The Family and Patient Outcomes

 1) Conditions and drug responses run in families, so interview of the family is important. The patient may know less about relatives than his parents. We need symptoms of relatives, medication responses, good and bad, and actually specific doses being used in relatives. One may also predict the future course of the patient's condition from the past of the relatives. Families could help by looking into these questions, and coming to the intake with that information prepared;

2) in no way am I against guns. I am against guns laying around with impulsive people who have dark thoughts. The best is removal to the homes of friends, and picking them up to hunt or shoot targets. Second best are metal safes in the home. I am not even opposed to the patient's use of arms. But someone should make a judgement about the mental state before handing over a weapon for sport. One of my patients committed suicide with his own gun. I demanded an investigation as to how he was allowed to legally possess a pistol after multiple hospitalizations for suicide attempts. The Berks Coroner has not responded, but that is a system problem. The family is the last chance to stop that system problem;

3) eyesight supervision, nothing beats that to prevent physical damage. We know that over 16% of depressed and manic patients will die by suicide. What is less known is that 10% of the murders around the world are committed by paranoid schizophrenics. That is 100,000 totally unnecessary and preventable murders a year. In the greatest achievement in psychiatry of the 20th Century, not the psychiatrists, but the prison wardens of the US dropped the prison suicide rate by close to 80% with no additional cost, staff, program,  treatment. Robin Williams was rich, and got fancy treatment for depression. He hanged himself, in his bedroom. Had a non-English speaking maid who knew nothing about anything except cleaning been sitting in his bedroom, he would be alive today. She would not even need to speak English, just have eyesight. She would try to stop him, and if she could not, she would get help to stop his hanging himself;

4) the law should be changed to support the physical control and commitment of people in brain failure by families, the people who know them best and care most about them. It is quite different for an addict to go out again, to score, or for an untreated schizophrenic to defend himself against imaginary threats by a rampage killing, than for a cancer patient to decline further treatment. In the case of psychiatry, the organ making decisions, the brain, has failed. I encourage families to storm the legislatures to change commitment laws to ones based on need and on safety, rather than based of loss of legal rights only after physical injury has taken place, and requiring the hiring of three lawyers for a full trial. If you liked the Sandy Hook School massacre, thank the Supreme Court. All rampage killings are 100% the fault of the Supreme Court interfering in a technical subject, psychiatry, that they know nothing about. The mother of the attacker at Sandy Hook had tried to get involuntary treatment for her son for a year, and was stymied by the legal system;

 5) no medication or therapy will work, ever, zero chance, if the patient lives with a person with inadequately treated and ongoing  criminality, addiction, or mental symptoms, such as depression. Family members who want success in the management of a loved one must get better themselves. There are few formulas with 100% certainty in medicine. This is one of them, with the cretainty of a law of physics. The duty of the family member to get successfully treated, before the patient will improve. Multiply this effect by ten if the patient is a child under 14. The undesirable alternative is the removal of the patient from that home. 

The most crucial take away message for families, today? Eyesight supervision.