Guardianship for an adult with a severe mental illness can be one of the most complex situations to support. Guardianship is a legal tool utilized to ensure safety and protection of another person.
Routinely, I hear this story from a loved one: Their adult child is diagnosed with a severe mental illness, like bipolar disorder. The adult starts medication and therapy which is helpful. Over time, the side-effects of the medication become bothersome, and they are feeling better, and they begin to believe they are healed or at least they can self-regulate without medication. They discontinue the medication, and soon the negative symptoms of their mental illness return, and they become a danger to themselves or others. The individual is then either court committed, or they self-admit to a mental health facility where they start the medication and therapy regimen again, and so the cycle begins. Often, this is the story I get, and the next question is usually: “Should I get guardianship to stop the cycle?”
Can a Guardian Force Medication and Treatment Participation?
A guardian, in most cases, can authorize treatments, medications, and seek out services and supports to help the individual obtain and maintain their physical and mental health. A guardianship can be as useful and productive so long as the individual will allow. Strictly having guardianship over another person does not magically stop them from having setbacks or make them automatically participate in treatment or take their medication. As the ole saying goes, “You can lead a horse to water, but you cannot make it drink.” As a guardian you can authorize the medication and the therapy, set up services, and even put in safety nets, but there is no mechanism within the role of a guardian through the law that can force another adult to take medication or to participate in treatment. There must be a level of cooperation and partnership to have long-term success.
What to do When a Ward Will Not Participate in Treatment
The next question I get after hearing that a guardian cannot force a ward to take medication or admit them into a psychiatric facility is, “What are the options?” I always tell people to start small. Have an open and honest conversation with the individual. The individual must be an active part of their long-term success. If the individual will work with their loved ones while they are doing good, they can establish a list of signs and symptoms of decline, and then work on future solutions when negative symptoms start to come up. Also signing and executing a Declaration for Mental Health Treatment will aid the actively involved people in getting help at the first sign of any difficulties.
Guardianship seems like an excellent alternative, until the reality of it is fully known. In a successful guardianship, the ward is an active and willing participant throughout the duration. If they are not, many times, even with guardianship, the court will need to be involved, especially if in-patient psychiatric care is needed and the ward is refusing help.
Hammerle Finley Can Help With Your Guardianship Needs
Courtney Carey is a Texas Certified Guardian and a Care Manager, with experience in Texas Medicaid waiver programs, intellectual and developmental disabilities, mental health, and geriatrics. This column does not constitute legal advice.