When a loved one refuses mental health treatment

What can you do if you feel that your loved one needs treatment for a mental health illness, but they refuse to seek care? What if they seek care but don’t follow their treatment plan?

For many families, living with a loved one who has a serious mental illness can be a tug-of-war of the heart and mind. On one hand, you care deeply for your family member. On the other hand, you may be at your wits’ end trying to cope with the frustration and hurt that come from witnessing your loved one struggle.

From violent behavior and property destruction to overt delusions and general chaos, untreated mental illness can take an emotional and physical toll on a family.

Why would a person refuse care?

Some people living with severe depression, anxiety, schizophrenia, bipolar disorder or other psychiatric illnesses who would benefit from hospital treatment refuse the help they need to manage their symptoms and improve their well-being. This can be due to a variety of reasons, ranging from believing that they are not ill or that treatment will not help them to not liking the medications they’re prescribed.

Many individuals with severe mental illness also experience substance misuse and addiction. This can add additional complicating factors. As a result, those close to them may shoulder the emotional, financial and physical hardships of caring for them while often tolerating very difficult symptoms and behaviors in the home.

Every family has their tolerance level and capacity, which are often impacted by cultural considerations. But it is never an easy road.

“As a social worker in an inpatient psychiatric facility in California, I spend a good deal of time talking to distressed family members who find it impossible to get their loved one hospitalized,” says Candy Elson, lead social worker at Sharp Grossmont Hospital for Behavioral Health. “When they are hospitalized, they hope that they will be able to be treated long enough to become stable. However, often, this is not the case.”

1960s mental health law offers challenges

One of the reasons having a loved one hospitalized is so difficult lies in the pivotal California mental health law called the Lanterman-Petris- Short (LPS) Act. The law was passed in the 1960s when state hospitals were closing, and community mental health was being advocated.

Designed to protect the rights of California residents, the LPS Act states that individuals cannot be detained indefinitely against their will for psychiatric treatment without the right to challenge that involuntary hold.

A person brought to a mental health hospital in California can be held for up to 72 hours after being admitted and evaluated. However, after 72 hours, if the patient no longer wants to be treated, they have the right to leave and refuse further treatment.

The only exceptions are if a patient is a danger to themselves or others or they are gravely disabled. This means that they cannot provide food, clothing or shelter for themselves due to their mental disorder, and no one else can provide it for them.

“If the patient does not meet these exceptions at that moment in time, they are often released,” says Elson. “If their family begs that their loved one needs to be hospitalized longer, it may not always be possible to keep them for treatment.”

The decision on whether to keep a person in the hospital is also based on other factors, such as the patient’s history, collateral information from family, insurance and the reliability of the information provided by the patient.

Advocating for longer hospital stays can entail lengthy court hearings involving testimonies from the patient and their mental health care team. But even after lengthy deliberations, a judge can still rule in favor of the patient.

“The judge or hearing officer is interpreting the law,” Elson says. “In California, everyone has a right to have symptoms of a mental disorder as long as they are not a danger to themselves or others and not gravely disabled. But I also understand that families may have a different point of view.”

Given this situation, patients may not get the necessary duration of care they need to effectively treat acute psychosis, depression, mania and other serious conditions. “I spend a lot of time trying to explain the law to families who feel hopeless, helpless and exhausted because their loved one refuses to get the help they need, and they cannot do much about it,” says Elson.

How families can cope

Elson recognizes that these families are between a rock and a hard place. She helps them to try and accept their loved one’s wishes and choices, as difficult as that might be. Although they may not be able to steer their loved one toward treatment, they can still protect their own mental health through self-care.

“There are support groups available, such as the one offered through Sharp Grossmont Hospital for Behavioral Health, that provide a place of support and education for families and friends of those living with serious mental illness,” says Elson.

She advises families that have a loved one with mental illness living with them to set clear boundaries and limits about conditions of living in the home. For example, family members may agree that their loved one can live with them as long as they take medication and do not use street drugs. If the loved one does not agree to those conditions, however, they should set a boundary, such as saying they cannot live in their home.

Families need to be willing to let go and allow the consequences of their loved one refusing treatment to unfold, no matter how painful, Elson advises. “All of us have limited control over what happens to other people and our loved ones. We cannot force people to take medication or comply with treatment, but we can say, ‘That is a condition of living in our home,’” she says.

If everything does not go as planned — or hoped — Elson encourages family members to forgive themselves and give themselves grace. There is only so much that is in their control. “It’s important to also take care of your own mental health,” she says.

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