My adult child, whom I will call Dawn, had been living in Europe with a friend for several years. In mid-winter, her friend contacted me and said Dawn had become aggressive and disrespectful and was having delusions, hallucinations, and paranoia. He feared for his own safety and for Dawn’s well-being. He was hoping I could help get Dawn back to the States for professional care, even though I was not her guardian since Dawn’s condition had been adult onset.
Dawn is a skilled, creative, hard-working, generous person with a deep faith in God and ability to make lasting relationships. She has a 20-year history of mental illness, including several hospitalizations. She had come to think that her faith had healed her mental illness and managed to go four years without medication or hospitalization before this incident overseas.
What follows is a brief account of the procedures and challenges my family and I faced in obtaining hospitalization for Dawn in Europe and her subsequent repatriation to the United States. If you should ever find yourself in a similar position, I hope my story will help.
The first step when a loved one needs help while overseas is to call the nearest U.S. Embassy or Consulate, whose job it is to help citizens overseas. A full list is available on the State Department’s website at https://www.usembassy.gov/. Alternatively, you can call the Bureau of Consular Affairs in Washington, DC, at 1-888-407-4747. I called the embassy and expressed my concern that Dawn might be apprehended and charged with criminal offense. The staff gave me a list of local bilingual mental health professionals. When the situation escalated to a crisis of psychosis, they advised Dawn’s friend to call the Emergency Medical personnel. The embassy answered my questions about legalities and cost responsibilities and helped with passport and transport issues. Over a period of weeks, I called and e-mailed them numerous times, and they treated me with respect and kindness throughout.
The biggest challenges were the time difference, language barriers, and determining whether coming back to the States was the best choice for Dawn. We found that brainstorming ideas with friends and family yielded results. For instance, I found bilingual relatives and friends who helped find out where Dawn was, who her providers were, and how to communicate with her. The hardest thing for me to deal with was that the hospital did not have interpreters or English-speaking staff. Here again, reaching out resulted in my other child finding an American psychiatrist in Europe on Google who responded personally to some of my e-mail questions and gave me the name of a respected American lawyer who also responded immediately to my concerns. The time differences can also lead to exhaustion, so schedule appointments for calls if you can.
Contact the Hospital’s Social Worker
In our case, the social worker proved to be the best asset. She spoke English, guided our expectations, and helped arrange times to talk with Dawn and the doctor. I e-mailed her a short statement of strengths and a health history within bounds of Dawn’s conﬁdentiality rights and expressed my feeling that Dawn would receive better ongoing care over there, without the greater threat of homelessness and the opioid crisis here. I let the doctor and Dawn know that we were not able to have her live with us.
The European health care system believes mental health care and recovery are of primary importance. Care is free for their citizens, but US citizens with income must pay for medical care. In Dawn’s case, a team met with her and had her sign a statement that she was indigent so that she did not have to pay for hospitalization. They also encouraged her to ask me to accompany her back to the USA to be near us when she was stabilized.
Dawn told me that although she would accept medication in the hospital, she would discontinue it upon discharge. She said that she felt she should return to States as soon as they authorized her release.
After two weeks the social worker gave us a discharge date for the following week. The staff asked me not to come until then. I booked flights for us to come back to the U.S. Dawn told me about a hostel that she felt comfortable staying in and we both stayed there. This gave us a little time to adjust. She also was able to peacefully say goodbye to her friend and gather her belongings. She showed me some of the places she had enjoyed while living there. The time together and the flight back were harmonious.
After we returned to the Northwest the reality of homelessness sank in for both of us. In Snohomish and King Counties, there are resources for care and housing for people with history of mental illness. Basically, the person who has the mental health issue must be the person to apply for the service themselves, in all cases, if not in crisis. The year before her return and while Dawn was hospitalized, I had contacted many resources, trying to find a place that would appeal to her if she returned to the area. My understanding was that for us to take her in even for one night would bump her off the priority list for housing. She was angry that she could not stay with us and felt we defined her by her mental health. She was more afraid of staying in shelters than on the streets. Dawn had to decide her own path. As her time on the streets became weeks, one of her comments was, “I can find my own resources!” She has, in fact, connected with a church in Seattle and made friends with members and staff who helped her line up resources. She has found a community to live and work in and thankfully welcomes calls and visits from us.
For many years, I have kept a journal regarding her condition. In this situation, it documented dates of changes in her condition. Since I had the names of programs and people from previous research, I did not have to second-guess myself about realistic choices. Logs of family conferences and NAMI webinars are in it too. It helps me assess my own emotional responses and assists me to better hear her experiences and aspirations. Fundamentally, keep in touch with your loved one as much as possible. The journal helps remember some of the amazing times as well.
Additionally, my family and I have always found it useful to attempt to practice the LEAP — “Listen-Empathize-Agree-Partner” — principles espoused by Xavier Amador, Ph.D. in his landmark book, I Am Not Sick, I Donʼt Need Help.
A few helpful numbers
2-1-1 is the phone number for Coordinated Entry for All (CEA) in King or Snohomish County. It is to ensure that people experiencing a housing crisis have fair and equal access. You can also access their website.
Seattle Downtown Emergency Service Center (DESC) housing 206-464-1570. H.O.S.T. Program (a branch of the DESC) works with people as they ﬁnd them on the street in a respectful accompaniment model.
Snohomish County Crisis Intervention 1-800-584-3578
Lutheran Community Services Northwest Housing Navigator: 425-309-0290