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Unbefriended: When loved ones burn bridges

A grandfather becomes abusive (from later-diagnosed dementia) and alienates family. An adult child stops taking medication to treat severe mental illness and goes off the grid. A cherished granddaughter continues to lose a fight against addiction.

What options exist for family members who continue to care? It is not possible to hospitalize someone for extreme depression, drug abuse or refusal to take prescribed medications. Mentally ill or drug-abusing individuals are generally left alone unless and until they pose a threat to themselves or others.

M-1 holds

Law enforcement will sometimes steps in. Colorado is one of few states that allow so-called "M-1" holds. This 24-hour incarceration is allowed in metal health emergencies even when a crime has not been committed.

A multi-agency report requested by Gov. John Hickenlooper has urged the state legislature to change this law statewide. In more urban counties, police often transport to a hospital rather than the over-crowded Larimer County Jail.

But the emergency room is rarely a better answer than a jail cell.

Who makes the medical decisions for the unbefriended?

For any of the people in the above scenarios, there may no longer be anyone left willing to step in. Medical care decisions should take into consideration what is wrong while considering what is possible depending on a patient's wishes and values. In a medical system that values patient autonomy, there may be no one left to convey the patient's wishes and values.

Colorado has looked at this patient population before. Studies have found an increase in incapacitated patients and an unprepared court system. Calls for improvements and funding for public guardianships have not kept up with needs.

What can be done? Speaking with an attorney about guardianship proceedings could provide a solution. Not every case will rise to the statutory requirements needed to appoint a guardian. And few in your family may have the patience or skill set to continue dealing with the individual. Hiring a professional into this role may be an option.

Each community has different resources, but early action might be enough to keep a trouble loved one in the family fold. Any intervention, however, needs to be done carefully.

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