A mental health arrest is the taking of a person to a hospital due to behavioral symptoms that put themselves or others in some perceived danger. Once at a hospital, a mental and physical evaluation is performed to determine if the person has some underlying infection or malady that would cause them to behave differently. Illness can wreak havoc on the elderly or memory impaired mind, that when addressed can return them to “normal” thinking and behavior. If they have dementia to begin with, an illness can cause them to display increased agitation or violence. The mental health arrest can be used when the person with dementia has progressed to a more paranoid, delusional, and agitated state to assess their condition and find appropriate placement. This may be just an adjustment of medications, or it may lead to placement in an assisted-living dementia care unit, or a nursing home. You may think you will never use this tool, but I advise everyone to take note. It will save some worry to know that this is a good road to follow when emotions and behaviors are out of control.
Let me explain how it works. A mental health arrest was used to get my husband to a safe place. Jim had hereditary Alzheimer’s for 18 years at the time. He had always been a warm and loving husband and father, a family therapist, and he was always concerned with the well-being of others. In this last year, however, he had forgotten that he had dementia, and became increasingly worried about his body. He had dry eye, dry mouth from some of his medications, and post-nasal drip (it was spring in NY and he was allergic). He was up many times each night taking baths which in his mind relieved his symptoms (I had to redress him each time because at this stage he couldn’t do it by himself). He had forgotten that I was his wife, I was more of a companion who cared for him and a “warden” because I placed limits on him that he resented. He thought that he was dying and would insist I take him to the doctor at 3 a.m. No amount of cajoling or offering of nasal sprays, etc. would appease him.
It came to a peak Easter week when he expressed the idea that he wanted to go to New Jersey (where we grew up) to be with his pals. I interpreted his mental age to be maybe 10-12 years of age, maybe younger . . . he wanted to go play with his friends. I questioned him: “What if your pals are working when you visit?” He said he would convince them to stay home. He also said I couldn’t come. (He sat me down and told me our marriage wasn’t working and that he didn’t want to be married anymore.) I told him we would make plans to go to New Jersey, but that we had to pack clothes and make reservations someplace. We would go there soon, I told him, hoping he would forget about it in time.
Easter Sunday Jim set out in his clothes and coat, with one shoe and one slipper, and no wallet or anything else. He started walking down the street to New Jersey. I got in the car and drove to where he was standing, and angled the car in front of where he was walking. He stopped, and I asked him to get in the car. If he had been of normal thinking ability, to get away from me all he had to do was go around the car and keep walking. But his mind didn’t know how to deal with the car that was in his way. He got in the car and I drove home, convincing him to come in the house. I called our closest male friend. He came over and tried to talk to Jim, but nothing helped. Jim was insistent on leaving for New Jersey.
I called our Monroe County Sheriff (911) and explained that I needed a mental health arrest for my husband who has had Alzheimer’s for 18 years, because he insists on walking to New Jersey. They intern called our local ambulance corps. Very quickly a sheriff’s car pulled in the driveway, and my friend went out to fill him in. The sheriff asked the paramedics who arrived next, to wait outside until called. The sheriff entered our home and introduced himself, and asked Jim if he would explain what he wanted to do. Jim did, and the officer asked Jim if he felt OK at that moment, and asked him to sit down. The officer sat down as well. He told Jim that his eyes didn’t look right and that worried him, and asked if it would be OK if the paramedics could check him over before allowing him to proceed on his journey to New Jersey. Jim said yes (Jim had always respected the police and was cooperative). The paramedics were called into the house. They checked him over, not saying anything that I could hear, but nodded to the sheriff. The sheriff then told Jim that he felt there was really something wrong, would it be OK if they took him to the ER to make sure Jim was alright. (During the entire exchange, the sheriff’s partner was really looking quizzically at his partner. He was learning a very valuable lesson evidently never having to perform a mental health arrest.) Jim willingly accompanied the sheriff and paramedics to the ambulance, and he was taken to our local hospital.
From there he was assessed. His behaviors were not due to any infection or medication imbalance. He was then placed with the help of the hospital social worker in a dementia care assisted-living facility 5 minutes from my house.
I was so lucky to get an officer that day who was well trained in dementia and how to “go with the flow” instead of against it by trying to talk Jim out of leaving. Jim was treated with respect, but the sheriff knew how to use the situation in his favor, not ruffling any of Jim’s feathers in the process.
We caregivers think that we can keep our loved-ones at home to their dying day. Many times in the end stages of dementia, however, our loved-ones become unmanageable and a danger to themselves or others due to the hallucinations and delusions that can be a part of the final stages. I had heard about Mental Health Arrest in support group a few years earlier, and I am so glad I did. It is a means of getting yourself and them out of a bad situation. What ensued was not easy, but I knew with Jim’s present thinking pattern I could not keep him at home any longer.
A Caution Is In Order!
If you perform a mental health arrest on someone who is not diagnosed with dementia, but rather Mild Cognitive Impairment (MCI), everything you tell the police and medical personnel will have to be weighed carefully as to whom is telling the truth: you or your loved-one. This is because MCI is a diagnosis where the person is still under their own care, they are legally in charge of their own being while someone with diagnosed dementia is under the care of their health care proxy, spouse, or family member. For the caregiver of someone with MCI who displays agitation and violence, this can be a very “sticky” situation.
Be Mindful Of The Following:
- Before this stage, when you notice behavioral changes that might lead to unpredictable situations, call or e-mail the neurologist to bring him/her up-to-date on the changes that are occurring.
- When performing the Mental Health Arrest by calling 911, make sure you tell them that the person you are calling them for has dementia. It is important to have a copy of the letter from the doctor stating the dementia diagnosis to show the sheriff/police, so there is no question upon their arrival that the caregiver is in charge and is the one telling the truth. Otherwise, it can put the law enforcement person in the position of having to decide for themselves who is speaking truthfully.
- If your loved-one mentions suicide or harming themselves or you, the Mental Health Arrest will take a different course. Instead of going to the ER and perhaps to a medical floor while tests are being run, the person will likely be admitted to the psychiatric side of ER and to a psychiatric floor awaiting further decisions. Most regular nursing homes will not admit patients to their floors who have suicide or violence in their charts, because they don’t have the staff to patient ratio in which to keep them and anyone else safe. These patients are usually sent to behavioral nursing homes which have more staff and a physical set-up for better monitoring of their patients. These special places come with a price tag double the regular nursing home and open beds are hard to find.