What do you do when a family member, showing clear signs of psychiatric or substance use issues, insists “There’s nothing wrong?” It’s a common problem; the classic work on the subject is I Am Not Sick, I Don’t Need Help! by Xavier Amador, first published in 2001.
It’s rare that an unwilling person can be forced into treatment without proof of physical danger. Menninger requires voluntary admission. “We cannot treat a patient or release information without their consent, except in an emergency,” says Ed Poa
, MD, medical director, Menninger Admissions
You needn’t stand by helplessly, however.
First, step back and take an objective look at the situation, preferably with the help of a less emotionally involved friend. It is possible that this is simply an ordinary deviation from what you consider normal.
Get a professional opinion. If you still think something is wrong, and your family member refuses to get an assessment, contact a physician or mental health professional on your own. Describe the situation, and ask for concrete ideas. Menninger Admissions coordinators address these issues daily and are happy to talk it over with you.
“We begin by gathering as much information as possible,” Dr. Poa says. “Coordinators ask focused questions about the most worrisome possibilities: suicide, self-harm, violence against others, substance use or withdrawal, psychotic symptoms. Our coordinators have extensive admissions and clinical experience to help determine how serious the situation is.”
Approach the subject with caution. In a panic, it’s tempting to plead or bully your family member into treatment—which intensifies resistance. Dr. Poa says, “We encourage family and friends to try any of the following, depending on the situation: provide materials about Menninger or other treatment facilities to the family member, who can let it sink in slowly; have the family member call us so we can answer questions and put fears to rest; consider an interventionist to help the entire family talk with the person; discuss with any outpatient providers whether to consider more intensive treatment.”
If treatment is rejected for the present, take care of yourself and other loved ones. Set firm boundaries. “We encourage family members to make clear that they will assist in healthy steps, such as seeking treatment and getting proper nutrition and safe housing,” Dr. Poa says, “but not support behaviors that are unhealthy, such as providing money that can be used for drugs.” Also, don’t let the situation consume you: Build rest and self-care into your own schedule; continue giving attention to other family members; and refuse to blame yourself or visualize worst-case scenarios. Finally, know warning signs of actual emergencies and whom to call in case of trouble (your treatment professional can advise you).
When your family member does agree to consider treatment, act promptly and be straightforward. The window of opportunity can be small and the risk of resistance returning is large, so be prepared to act on a moment’s notice. “Have a clinician get involved quickly,” Dr. Poa says, “so there can be at least a quick assessment to determine what level of treatment is indicated. This will help avoid misunderstandings about what is needed and when. Information can also be provided about options for where to receive treatment so the person retains some choice in pursuing treatment.”
Above all, don’t give up hope.