Do you have someone in your life who has major depression or bipolar disorder and refuses to get professional treatment? This can put you as a family member in a very uncomfortable and difficult position. You know that you care for the person, can see that he or she needs professional mental health treatment, and it makes you feel powerless to just stand by. You cannot force treatment if he is over age 18, that is unless he is at risk of harming himself or someone else or shows signs of psychotic thinking, which means he sees or hears things that are not really there (this is an uncommon condition). So now, what do you do?
First, reinforce your love and concern, and that you are there for him or her.
You might then clearly and simply describe what you observe in him that’s different from his usual baseline state. In doing so, make sure that your tone is not judgmental or critical. Changes of concern that you might mention are alterations in overall appearance; decreased level of energy or fatigue; lack of interest in previously enjoyed people or activities; changes in sleep, appetite or weight; or negative thoughts or feelings noted in conversation. It’s quite valuable if you can share clear and reliable information on treatment for depression that you have received from your family doctor and have read about.
Next, offer to help with the fine details of getting there, which can sometimes feel overwhelming to a person in the midst of a depression episode.
This could include providing phone numbers for the mental health professionals in his area or driving him to an appointment. Tell him that you don’t expect that going for an evaluation means that he has to agree to the proposed treatment – he can take time and think about it.
Another effective step is trying to understand what is behind his or her reasons for refusing treatment and then address those issues.
A person may refuse to accept mental health treatment for many reasons -– he may believe it indicates he is a failure; it may make him feel more vulnerable and that it is intrusive; he may be concerned about finances in paying for treatment or privacy issues and fear of stigma if friends or co-workers find out; he may believe that treatment is not effective, at least not for him; an elderly parent may not buy into the idea of psychiatric diagnoses and treatment – it’s a generational obstacle you will have to negotiate. Other reasons for refusing mental health treatment are that he may fear becoming dependent on medications or dread the side effects he has heard rumors of; and he may be concerned that talk therapy may raise up strong emotions that he fears having to deal with.
If you can you understand his reasons for refusal, that opens the door to talk with him about the logic behind his thinking. In general, those who are in the midst of an episode of depression have holes in their logic which will become obvious to you. Gently point these out in a non-critical manner. Then provide him with reliable, sound information on the treatment, the reasons you believe treatment is important for him, how with treatment he will be better able to achieve his goals in life, and help him to understand that with treatment he is much more likely to feel better. Information is a powerful tool.
In some situations, such as if your loved one is an adolescent or teenager, you might have to set boundaries.
This includes both of you agreeing upon acceptable behaviors and using a “tough love” approach. You might have to take away certain privileges from a teenager until such time as he or she demonstrates that she can care of herself safely. For example, she must show that she can take her medications, attend and participate in appointments, comply with the treatment plan, not drink and drive, things like that. If your family member who has depression is an elderly parent, you may have to arrange for someone to be with her so that she’s not left alone during the day when others in the family are away at work or school.
Caring for someone is a full time job that is not easy. Good luck!