My friend/family member doesn’t want medication or therapy. What can I do?

While you may care for someone’s wellbeing and believe you know what’s best for them, adults have the right to make decisions about their treatment.

There could be many reasons why a person decides to not engage in treatment or rely on only some treatment options. Some people make a decision to not take psychiatric medication because of unpleasant side effects or decide to manage their symptoms on their own. Some people don’t think therapy helps. What’s important is that the person is living a life that brings them satisfaction and happiness.

However, without treatment some people aren’t able to achieve the type of life they’d like to have. In this case, a relationship build on trust will put you in a better position to discuss the benefits of participating in treatment and how it may help them achieve their life goals.

Some people become overwhelmed with accessing treatment, managing appointments, transportation, finances, etc. You can play an important role by helping to make treatment more accessible. The HelpLine and your NAMI Affiliate can help you identify resources and options.

It may also be important to have an honest discussion about how their treatment decisions affect your relationship with them. Set clear expectations and discuss the possible outcomes of both accepting or not accepting treatment. Some mental health professionals believe a related condition, anosognosia, or a person’s inability to recognize their own mental illness contributes to an unwillingness to take medication or participate in treatment. When a person has no insight into their condition, it can create a difficult situation where they may not believe that treatment is necessary.

Sometimes a person’s refusal will lead to a significant worsening of symptoms and lead to a crisis situation. If you believe your family member or friend might be at risk of suicide, in danger or a threat to others, please get help immediately.

NAMI State Organizations and NAMI Affiliates offer education courses and support groups where this issue is discussed. NAMI Family-to-Family, NAMI’s 12-week free education course, is particularly helpful for family members and caregivers.

Helping a loved one see the need for treatment and working with them to locate treatment services can sometimes be difficult. A book that many families and friends have found helpful is I Am Not Sick, I Don't Need Help by Xavier Amador, Ph.D. In the book, Dr. Amador teaches a communication strategy known as LEAP. This approach teaches a person how to help someone see the need for treatment, partner with them to identify options and support ongoing recovery. The LEAP Institute offers additional resources and advice on how to improve communication between you and your loved one.

In extreme cases, when a person has a long history of noncompliance, court-ordered treatment or assisted outpatient treatment (AOT) may be an option. Long-acting injectable anti-psychotics may also be an option for people who have difficulty remembering to take daily pills or who have a history of discontinuing medication.

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