03/16/2026
MArietta Daily Journal March 14, 2026
A Paranoid Challenge
Dirk E. Huttenbach, MD
I have basically retired from psychiatric practice and closed my office in Smyrna in late 2021, friends still try to pick my brain regarding challenging emotional issues.
Recently, a friend asked me about a middle-aged relative. He described her as a “paranoid schizophrenic.” She has been “suspicious of everything and everybody” lately. She is no longer able to hold employment, despite being college-educated and having held employment before.
She is in the process of divorce. Her children already live with their father. Contact with all her relatives is very strained and difficult. Relatives are fearful. Some have strengthened their home alarm systems. They have changed locks and security passwords.
Interestingly, her only financial support comes from a relative, who pays her rent, provides her with a car, and also covers groceries.
Attempts have been made by her family to get her involved in psychiatric help. She has managed to avoid and refuse such help, seeing no need for it. Probably, since she does not trust anyone, why should she trust a psychiatrist?
An effort was made fairly recently via the Georgia Crisis and Access Line, also commonly known as the Su***de Hotline. It is available 24 hours a day, 7 days a week. It is accessed by calling 988. They can listen, they can arrange to send out a Mobile Assessment Team. This team can arrange for treatment, including an initial involuntary psychiatric assessment. This service can be very helpful.
The police were already there also. Our lady in question steadfastly denied suicidal and homicidal thoughts. She was able to present herself well during the 10- to 15-minute assessment. The assessment team and the police left. Things are now getting worse.
So, what can and should be done? How can this lady be helped? What leverage does her family have to get effective treatment started?
It seems to me that her family has financial leverage. Financial support could and should be contingent upon her agreement to engage in and remain engaged in psychiatric care. This should be made very clear in a family “intervention” discussion. She may, however, see that as a bluff and refuse. Hopefully, she would change her mind when her money runs out. She may also become more paranoid and difficult.
An attempt could and should be made at another involuntary psychiatric assessment, followed by treatment, which would include psychotherapy and medication.
A Georgia Form 1013, mandating psychiatric assessment, can be requested by family members from the Cobb County Judge of Probate, 32 Waddell St., off the Marietta Square, 770-528-1900. They are open weekdays, 8 a.m. to 4:30 p.m.
At least two persons, usually relatives, need to request this in person at the Judge of Probate’s office. If the judge agrees, an order, Georgia Form 1013, can be given to the County Sheriff. This empowers Sheriff Officers to apprehend the patient and transport the patient to a hospital Emergency Room or directly to an emergency psychiatric receiving facility, i.e., a psychiatric hospital. Here, a more thorough psychiatric assessment can be done, and treatment can start.
If the patient is initially seen in the ER, the ER physician, after ER psychiatric assessment and medical clearance, can send the patient to a psychiatric hospital, either via the County Sheriff or via ambulance for further involuntary assessment and treatment.
Any physician or psychologist can complete Form 1013, but they must personally assess the patient. Subsequently, however, getting an unwilling patient to a treatment facility can be challenging without law enforcement help. Regular police are limited in their actions. They can transport people to jail if they have broken the law or are very dangerous.
Major emergency rooms have staff available to assess whether patients need psychiatric care, voluntary or involuntary. They can contain out-of-control behavior with staff controls and medication. As noted earlier, the ER physician can sign or continue Form 1013 to have the patient transported to a psychiatric facility.
Having the patient assessed directly at a psychiatric receiving facility is a lot more efficient and quicker, if not more humane, in my opinion, than going to the ER first. It avoids busy ER commotion and expense. It avoids waiting for many hours for the assessment, for the paperwork to be completed, and for Sheriff deputies or an ambulance to arrive for a second transportation. This can be very stressful for everyone before finally arriving at the psychiatric facility. If there are additional medical issues, the patient should go to the ER first.
The psychiatric hospital most conveniently located for residents of Greater Cobb County is the Ridgeview Psychiatric Institute in Smyrna. There is a small psychiatric unit at Wellstar Cobb Hospital. Peachford Psychiatric Hospital, Emory Decatur Hospital, and the Georgia Regional Hospital are all located in DeKalb County.
Complicating matters, of course, is that we live in a free society and enjoy certain civil liberties. Involuntary psychiatric treatment interferes with civil liberties and should only be used under severe circumstances, i.e., when there is a severe risk of harm to society or the psychiatrically severely disturbed individual.
A psychiatric hospital, like a regular hospital, cannot refuse to accept an emergency patient, but there can be later complications involving insurance coverage. Medical insurance companies, via their managed care staff, often, if not usually, will place limits on what they will pay for. Thus, patients, once they hopefully consent to treatment and become voluntary patients, often rapidly move to partial hospital care and outpatient care. Unfortunately, many patients drop out of treatment at or soon after these transition points. The family will have to strongly insist that their relative stay in psychiatric treatment. Financial realities may need to be stressed again.
I should note that severe paranoia is not the only psychiatric emergency. Severe depression, suicidal and homicidal thoughts, hallucinations, plus severe alcohol and drug abuse also often result in needing involuntary assessment and treatment. For involuntary alcohol and drug abuse assessments, Georgia Form 2013 is used, which functions the same as Form 1013 for regular psychiatric assessments.
My friend asked me to write this article. He would like our Greater Cobb community to be more aware of these types of problems and of how to help. Hopefully, by the time this article is printed, there will be better news from my friend.
Dirk E Huttenbach, MD, joined the Greater Cobb County Medical Society in 1972. Dr. Huttenbach is a Board-Certified Psychiatrist who focuses his practice on Child and Adolescent Psychiatry.
