Mental health patients can resist treatment for a variety of reasons. Although close family and friends are in the best position to urge a troubled person to seek help, this task can often be the hardest. We can feel it’s impolite or insulting to approach this awkward topic. We are too easily put off or intimidated by the resistance and rejection we may encounter so we give up far too easily.
Persuading a loved one may take more than one approach. It might start with delicately and strategically discussing the pain they may be causing you and your own sense of helplessness in the face of their behaviour or mood. This effort to persuade requires overcoming the fear of being rebuffed and bravely persisting with the message “you need help.” Rather than offering your own conclusion about what’s wrong – “you’re depressed” “you are an alcoholic” – it’s more helpful to focus on specific behaviours that are worrisome.
Some examples include
You have missed so many days of work because you can’t get out of bed.
It takes you hours to finish washing the dishes because you keep repeatedly sponging them, hundreds of times.
You are more afraid of driving over bridges than you have ever been.
You talk about not wanting to live anymore, and that scares me.
Many people have succeeded in convincing a loved-one with mental health problems to get psychiatric evaluation through creative means, like the woman who asked her husband for a unique Christmas gift – seeing a psychiatrist just one time to talk about his depression. It worked. He gave her the gift she wanted and was persuaded at that appointment to give treatment a try.
Serious conversations need to be pursued at the right time, not in a sudden, aggressive way, not when the troubled other is drinking, and not at family gatherings when people want to appear at their best.
If private and personal conversations are not fruitful, you might need to call on key allies for help, such as the person’s primary care provider, clergy, coach or influential family members. There are also many support groups for families, like the National Alliance on Mental Illness. Those who have struggled with the same challenge of convincing someone to get mental health treatment fill the meeting rooms of these support groups. They can be extraordinarily helpful, both through providing practical tips, and emotional support.
Occasionally problems may be more severe and a person’s resistance to getting a proper evaluation is so strong, or even irrational, that it becomes necessary to push harder. I have found that the greatest resource is often untapped: the power of family to steer, even to coerce family members toward entering treatment.
One family I counseled decided they would password protect their modem at home preventing their 23 year old son, stuck in his room and sleeping all day, from staying up all night on his computer. They promised to give him the password as an incentive for getting help. This approach worked and when he showed up for a psychiatric evaluation, it turned out he had the early signs of schizophrenia, and paranoia was keeping him shut up in his room. Treatment worked, and three months later he was working part-time.
Sometimes the situation becomes more acute and potentially dangerous. Perhaps the person is threatening suicide, has said or written things that sound violent or has behaved in violent ways that seem to be caused by mental illness. In this case it may be necessary to ask authorities to take your loved-one to a hospital. To act against someone’s refusal in this way typically requires that the situation be imminently dangerous with life or safety at stake. The local police can explain the procedures if you call.
If it’s necessary to take this step, it’s vital to show up to the emergency department to give detailed information to the evaluating team, emphasising all the behaviors that are worrying you which make the situation seem acutely unsafe.
When you see someone in emotional trouble that goes beyond the ability of your attention and kindness to help, or when you feel that more professional expertise is needed, do not remain silent. Do not avoid the subject or let it go for fear that you might be meddling. Alone, or with the help of others, you need to say to him or her: “You need help.”