If your friend or relative with schizophrenia won't get treatment, there are steps you can take to help.
First, listen to his concerns in an open-minded, supportive way. Then talk about how treatment will help. Explain that he has an illness and it's treatable.
What You Can Do
Focus on your concern for your loved one's safety and try to form a partnership. Don't confront delusional or inappropriate thoughts.
"Try to listen and empathize whole-heartedly with your loved one's perspectives, even when his or her beliefs seem outlandish, bizarre, distorted, or delusional," says Jason Bermak, MD, PhD, a psychiatrist in San Francisco.
If your loved one is paranoid, talk with him alone so he doesn't feel threatened by a group, says San Diego psychiatrist David M. Reiss, MD.
If he's not paranoid, having a group of known and trusted friends or family members talk to him may give him a sense of agreement and concern. A group is also best if he has a tendency to "turn" on one person.
How to Encourage Them to Get Help
Reiss suggests following these guidelines when you and others talk to your loved one about getting treatment:
- Don't use a threatening or confrontational tone.
- Close and trusted family members or friends should lead the conversation.
- Don't include people your loved one doesn't trust or feel close to, which can cause more anxiety, fear, or confusion.
Get Support for Yourself
It’s really stressful to have someone you’re close to deal with a mental illness such as schizophrenia.
"Support groups for patients and families are not only helpful, they are essential," Bermak says. They can also help you get your loved one into treatment.
Try these organizations for help:
- The National Alliance on Mental Illness (NAMI) has an information helpline (800-950-NAMI), referral service, and programs for individuals and families.
- The Treatment Advocacy Center has information about treatment options. Or try its cell phone app, the Psychiatric Crisis Resources Kit, which has resources for emergency situations.
- Local psychiatric hospitals, clinics, and universities run support groups and give referrals to other groups.
Get Help in an Emergency
First, call the police or 911. Explain the situation so they send someone trained to deal with it. "It takes the pressure off you," Krishna says.
Some states will send a mobile crisis unit or psychiatric emergency team, often called a PET or SMART Team, to your house. The team often has a social worker or psychologist who can assess and de-escalate the situation.
If your loved one is calm and doesn't need to be hospitalized, the team will talk to him about getting treatment on his own. Or they may take him to a hospital with the help of police.
In some situations, your loved one may need to get treatment in a hospital even though he doesn't want to go. You may hear this called "involuntary hospitalization" or "involuntary commitment."
"Laws governing involuntary commitment differ from state to state," Reiss says. Most states allow it only if someone with schizophrenia is in one of these situations:
- An immediate danger to himself or others
- "Gravely impaired" and unable to function (for example, being unable to provide basic things for himself, like food, clothing, and shelter)
If your loved one is in danger, doctors may place him in psychiatric "hold.” This means that the hospital can keep him there for a certain period of time.
The length of time and who can write the hold vary from state to state. It's important so doctors can keep the person safe, watch him closely, and rule out or treat upset or threatening behavior and medical or substance abuse problems.
More Ways to Get Help
Besides involuntary hospitalization, there are other options for someone who refuses treatment. The choices vary depending on where you live:
Outpatient commitment. When he gets out of the hospital, a court order requires him to stick with treatment, or he will be sent back to the hospital. You may hear this called "assisted outpatient treatment," or AOT.
Conservatorship. The court gives a family member or guardian the right to make medical and legal decisions for the person with schizophrenia.
Assertive case management. A team of professionals will go to your loved one's house if he doesn't go to his appointments.
Advance directives. These are legal documents, written when a person is in a competent state of mind, that outline the treatment he wants if he later loses his ability to make reasonable and informed health care decisions.
Court-ordered treatment. In some situations after a person has been arrested, a judge may offer him treatment in a residential program as an alternative to prison.