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Refusing treatment

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Refusing treatment

Sometimes a person may be showing signs of a mental illness, but will not to seek help – by seeing a GP for an assessment, for example. Sometimes they have a diagnosis, but still refuse to accept treatment and support.

There are a variety of reasons why this happens. The symptoms of psychotic illnesses such as Schizophrenia, for example, may involve delusions, hallucinations, and disturbance to thinking processes – these can make it difficult for the person to realise or acknowledge that they have a mental illness and need help. The person may have stigmatising attitudes towards mental illness, which make it difficult to acknowledge the need for help. Or they may accept they have an illness, but not want to take medication, with the possible side-effects involved.

Whatever the reason, the longer someone goes without treatment, the more distress they will experience, the harder it makes it for them to recover. The situation is also deeply concerning and worrying for family and friends.

While legislation in each State and Territory differs, if someone you know fits into these categories, please see Dealing with crisis.

Encourage the person to access treatment on their own volition and with your support. Here are some strategies to make communicating your concerns easier and hopefully more effective:

  • Dedicate a conversation to your concerns. Choose a time and a place that is suitable for both of you. A time when you are both calm and when you feel the person is most likely to be receptive and cooperative.
  • Plan what you are going to say but prepare to be flexible.
  • To set this up you might open with ‘I’d like to talk something over with you that’s been worrying me. Is this a good time or shall we talk later?’
  • Do your best to speak in a calm, quiet voice. Try to avoid expressing any frustration that will interfere with the person’s ability to hear what you are saying. Do not get drawn into an argument about the content of delusions, but focus on practical help that is available.
  • Emphasise talking about changes and symptoms rather than a disorder. Talking about a disorder can often feel stigmatising and prevent a person from engaging.
  • It can be helpful to focus on aspects that the person feels the most comfortable talking about. For example ‘I know you’ve been having trouble sleeping and concentrating lately, can we talk about that?’
  • Be patient, it may take a while for the person to process what you are saying and respond to your concerns.
  • Do not underestimate the power of listening. Giving the person space to talk and letting them know that they have been heard is a valuable and supportive contribution.
  • Remember that you do not have to offer immediate solutions.
  • It may take several attempts to break through the denial of the significance of the changes you are seeking.
  • Remaining calm and supportive during this conversation will make it more likely that the person will be willing to talk again.
  • Offer to make an appointment for them and suggest that you or another relative or a friend accompanies them.

 

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What if they still won’t accept help?

If the person is still reluctant to acknowledge a problem or to see a mental health professional, ask what is stopping them. Once you know what they are worried about, work together to find solutions to overcome these barriers. For example:

  • Sometimes people don’t want to see a doctor because they feel frightened, anxious or angry, that others are against them, or that they are being criticised. You can help by encouraging everyone involved to think of the doctor as someone who can help and who will not judge them.
  • Sometimes people may have trouble putting their thoughts together to explain their problems, they might be reluctant to talk about how they feel, or not realise they are ill. In this case, you could discuss the situation with the doctor beforehand, writing down some notes about your concerns as clearly as possible in advance.

Remember that if at all possible it is best for the person involved to voluntarily seek help.

Don’t worry if your first attempt to talk isn’t successful. An initial conversation may plant the seed of seeking help in the person’s mind. By showing that you care and are not going to judge them, they will be more likely to come to you when they do decide to seek help.

If there is outright resistance to the idea of getting medical help, talk to the doctor yourself to work out a plan. The doctor may be able to visit the person at home to make an assessment. If this is not possible, they should still be able to tell you where to get help and support – for the person as well as others who are worried.

Someone refusing to acknowledge a problem or accept treatment can place family members and friends under significant strain, especially if the person is experiencing active symptoms. Don't think you have to deal with this situation alone, contact local mental health services, a helpline or carer organisation for advice and support.

Last updated: 31 January, 2017

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