Anyone have experience with a Community Treatment Order (CTO - Canadian) or Assisted Outpatient Treatment (AOT - US)?

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I was informed by a community geriatric psychiatrist (part of the team which has been visiting mother) that she will be hospitalized with or without her consent. Mother, who has a personality disorder and increasing paranoia, will be certified, stabilized by treatment with meds, then released back to her ALF after a Community Treatment Order has been enacted. I believe that this will take about a month, This (the CTO) enables the team to ensure she takes meds and any other recommended treatments. Mother has mentioned to me thoughts of suicide several times, and I think that combined with her refusal to take the antipsychotic meds prescribed for paranoia is what prompted the community mental health team to take this action. I know this is a drastic step, yet her life has become increasingly filled with fear and bizarre delusions. The cut off point for hospitalization and treatment is when a person becomes dangerous to others and/or to themselves. Mother did take a small dose of the antipsychotic early in the fall for about a month and was much calmer. Now she is adamant that she will not take it. This is consistent with behaviours earlier in her life. She does not want to take anything which affects her mind. Her life was manageable on the antipsychotic, but it is not now. She has delusions and fears of being mutilated, and believes she is being harassed regularly.
Mother does not have dementia but does have age related (she is 101) pretty severe, short memory loss. She passes the cognitive tests well. Fortunately, she has asked me to take over more of her financial business which I am in the process of doing. She is more and more alienating her support system including me. After a lifetime of it, I can only tolerate so much more abuse and some of it now is getting pretty bad.
I have mixed feelings about what is coming. The psychiatrist said it will happen in about another week or so depending on when a bed becomes free. On the one hand, I do not like what will happen and would not wish it upon anyone, and yet mother's disease has progressed to a point where it is endangering her life. The psychiatrist said that with treatment she will be able to live out the rest of her life with dignity. Without a change in her I am about at a point that I have to separate myself completely, as her accusations etc. and too damaging to my emotional health. A girlfriend of over 45 years died just before Christmas and with from 3 to 8 crazy phone calls a day I have not had the space to do the grieving that I need to do. I am letting the calls go to voice mails but do listen to the messages and attend to the very odd one that appears to be a legitimate concern. Most of them are totally off the wall. As well, my ex, who has become a very good friend and is part of my support system, is experiencing serious health problems and may not have long to live. All together it is hitting me pretty hard and makes it easier for me to accept the proposed treatment.
I suspect mother will fight all of this with her considerable energy, intelligence and determination. Once my sister finds out - I have not informed her as she has already back some very cruel accusations towards me - I suspect it all will get much nastier.
Any comments, recommendations are welcome I suspect some of you will be horrified at the thought of enforced drug treatment. I understand.

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Thanks ba8alou. Things are going in a good direction. Mental illness was always there - Borderline Personality Disorder - but she has always refused any meds that would help that. The paranoia has tipped her over the edge permanently, as opposed to once in a while.

Update: I had a good phone chat with the psychiatrist and another one with the social worker. They are kind and supportive. In future, they can either conceal meds in the food, as now, or give her a 2 weekly injection. Her ALF cannot deal with the meds in the food. It is beyond their capability, so if she is to return there it would have to be with injections. They are testing her for function (OT) and also doing in depth cognitive testing (psychologist) to see if there is anything else going on causing the rapidly increasing paranoia. The testing and results will not be available for a while, so she will be in there a couple of months anyway, I think. If she is found not able to return to independent living with homecare they will find another placement for her, a controlled environment, with more care where they will be able to conceal the meds in her food. They may choose that option anyway considering her age, and the likelihood of her needing more help in the future, though she is amazing physically for her age.

I will have a meeting with the psychiatrist and the social worker in a week's time. I may see mother if she has calmed down some by then. I am only realising what the daily phone calls with paranoid accusations have done to me on top of everything else. Some of the calls were pretty nasty, The thought of seeing her literally makes my stomach turn. It triggers PTSD. When I saw my doctor, my BP and weight were up from the summer - stress. I got my BP down and am working on the weight - only 5 lbs. and a couple off this week, but still too much. I could stand to take off another 10 -15 after that. My thyroid is whacked. I will go for extensive testing in a week or so. Read an article which connects chronic fatigue with childhood abuse. I believe it. The fibro has flared up and I am fatigued. I have upped the meds for the fibro a a little and it is helping. Dealing with mental illness in a family is very stressful and as you get older, it takes a bigger toll physically.

This past week has been peaceful, which home needs to be. I have been wanting to take some courses, but couldn't with all of what was going in. Maybe I can plan to now, though if mother has to be moved to another facility there will be a lot of work dealing with her things. She set herself up with totally new furniture in this apartment and I haven't gotten rid of all the old stuff yet - not so much the furniture, but crystal vases and china that no one wants these days.

G is planning a holiday in warm places for us in March. Can't come soon enough. March here is windy with raw cold.

Thanks all for the support. Looking like the future will be better. ((((((((((hugs))))))))
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Good thoughts for you and your mom, emjo. Hope this is going well. Concealing meds is like therapeutic fibbing...just what we have to do when mental illness sets in.
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The caller also called my cell phone and left a message. It was mother's psychiatrist from the hospital. Who is paranoid now? lol. Maybe the internet info about the number was wrong, other than it was from that institution,

We connected with a very bad phone connection, but enough to cover the bases. He described mother as tortured, and unable to make rational decisions about her own treatment. I agreed with that. He described the drug side effects with which I was already pretty familiar, and asked if I would give them permission to conceal the drug in her juice. I said yes. I know there are huge ethical issues around this. It is a different ballgame than the matter of carrying out her wishes, as she is still cognitively sound, but she is also irrational and self destructive, so it is ensuring that she gets the best treatment available for her condition. I liked the psychiatrist. He is a different from the one I saw a week ago, but they have been consulting for a while over mother. We made an appointment to talk again on Monday. I hope this very small dose has as good an effect as it did last summer.
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Thanks pst. As much as I know the accusations mother makes at me are to some extent a product of the paranoia, she also made accusations at me years ago before any paranoia set in. These were a product of the Borderline Personality Disorder. Either way, having had them from childhood, they still hurt to a degree, not as much as they did, but they trigger some bad memories.
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Fingers crossed emjo, I'm lighting a candle for you.
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I spoke too soon Just got a call from a number which I didn't recognise so didn't answer. No voice mail. I checked online and it is supposed to be an outpatient line at a hospital inpatient psychiatric ward of a hospital associated with the one mother was to go to.The psychiatrist said they were not allowed to make long distance calls. Oh, dear.
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Vikki, thank you – several of your comments were very helpful. "She can suffer and die with all her rights to self-determination intact, or she can receive treatment and have a life that is not totally dominated by her illness” “taking away that one choice, which she is showing she cannot make in her own interest or rationally, will give her a lot of other choices about other things.”
Mother has lost so many choices. The illness envelopes her more and more. She is afraid to go to the mall in her scooter, she is afraid to go to the common room and do the jigsaw she used to enjoy, she worries that the staff are a putting poison in her food, her sleep patterns have been disrupted recently...

sunny – she has been living in increasing fear since before last summer No need to screen calls right now. It is better for her to load her fears on the staff there, so they get a picture of what she is going through.

mbvargo - as you see it is looked after for now. Yeah, there is only so much crazy a person can take. She went quietly. The staff at her ALF said she seemed relieved to go as she sees her ALF as such a dangerous place. However, those fears will soon be transferred to the hospital, as they were to the other hospital last summer. I think the Community Treatment Order gives then the authority to make sure she gets her meds or stays in hospital where she is safe. Sounds like they did a good job with your grandmother, but not your mother. I am so sorry that they did not follow through with your mother. Families are not equipped to deal with mental illness. Yes, the screaming is very hard to take. I grew up with it. I do think they have a pretty good system once she was identified as paranoid, and tried to fly east alone last summer, which could have been dangerous for her. Up to that point no one did anything. Thanks for the good wishes. You have mine too. I hope she will be a calmer, saner woman too.

cap thx - I can see that paranoia is a terrible condition. A friend of mine had it for a while and she told me how awful it is

pst - at 101 am not sure they would give her chores, but I believe that she does need an environment better structured to her needs. As I understand it the Personal Directive here in Canada gives me the same basic authority, as guardianship. The former is set up while the person is capable of making decisions, the latter for a person who is not capable of making decisions, and in the case of an adult, does not have a PD and is facing a situation where some decisions need to be made.

I was just reading about the CTO
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Can treatment be forced through a CTO?
No. Regardless of whether the CTO is issued with a person’s consent or without a person’s consent, the person must agree to any treatment before it is provided.
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This clarifies it a bit for me. Last summer, initially mother agreed to treatment, then did not comply. I believe that the CTO deals with non-compliance after initial agreement. I think one option after non-compliance is rehospitalisation.

I am wiped today. Fibromyalgia has flared up. Mother is in the best place available for her needs. Now, I wonder how, as per psychologist, Pauline Boss, you achieve “no further harm” to yourself.
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Yes, emjo, I have worked with a foundation that houses AOT's and it does seem to work for a while until something triggers a setback. The court may be able to refer her to appropriate housing, but you can ask them now, and ask about guardianship if the judge thinks she needs one. She will need tighter rules than ALF, someplace with strict house rules, chores, meds, consequences. ALF just can't do that stuff, and she knows it.
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Mother left for the hospital with no trouble. The ALF is now saying that they are not sure it is a good place for her to return to. After her session in hospital in the summer when she agreed that the staff could administer her meds, she then changed her mind and ended up ditching the antipsychotic after a few weeks. We suspect this will happen again. I asked them if they had any other residents like mother and they said no. We are thinking that she might be better placed in a facility with a mental heath mandate, as her case manager mentioned some months ago. I suppose to some extent it will depend on what happens in hospital and what they recommend.

gotta fix supper...
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it makes one feel a little sorry for the demons.
honestly i hope they get her stabilized because paranoia is a torturous condition.
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