“Can’t you force him to get treatment?”

Robert had called for a Mental Health Mobile Crisis Team to come to his house. His 28 year old son, Joe, had been ranting about water being poisoned by plastics for half an hour and there seemed to be no end in sight. And as usual, he refused to get mental help.

The outbursts had gotten so bad that Robert had come home from work so often, he was on the verge of being fired.

“Can’t you force him to get treatment?” he begged me. After a brief assessment that showed Joe was not a danger to himself or others, I sighed and shook my head: As Joe was a legally autonomous adult, no one could make him do anything against his consent.

When a Family Member Won’t Get Mental Health Treatment

One of the hardest challenges families can face is when a family member is struggling with mental health issues but declines to seek treatment, whether it is a spouse or a sibling, a child, or a parent. Many families attempt to manage these individuals for months, and sometimes years, by changing their own behaviors and thoughts because they want to help the person.

In fact, families often bend over backward to cater for their loved ones in various situations. Some examples include:

• A parent might stop going to work in order to stay home with a teenager with suicidal thoughts who refuses to attend school;
• A wife might stop attending social functions because she fears asking her husband to go out might lead him to explode;
• A daughter might change into a new set of clothes every time she enters the house because her mother is worried about outside germs being transported into the house.

Despite the best of intentions, these actions in fact usually just worsen the problem. Changing your behavior to meet the needs of the family member who won’t get mental health help generally doesn’t work to actually get the person help; instead, they just keep stuck in an endless cycle where everyone hurts.

This is no way to live.

Good News for People Whose Family Members Refuse Treatment

The good news is that various strategies are being developed, including one by Dr. Pollard and his team at St. Louis University who have recently pioneered a “family well-being approach” that aims to help families facing exactly these kinds of situations.

They undertook this work after being contacted time and time again by families requesting that their clinic force a family member into treatment, which the clinic was unable to do. They discovered that family members engaged in numerous burdensome behaviors – often to their own detriment – due to a family member’s untreated mental health symptoms.

The bottom line: family members of loved ones with mental health needs should not have to live like this.

The Family Trap

According to Dr. Pollard and his associates, the problem is what they refer to as “The Family Trap.” This is when family members become trapped into a system of Accommodation and Minimization. Accommodation is divided into two parts:

• “Omission” is when you give something up in order to accommodate your family member’s request. For example, you might stop playing cards with your friends on Thursday evenings, because your husband feels too anxious about you socializing.
• “Commission” is when you do something extra to meet their perceived needs, such as continuously sanitizing every surface in your house because your son is afraid they might have become contaminated.

These actions are counterproductive, however, because they validate your loved one’s perceived needs as being reasonable and make them believe that both their own behaviors and those of their family to accommodate them are normal.

• “Minimization” is when you try to influence your untreated family member using verbal and emotional tactics such as nagging, yelling, crying, or criticizing them, all with the goal of getting them to seek treatment. (In so doing, you are “minimizing” the extent of the challenge they face in reaching out for help.)

But these efforts are also self-defeating. Your loved one typically feels attacked and invalidated, leading them to become defensive and even less likely to seek treatment.

Escaping the Family Trap

There are a number of steps that family members can take when a loved one with mental health needs refuses to seek treatment. (Of course, easier said than done; often it is helpful for the family members to seek professional support even if the one with a mental illness will not.)

1. Make a list of any and all accommodations that you are making for your loved one. You will work on a plan to withdraw these accommodations over time. Even if this is a single accommodation, a week at a time, this will change the negative family dynamic.
2. Write a letter to your family member outlining the date that you are going to stop your accommodations for them (or each accommodation individually) and explain that this is about the well-being of yourself and your family; and although you meant to help while doing these accommodations, you understand now that they are not helping, and you take responsibility for the changes to your own behaviors.This is an important part of the process because it lets your loved one know what you are doing and why. Without this letter, you run the risk that your untreated relative may believe that your failure to engage in accommodating behaviors is a temporary accident rather than an intentional decision.

3. Make a “family crisis plan” for how you and your family are going to respond when the family member who is not seeking treatment reacts to this information and when your family no longer accommodates. This should outline the behavior you are likely to see, your goal in the situation, and the action steps you will use.

   Their behavior should be predicted based on their previous behaviors when pressured. These are most often either suicidal statements, aggression, or property destruction. For example, if your family member starts acting aggressively (the behavior) towards you when you decline to engage in your traditionally accommodating behaviors (your goal), then you are going to leave the house, contact a Mobile Crisis Mental Health team, or even call 911 to ensure everyone’s safety (your action steps).

4. Share this plan with the loved one experiencing mental health issues so that they know what the new responses to their behaviors will be. Ensure that your responses to specific behaviors are outlined clearly to the person.
5. Implement the plan and stick with it. This can be tough! We all want to help someone who is suffering and have the best intention in doing this, but it is crucial for you to hold your ground and not allow yourself to fall back into prior accommodations. (Again, professional support can be super helpful here.) This will enable you and your family to achieve the next step.
6. Work on creating a life worth living. While you were accommodating your loved one with mental health needs, you almost certainly lost certain parts of your life that you once enjoyed. Now is the time to get those back, using your own action plan, regain control, and begin living your life how you want to live it once more.
7. Improve your family’s overall well-being. Your family’s internal relationships have likely suffered from your past accommodations of the mental health issues of your loved one. Now is a good time to work together to support one another in sticking with your plan and troubleshooting issues as they arise.

For example, if you ended up cleaning up after your daughter because she was too depressed to do so herself, you might have vented your frustration later by yelling at your spouse. Now that you are no longer accommodating the mental health issue, you can work on restoring the collateral damage it caused.

It’s worth it in the end

Some things in life are not easy and the above steps are no exception. One of the biggest challenges faced by family members who attempt to withdraw accommodations is that, in the short term, things may get worse. A loved one with mental health issues who has become used to having their challenges catered for is going to be wholly unprepared for a world in which those concessions are no longer provided.

But you are going to be helping them and helping yourself. There are several positive outcomes that should result following this course of action, including:

1. You are going to regain your own quality of life. One of the major findings from the work by Dr. Pollard and his team was how great of a toll is exacted upon the relatives of people with mental health problems who do not seek treatment. Once the burden of having to orient every aspect of your life around your loved one’s untreated mental health needs has been removed, your own well-being and your family’s well-being will improve dramatically.

2. You are more likely to have your relative see the need for seeking treatment. When a person with mental health issues is being accommodated, they may believe that their expectations are reasonable and that they do not need help. Once your accommodations and minimizations are withdrawn, the discomfort that they face may help them to see that they cannot continue with things as they are and that they do, in fact, need professional help.

3. Once your untreated loved one seeks a small amount of help (e.g. reading a book on their condition), they are likely to start seeing an opportunity for a better life. This is huge. Everything that you have done to accommodate and minimize their circumstances in the past has, in fact, been a barrier for them from being able to get better. Once they finally obtain treatment, their own quality of life is likely to improve.

4. Your family can begin to heal. Once the weight of needing to orient everything around accommodating your untreated relative’s mental health issues has been lifted, the wounds your family has suffered can start to heal and you will all move closer to creating better family interactions which will help on your path towards a life worth living.

You are not alone

If you have a family member who is suffering from an untreated mental health issue, be it your husband or your wife, your son or your daughter, your mother or your father – you don’t need to struggle alone. Reach out to a therapist with experience working with the loved ones of people with untreated mental health issues; family therapy can be tremendously helpful, even in the absence of the “identified patient.” We’ll support you in devising and implementing a plan that works for you and your family, and gets your life back on track.