Getting sister help when she refuses it

Q: I found your site while trying to find Ward Bein, MD, a childhood friend of mine. Specifically, I am trying to find psychiatric help for my sister who lives in Northampton, Mass. and is currently in crisis with bi-polar disorder. Unfortunately, my sister is refusing medical treatment and totally non-compliant. Our attempts to have her involuntarily committed for psychiatric treatment have been unsuccessful. I would appreciate any advice or help that you or Dr. Bein could offer.

Dear Dr. C' --
Unfortunately, your circumstance is common and does not have a clear solution.  Contact the National Alliance for the Mentally Ill (NAMI: in your area to network to the Massachussetts branch and learn from them about specifics of committment rules in Mass., then a Northhampton group to find out who specifically in that community handles committments, then try to befriend someone in the mental health community there (perhaps with a personal visit and some nice major stroke for the mental health system, or perhaps a nice donation to the local NAMI there, to get some local ally who knows all the ropes interested in helping your sister.  As you know, "danger to self or others" can be interpreted broadly or narrowly, but sometimes it helps little if you get a doctor to commit her and then he court follow-up, where the more lasting clout resides, does not agree.  Rarely a patient will have enough ambivalence about treatment that we can find the positive side of that ambivalence in a few days stay inpatient; get treatment started, however reluctantly; and then the person gets well enough to acquire insight and stick with treatment (obviously, this is strongly to be wished, as otherwise even succeeding in arranging treatment will fall apart later for lack of that insight).  It's hoping your sister might be such a person that makes all this effort worth it; but brace yourself that the more common outcomes (hospitalized but won't accept treatment at all; can't even get into the hospital in the first place; gets to court and doesn't get committed).  NAMI has the most sources on how to cope with all this. 

Dr. Phelps

Published January, 2001