in but this support didn't really improve matters.

It would be great to think he could have hobbies and friends one day. He has isolated himself for so long it seems unattainable.

I will look at that support group thank you. I don't think I have the feeling of obligation that my parents do but I definitely fall into the trap of enabling behaviour that I would definitely not stand for anyone else doing. I realised this when he was really bad 4 years ago that we have enabled his drinking for a very very long time and this is still happening now.

My friend (who has schizoaffective disorder) sounds a lot like SwimPanda's brother.

OP, ideally your brother needs to visit the GP and ask to be referred to a psychiatrist. Your parents can raise concerns with your brothers GP, but I'm not sure what if any action the GP would take.

I believe there is an option under 111 to raise serious mental health concerns about yourself or loved one, you may wish to look into that. Your brothers case is complicated by alcohol use, which will make it hard to reach an accurate diagnosis.

In my experience, unfortunately, unless it ends up being a crisis (which is what happened to friend, he got sectioned and that's how his treatment started) it is upto the individual to take responsibility. Easier said than done!

You are looking out for your brother and doing what you can. I do agree that a serious family chat is in order. Please take care of yourself as well

He was under a psychiatrist under the old health trust but I'm not sure if that is still the case. There's been so many crises dealt with 'in-house' like he's been a naughty boy, I think I need to prepare my parents for how tough a stance they need to take next time we get another big incident. It falls to them because often the rest of the family don't know until several days after the incident. I'll visit tomorrow night and try to have a chat.

Just saw your reply. DB was sectioned for a month and given the dx during that. I think it was a mental health social worker. This was 15 years ago so it may have changed. Your posts bring up a lot of the things I went through. Getting the right medication took a few years. There was a hearing voices support group he went to for a while. That's really good to realise about the enabling. I hope you manage to get some more external support for him/your family and your sake.

'He isn't seeking the correct medical help and now with covid couldn't get it even if he wanted it.'

You mentioned enabling brother's behaviour later in the thread - was it from yourself or your parents, and does it continue? I'm afraid that if he's not seeking help, unless he's a danger to self or others there is little you can do to change his behaviour. I'd be getting concerned about violence if there were episodes recently, and especially about his alcohol use which is likely to make his mental health deteriorate even further. The emergency team should still be available though so I'll second speaking with your parents about the steps that they should take when your brother deteriorates, and the Police would be another service to contact if the situation escalates.
I'm sorry you have to deal with such a difficult situation, especially now.

Mental health help is shocking.
The crisis team just tell you to make a cup of tea or have a bath.
Even worse with the covid situation.
I really emphathise with your situation.