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When Someone Refuses Treatment

What to do when you see a need but feel unable to help.

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When someone you love refuses to get professional treatment for their mental health disorder—such as depression, bipolar disorder, or substance abuse—this can put you, as a family member, in a very uncomfortable and difficult position. You care for the person and can see that he or she needs help, but feel powerless and unable to just stand by.

You cannot force anyone over the age of 18 into treatment, unless they pose a danger to themselves or others or show signs of psychotic thinking (which is not very common). What can you do?

You might begin by spelling out for your loved one what you observe in her that’s different from her usual state. Gently mention any changes you have noticed in her, making sure that your tone is not judgmental or critical. Common areas of concern are:

  • alterations in overall appearance
  • decreased level of energy
  • fatigue
  • lack of interest in previously enjoyed people or activities
  • changes in sleep, appetite, or weight
  • negative thoughts or feelings that are frequently brought up in conversation

Reinforce your love and concern, and emphasize that you are there for her. Try to provide clear and reliable information on treatment for mental health disorders (you can get this from your family doctor or can read about it online before initiating the conversation). Offer to help with the logistics, which can sometimes feel overwhelming to a person in the midst of a mental health episode. This could include providing phone numbers for the mental health professionals in her area or driving her to an appointment. Help her to understand that going for an evaluation does not mean that she has to agree to the proposed treatment—she can take time to think about it.

If your loved one refuses to move forward, it’s useful to try to understand what is behind his reasons for refusing treatment and then address those issues. A person may refuse to accept mental health treatment for many reasons, including:

  • He may believe it indicates he is a failure.
  • It may make him feel more vulnerable.
  • He may be concerned about paying for treatment.
  • He may fear a loss of privacy.
  • He may have a fear of stigma, particularly if friends or co-workers find out.
  • He may believe that treatment is not effective, at least not for him.
  • He may fear becoming dependent on medication or dread the side effects he has heard rumors of.
  • He may be concerned that treatment, particularly talk therapy, may raise up strong emotions that he fears having to deal with.

Once you understand his reasons for refusal, try to discuss with him the logic behind his thinking. Information is a powerful tool. Provide him with reliable, sound information on the treatment, including the reasons you believe treatment is important for him and how treatment may render him better able to achieve his goals in life. Ultimately, help him to understand that with treatment, it is more likely that he will eventually feel better.

In some situations—if your loved one is an adolescent, for instance—you might have to set boundaries, including agreeing upon acceptable behaviors and using a "tough love" approach. You might have to take away certain privileges from a teenager until she is able to demonstrate that she can care for herself safely. For example, she must show that she can take her meds, attend and participate in appointments, comply with the treatment plan, not drink and drive, etc. If your family member who has depression is an elderly parent, you may have to arrange for someone to be with her so that she’s not left alone during the day when others in the family are away at work or school.

Caring for someone is a full time job that is not easy. Good luck!