Desperately seeking help for nephew

[OneSharpOtter]

My nephew, a graduate from Harvard had a mental breakdown after graduation in 2019 and has not done anything meaningful with his life since. Now he paces a lot at home and robs his chest with a smile whilst doing that, cannot hold down a job, very messy and lacking in personal hygiene. He washes l
once in 6 months, if that, doesn't talk to his mum, sister, relatives and friends. Violent towards his mum occasionally and has refused to get help or engage with the mental health. He used to be the best son any mum could ask for and given his nature he would not survive out there if he gets kicked out of the house, in the state that he is in. Please can anyone suggest what could be done to get him to engage with the medical team and get help. He is in his late twenty.

Is he in the UK or the US? In the UK there isn’t much that can be done if he has capacity and refuses to engage with the medical team. The threshold for sectioning is so high and it doesn’t sound like he is a danger to himself or others.

@Pantsareonfire thanks for your prompt response. He is in the UK and my sister is now scared of being alone in the house with him. It's the violence we're more concerned about now.

If he won’t engage willingly with mental health support, then his Mum needs to engage with agencies to support her and keep her safe.

Mental health aside, he is physically abusing his mother. She can engage with local domestic abuse services (search domestic abuse services and your area). She also needs to call the Police whenever he becomes aggressive or violent.

I know you say he will not survive if he is ‘kicked out’, but he (and the wider family) are simply surviving and not thriving right now. And if his behaviour escalates, he could seriously injure his mother or others.

His parent(s) need to tell him he must leave, if/when he next becomes aggressive. I wouldn’t even give notice, as he could then escalate. Call the police if he becomes obstructive, and ring adult social care (parents can complete a referral) and your local housing authority in advance to advise them a vulnerable adult with serious unmet mental health needs will be presenting as homeless.

They could also try having a serious discussion with him, stating that a condition of staying in the family home is to engage with support - and keep to this.

You can’t force him to engage with support, but they can put boundaries and support networks in place to protect themselves.

@Liketwodeflatedballoons Thank you so much. Your contribution is helpful.

I don’t understand how someone can live like this for six years rather than google what they can do about it. www.mind.org.uk/information-support/legal-rights/sectioning/being-assessed/
His mother needs to contact the GP or mental health services and request an urgent mental health assessment by an AMHP (approved mental health practitioner). These are the people that can section him if necessary. There are many different types of section with differing criteria.
Police need to be called for every episode of violence. They can also place him under section 136 if he is at risk of harming others.

Do you have practical experience of this or is it just what should happen in theory? I think it is very difficult for family members to get help in practice as resources are so scarce.

@AnotherVice Thanks for your imput and happy new year! The mother has done what you mentioned a while ago but it's not straightforward in reality. The system can't force him to get help and the mother doesn't want him out unless she knows he will be safe. He is his child after all and she doesn't want to do what she'd regret. She probably wants to know if there’s a system out there that can help in a non conventional way. Perhaps, a private one even.

@Pantsareonfire happy bew year and thanks for your input. You're absolutely right. It seems resources are scare. He was sectioned once and they didn't even see him for almost 28 days. They told the mum they didn't know what exactly was wrong with him as he wouldn't engage enough for the to find. Subsequently, they transferred him to the psychosis team who quickly discharged him and said he is jot psychotic.

I’m so sorry she is having to deal with all this without the necessary support. I don’t know what to suggest because I think the MH services are quite happy to absolve themselves from any responsibility if family members are there to pick up the slack. Hopefully someone else will be along with some good advice.

Thank you so much for your kindness.