When families say they want their loved one to accept treatment, what they often really mean is they want their loved one to get better. Many families imagine treatment will be straightforward: see a healthcare provider, receive a diagnosis, and take medications. It’s natural to want your loved one to get better. However, with mental illness the process is rarely that simple.
Getting better for mental illness often means recovery and stability. The recovery journey includes ups and downs, and treatment refusal is one of them. While there is no “cure” for mental illness, most people live well while managing symptoms.
It can be hard for families to understand why their loved one doesn’t want to accept treatment. It can feel like they’re refusing to get better. The truth is your loved one likely doesn’t see the situation the same way that you do. What’s often overlooked is that there are valid reasons people refuse treatment. So the key to helping them get help when they refuse is understanding why they’re refusing and adjusting your approach accordingly.
Mental Health Treatment Refusal Is Common
Many people who accept treatment have refused treatment in the past, often adamantly for long periods of time. This means that it’s not only possible for your loved one to accept treatment in the future but that it’s likely that they will be more open at some point. Social networks, including family and friends, also have an influence over a loved ones’ willingness to seek out and accept help. Evidence shows that families can have a life-saving impact on a loved one’s recovery from mental illness.
There is always a reason someone avoids or delays treatment. We’ve outlined the top reasons people refuse treatment for mental illness, along with steps you can take to support your loved one. Chances are, your loved one’s personal reason for refusing is a mix of these reasons. It’s important that you have conversations with them to understand their unique experience.
Your loved one doesn’t think there is a problem
Many families think their loved one is in denial. Conversations about seeking treatment can easily lead to feelings of defensiveness and anger. Families often don't discuss symptoms for fear of upsetting them or concerns about pushing them away.
Because symptoms seem so obvious to family and friends, it’s hard to imagine a world where your loved one doesn’t see them too. However, it’s common for people to say that they’re completely unaware of the symptoms their family and friends express concern about.
There are people who can’t recognize their symptoms. If your loved one experiences this type of lack of insight, often referred to as anosognosia, they genuinely aren't able to see the symptoms you see. That can be hard to imagine if your loved one is experiencing symptoms that seem clearly wrong, like hearing voices or not being able to do things they’ve done in the past.
Even in cases where people can recognize symptoms, they might not interpret them the same way you do. For example, what a manic episode is like for your loved one is different than what it’s like for you. They might feel amazing while you see they are behaving erratically.
It is possible for your loved one to accept treatment, even if they aren’t convinced there is a problem. Here’s what you can do:
1. Accept that your loved one likely sees the situation differently
Your loved one is likely perceiving the world differently. Because everyone has a different brain, everyone has a different way of perceiving, predicting, and acting in the world—even to the same things. The biological factors related to mental illness can distort these differences and make them more extreme.
An easy way to imagine this is to think about an optical illusion you saw as a kid, or the gold vs. blue dress craze that swept the internet. If you’re someone who believes the dress is blue, it is nearly impossible for someone to convince you otherwise. And that’s just a dress on the internet.
An example of this related to mental illness is someone with an anxiety disorder. They often perceive the world as more dangerous than others. Their experience of reality is different. Trying to convince your loved one that their experience isn’t real will leave you both frustrated and misunderstood. Instead work to accept that they see things differently.
2. Build trust by listening and empathizing
Trust is crucial when a loved one is considering seeking treatment. Yet, it’s difficult to trust family members when you don’t believe they understand your perspective. Empathy is essential when trying to understand your loved one's perspective. It allows you to connect with their emotions about their experience, even if you’re unable to agree on the facts of the situation.
Although you can never have the exact same experience as your loved one, you can draw on times when you’ve felt similarly. Imagine what it could feel like if everyone who loved you believes there is something wrong with you that you know isn’t true. You might feel angry or confused or alone. By focusing on how your loved one is feeling about the situation, you can directly address their emotions when talking about next steps.
For example, if your loved one is feeling misunderstood, you can tell them you want to understand better. Your next step could be setting aside time to simply listen without judgment. By showing your loved one that you are making an effort to understand, you can build more trust.
3. Partner with your loved one to find common ground
What does it look like to partner with your loved one? Partnering is being willing to walk alongside your loved one on their journey of recovery instead of trying to control everything for them. We can’t force our loved ones to accept help. We can be there to offer support, a listening ear, remind them that they’re loved, and nudge them in the direction of actively caring for themselves.
Once you understand their perspective, you can move forward with finding what you can agree on. Perhaps your loved one still isn’t convinced there is a problem, but they feel they’re not getting enough sleep. Agreeing that sleep is an issue for them that they can seek help for shows that you’re supportive of what matters to them. The goal isn’t trying to convince them to see things the way you do, but to be a safe space for them to share their wants and concerns.
Your loved one is afraid to be labeled with a diagnosis
Accepting a diagnosis often feels like accepting a new identity. Depending on your loved one’s symptoms and behaviors, they might be afraid of the type of diagnosis they will receive.
Although mental health is less stigmatized in general, there are many diagnoses that still carry a lot of stigma, including schizophrenia, substance use, bipolar disorder, and personality disorders. Your loved one might fear becoming the person seen as "the crazy one” or worried the future they dreamed of will never come true. In some cases, they might carry the weight that they are the reason for all the challenges they face.
Depending on your family's past experiences around mental health, your loved one might have already internalized messages that they won’t be loved or will be judged for being different. They might think accepting treatment means giving up their creativity or what makes them special. Many people fear medication will make them into someone they don’t recognize. Here’s what you can do:
1. Talk openly about mental health, including any challenges you might have of your own
You might not think stigma is present in your family, but it often shows up in the form of silence. Family members struggle to talk about their loved one’s experience, which can lead them to hide it away. Open communication is the key to building a more trusting relationship.
Families often struggle to talk with their loved ones for fear of upsetting them, not wanting to label them, and concerns about pushing them away. Unfortunately, silence can lead to even worse outcomes. Feelings of shame can arise when no one talks about what's happening which can hurt their mental health. Use open-ended questions to get the conversation started.
2. Validate their feelings about not wanting their identity to change
Symptoms of mental illness are often isolating and debilitating. When people are experiencing symptoms, they usually feel like they’re being ignored and judged. Even if you are doing your best to create a safe space for your loved one, opening up about their experience can still feel painful. You can use validating phrases to show them you are trying your best to understand their feelings:
“It makes sense that you’re feeling this way.” “I know this isn't fair. You're allowed to feel frustrated about it.” “I think I would feel the same way in this situation.”
Your intention is to show them that you believe their feelings are real. Avoid pretending like you understand when you don't. You won't be able to relate to everything they are experiencing. That's okay. Acknowledging when you don't understand shows you have something to learn from them about their unique experience.
It's also exhausting to have so many conversations centered around their behaviors and emotions. It’s worth it to take space from conversations about mental health and show that you still see them as a whole person instead of a list of symptoms.
3. Seek out support and stories of recovery for yourself and your loved one
One of the most powerful ways to reduce stigma is seeing real life examples of people living well with similar experiences. There are many people online sharing their stories, which can be a great first option. Support groups can also have many benefits for families. You can join a support group even if your loved one refuses treatment. You’ll expose yourself to stories and advice of people living with mental illness and their families.
You can also enlist the help of others in you or your loved ones’ extended support network. You may not be the person most likely to “get through to them” right now. These can be hard conversations but really worth it. Identifying people who support your loved one and can positively influence their decision to seek help can make a big difference.
Your loved one has had bad experiences with treatment or already expects the worst
Treatment can feel like a gamble. Because of media representations, many people believe having a mental illness means they will never recover. In reality, the expectation for most mental health conditions is recovery for most people. Even so, people do have bad experiences in the process of receiving treatment.
Two common negative experiences are being hospitalized and taking medications. Hospitals are usually understaffed with poor conditions. Many medications are ineffective or cause debilitating side effects. People are also often discharged very quickly without having enough time to receive or adjust to medication. Many people cycle through different clinicians, medications, therapies, and hospitalizations. Even if your loved one believes that treatment can help, the process is often exhausting and overwhelming.
People with mental illness also often interact with the criminal justice system. Since law enforcement is the typical first responder during mental health crises, people experience being handcuffed or spending time in jail. Here’s what you can do:
1. Take concerns about medication side effects seriously
Medications prescribed for psychiatric conditions can be effective for many people. However, they often require trial and error and come with a long list of side effects. Dealing with debilitating side effects can feel as awful to your loved one as their symptoms.
Be open to discussing alternatives and going through the trial and error process with them. When needed, help them express their concerns about side effects to their healthcare provider. Showing them that you’re on their team builds trust.
An example of this could be your loved one wanting to switch to a medication that’s less effective because the side effects are more manageable. Remember your shared goal is for them to live well, not to stay on one medication forever. Think in terms of “better options” instead of the “best options”. This shift leaves space for you to have honest conversations with them about pros and cons where they feel heard.
2. Talk to a trusted provider, even if it’s not a therapist
While many people often refuse to see therapists and psychiatrists about their symptoms, they might be open to talking with a primary care provider, especially if they have one they already trust. The visit can be for a general physical or check up and gives your loved one the opportunity to talk about their symptoms with someone who isn’t going to immediately diagnose them with a disorder.
The goal is to find someone they trust and can talk openly with. It's not a good idea to blindside them with a doctor’s visit if they’ve adamantly been against it. This is one of the times where partnering with your loved one is important. Your shared common goal is helping them seek professional support. It's crucial that you're open to their desires about who provides that support.
3. Understand what in the healthcare system they are avoiding and research different options
Your loved one can be avoiding medication, therapy, hospitalization, or something else. It can be valuable to figure out exactly what they hope to avoid. Did they have bad experiences with the system in the past? Do they have particular fears about what could happen? You can work together to come up with a list of questions they can ask when finding something that is a better fit.
Are they reluctant to have weekly meetings with a therapist? They might be able to see a different type of provider or negotiate shorter or less frequent visits. Are they avoiding a specific medication? There are often alternatives and treatment options beyond traditional therapy and medication. Different programs are available for different experiences.
Programs are available for first time psychosis, in-patient, outpatient, virtual, and even in-home in some cases. Because mental illness impacts a person’s whole life, it’s also critical to consider options outside of therapy and medication. Structured support could include peer support or programs for vocational or cognitive training. For some people, it can help to seek support from a mentor, community leader, a spiritual leader, or an old friend. Together, you can be committed to finding something that works for them, even if it takes additional research to find.
Your loved one isn’t ready for change
The last reason is likely the one you may relate the most to. Your loved one might be struggling with accepting such a huge life change. Change is hard for nearly everyone. There is a natural pull toward keeping things the same, even if they aren't already good. The status quo is familiar and can stop your loved one from acknowledging the need to change, especially if they think it’ll be a lifelong commitment.
Symptoms of mental illness can make it even more challenging to change. Your loved one might feel like what they’re experiencing is a personal failure. Lack of motivation and lack of energy are both common symptoms of mental health conditions, but can be interpreted as laziness. There are also symptoms like impulsivity which your loved one may not want to change. You can't get someone to change in the way you want them to. They have to want to change, and it has to be on their terms, but you can help. Here’s how:
1. Make things easier to do and follow through with support
If your loved one is reluctant to make changes, knowing you’ll be there through the ups and downs can be a reason for them to start. What feels supportive to them might be different than the type of support you can offer. Yet, simply knowing that you’re there for them is its own type of support and can give them momentum.
For example, you can make things easier by helping to find care, driving and coordinating care, and reminding them about medications. This follow-through is especially vital if one of your loved one’s barriers to treatment is a lack of motivation. You might need to set boundaries with them so you’re not trying to do everything for your loved one.
2. Encourage small steps and gradual progress
The goal isn’t to convince your loved one to do something you want them to do. You want to partner with them to figure out what help looks like to them. For some people entering into a program overnight works, but for many others it takes time to be okay with such major changes. Instead focus on what feels manageable for your loved one right now.
Devika Buschan, previous surgeon general for California, shares that you can’t rush recovery in her top 9 mental health tips. As someone who lives with bipolar disorder, she herself refused treatment for years. She now recommends setting small goals and celebrating the small wins when things are hard.
We forget to celebrate the positive in the midst of difficult times. But as you have conversations with your loved one, it’s important to acknowledge when things are improving, no matter how small. One common symptom of mental illness is not experiencing the motivation most people get from big or little achievements in life. Family members can help by acknowledging any positives wherever possible.
3. Problem solve together to come up with next steps
Hard problems will come up. The stressors you and your loved one are managing likely make problem-solving more difficult than it usually is. Try taking a more intentional approach to problem-solving. Being more intentional in working through problems can bring structure to a chaotic situation.
When working collaboratively with your loved one, focus on a shared, common goal. At Akin, we recommend a 7 step approach to problem-solving that’s shown to work for families. Families in the Akin Family Program are able to work through worksheets live and download them to work through later with their loved one. Without a specific framework a good place to start is clearly defining the problem and brainstorming options.
Feelings about treatment change over time. Many people accept treatment in some form but don’t always adhere to it long-term. Expect setbacks even if your loved one willingly accepted treatment in the past. How a medication impacts their life or how therapy aligns with other priorities can change over time. As their life changes, they will go through phases of instability.
Trying to force someone to change rarely works. A better approach is moving away from trying to “fix” and instead partnering to figure out what your loved one's path to recovery looks like to them. Here are a few bonus tips to keep in mind regardless of why your loved one isn’t ready for treatment:
Keep notes about what has worked and not worked in the past. As you try these different techniques, you’ll likely get different responses from your loved one, but not everything will work with them. Keep track of what you’ve tried, what you’ve talked about, and what you can try next. These notes can also help contribute to collaborative recovery tools like relapse prevention plans or psychiatric advance directives in the future.
Familiarize yourself with crisis and emergency support. Crisis and emergency support are available as a stop gap for treatment. You can call or text 988 to connect to the Suicide and Crisis Lifeline for 24/7 support. The National Alliance on Mental Illness (NAMI) offers resources for families. In emergencies, families also consider getting their loved one admitted to the hospital by calling 911. Understanding what happens when you call 911 is important for feeling prepared and making decisions that work for you and your loved one.
Don’t expect a quick fix. Even if you implement all this advice and do everything right, change is often slow, back and forth, and unpredictable. Your efforts could be the case of “right approach, wrong time”. Big shifts in a person's approach to life require a lot of factors to converge. So, change might not happen as quickly as you hope. Remember change does happen, especially when it comes to treatment refusal.
Get the support you need. It’s not easy to have a loved one who refuses treatment, even if you can understand their reasons. There will be uncertainty and ups and down. Learning how to roll with resistance and cultivate patience are key to being in their corner long-term. Akin offers expert support and a program for families. Learn the most valuable information with other families who get it. Join the program to unlock strategies and tools to support your loved one on their journey of recovery.