What can I do when my loved one refuses mental health treatment?

Why might my loved one not see the illness?

Refusal is often a symptom called anosognosia. It is not stubbornness, and it is not a choice. The illness gets in the way of recognizing the illness.

The Treatment Advocacy Center reports anosognosia in about 50 to 98 percent of people with schizophrenia, and about 35 to 63 percent of people with bipolar I disorder.

Arguing the diagnosis often closes the conversation. Ask about a problem your loved one does notice, such as sleep, fear, or conflict.

What can I do this week?

• Keep a dated record: symptoms, what was said, what escalated, and what helped. A clinician or a court meeting your loved one for the first time can use that record.
• Ask the prescriber about a long-acting injectable. The shot is given on a schedule of weeks or months, so a missed daily pill is no longer the failure point. Your loved one still has to receive the shot. If you can, ask during a stable stretch whether you can join that conversation.
• You can tell the care team what you are seeing. Under 45 CFR 164.510(b), a provider may share relevant information with a family member when your loved one does not object, or when your loved one is incapacitated and sharing is in their best interest. Some states are stricter. A release signed in a stable stretch makes later stays clearer.

When can a court order care?

In some states, refusing treatment and getting worse can be enough. Rules differ by state. See your state.

Many states let a family member or another adult ask a court to order outpatient treatment. Who can petition, and what the court has to see, differs by state. See your state. Assisted outpatient treatment is the name for that court process where it exists.

Which programs can a family member start?

A refusal does not close every door. These can be started by a family member:

• Medicaid can pay for psychiatric care, medication, and a hospital stay.
• A representative payee can receive and manage SSI or SSDI if your loved one cannot manage the money.
• SSI and SSDI can replace wages if your loved one cannot work. If your loved one cannot take part, a guardian, conservator, or representative payee may be able to apply.

When should I step away?

You can love your loved one and still leave when you are not safe, or when someone else in the family is not safe. That limit is not abandonment. It is often what keeps a path open later.

When a loved one hurts someone in the family covers the first safety steps.