Again, Naomi refused to take medications. She avoided attending support groups, explaining to the therapist who asked about her resistance, “Why? They’ll all hate me. I’m a person of color [Asian] but I have class privilege. I came out [about her bisexuality] to my parents and it went great. They love me, so I have nothing to complain about.”
During the course of Naomi’s illness, Connie attended several civil commitment proceedings.
Note: Civil commitment involves the legal system. A court order mandates treatment for mental illness when individuals are unable or unwilling to seek treatment and are a danger to themselves or others.
At her second commitment, Naomi’s assigned attorney convinced her to accept treatment; however, at a third commitment hearing, Naomi convinced her attourney to fight the commitment. This meant Connie had to go to mental health court to testify about Naomi’s behavior. The judge at mental health court, who happened to have a daughter living with bipolar disorder, did “get it” and ruled in favor of the commitment. Connie explained that dealing with the legal system on mental health situations is a “crap shoot” and the “luck of the draw.” She learned about the language, how to work effectively with different systems of hospitals and the court, and became knowledgeable about the continuum of services available for people living with mental illness.
They’re talking to you, but until you understand language, it can feel like they’re talking at you. You’re under stress already. It’s not an ideal time to be learning a second language on mental health and legal, yet you kind of have to. I felt like I was running as fast as I can, like walking through Jello or concrete that is starting to harden. Like here’s where my kid needs to be. Here’s where my kid needs to go. There are all these people in between and you can kind of see her struggling and you’re trying to walk, like you can feel the stuff around you thickening and you can watch her sort of struggling. But because she’s manic, she’s happy, and the struggle—she’s flapping her arms and sinking more. You’re going no, no, don’t flap your arms.
After her second commitment, Naomi’s spiraled into a grueling cycle of homelessness, arrests, and hospitalizations. She was mandated to take medication and received a referral for integrated mental health and substance abuse treatment. Luckily, she found a therapist, who was out as a lesbian, and an African American psychiatrist. Naomi approved of the diversity of her care providers and agreed to take medications, but encountered challenges in finding a medication that worked. She struggled with side effects of tremors and weight gain.
Finally, Naomi found an effective medication and has been medication compliant for the past three years. Also, she discovered DBT (dialectical behavior therapy) is helpful in managing her behaviors. Connie is thankful for Naomi’s mental health team and the supportive services she receives, observing, “She finally got the dream team, the social worker, the therapist, and the psychiatrist. That was awesome and I think the really big thing for Naomi.”
Note: DBT (dialectical behavior therapy) is psychotherapy or “talk” therapy that uses a cognitive-behavioral approach. Sessions focus on developing skills for acceptance and change, including mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
After a hospitalization, Naomi was discharged to an Intensive Regional Treatment Services facility (IRTS), followed by a move to long-term transitional housing. Now, Naomi lives in her own apartment on a bus line within two miles of Connie and Dan. She is back to school taking one class at a time.
Note: Intensive Regional Treatment Services (IRTS) are facilities that provide mental health services in a residential setting. Services are time-limited with the goal of assisting the resident to achieve psychiatric stability, self-sufficiency, and obtaining the skills needed to live in an independent setting.