She doesn't want help, but I want to help her.
December 24, 2012 9:26 PM   Subscribe

How to convince someone who may be schizophrenic to seek help?

I am home for the holidays. I have a cousin who I used to be very close to but have not seen much for a few years, as I now live far from most of my family because of my job. She's in her mid twenties and was acting very strangely. She was never like this in the past, but she was brimming with conspiracy theories; a lot of it typical right wing stuff (Obama is a muslim who was born in Kenya), but some of it regarding people in our family (that one of our family members did not actually die of cancer but was killed by another family member, for one).

She was just acting a lot more paranoid than usual, so I told the cousin's mother, my aunt, that I was worried about her. This cousin still lives at home so my aunt has probably seen her the most out of anyone over these last few years. My aunt broke down, saying that's it's actually much worse than it seems; my cousin hears voices and believes that she can control spirits to harm other people. My aunt has tried to get my cousin to seek treatment, but hasn't been successful. My cousin has an enormous disdain for medicine and doctors, which doesn't help anything.

In the past my aunt hoped that my cousin's behavior was due to illegal drugs, but my aunt is now almost certain that my cousin is not doing any drugs and the odd behavior is still very bad.

My cousin is definitely smart enough to hide most of the things people would think are crazy. I want to help my aunt and my cousin, but I don't know how. How can you help someone who doesn't want help? My cousin is also pregnant and I worry about the welfare of the coming child. My cousin also owns several guns. I know that most mentally ill people are not violent, but the possible untreated mental illness and guns combo definitely worries me.

My aunt is afraid to push too hard because my cousin is distancing herself from almost everyone, and my aunt is the only person she still trusts and confides in (the child's father is not in the picture). She asked me for advice but I was completely at a loss.
posted by anonymous to Human Relations (9 answers total) 1 user marked this as a favorite
If it weren't for the coming kid and the guns, I would shy away from involuntary commitment, but as it is... it seems like a reasonable option if she is really that resistant to treatment. It's a nuclear option that can really wreck your cousin's trust in her mother, but if she won't even talk to a GP or therapist, I'm not sure what else is possible. I mean, what's worse: having her taken away by doctors or by police? (The latter would be after she harms someone.)

It does depend on what state they are in, I believe. Lengths of psych holds vary by location.
posted by supercres at 9:56 PM on December 24, 2012 [1 favorite]

Go to Google and do a search for "crisis hotline," "mental health crisis hotline," and similar variations, along with your location. Then, call this number. Explain to the person what is going on, and they will (hopefully) help you figure out what your options are. (Your search will also bring up suicide hotlines -- which clearly isn't what you need. At least where I live, however, there is a separate line for psychological emergencies separate from the suicide hotlines.)

I have called crisis hotlines before. In fact, I did it just this afternoon, in order to get help with handling a loved one's current psychological crisis. They helped. It was anonymous. And they reassured me I can call back at any time.

I'm sorry I don't have actual help to give you. This is very difficult, and my heart goes out to you, your aunt, and your cousin.
posted by meese at 10:08 PM on December 24, 2012 [3 favorites]

I recently called a suicide hotline because I didn't know how to help my friend. The therapist had excellent advice and gave me a script and options based on how my friend responded. It really helped me to help my friend and also helped me check in to see how I was feeling handling all of the heavy stuff. Please take advantage of the help that's out there.
posted by kamikazegopher at 10:12 PM on December 24, 2012 [4 favorites]

If you can tell us what state she's in, that would be helpful.

This is one of the hardest situations to handle -- when the person doesn't realize they are sick. 52% of people with schizophrenia don't have insight. They literally don't think they have a problem -- everybody else has the problem. And it's VERY hard to get someone into the hospital unless they express homicidal or suicidal ideas. Our mental health system is in shambles, and unfortunately, it's extremely difficult to get someone help.

The fact that she's pregnant may be helpful in showing the authorities that she is "a danger to others" if she's not taking care of herself, but I think that would still be difficult.

On Wednesday, I'd suggest that your aunt call the local NAMI affiliate, explain the situation, and ask for help and resources. Everyone at NAMI either has a mental health diagnosis or is the family member of someone who does, so they know what it's like. (I worked at NAMI for five years and we used to get these kind of calls all the time.)

I'd also suggest that she call a local mental health crisis line and see if they have any suggestions.

In the meantime, it's important to keep her trust by not trying to argue or talk her out of her false beliefs. You can respond to the feelings rather than what she's saying. So when she says that a family member killed another family member, instead of trying to convince her it's not true, you could say something along the lines of "it must be scary to think that." If you argue she will just think that you don't get it, and not believe other things you say.

I'm sorry you and your aunt are going through this. Having a family member with this illness, I know how hard it is to see them going through this and not be able to get help.
posted by la petite marie at 10:19 PM on December 24, 2012 [4 favorites]

This is a good book: "I Am Not Sick I Don't Need Help: How to Help Someone with Mental Illness Accept Treatment".
posted by cheesecake at 11:08 PM on December 24, 2012 [3 favorites]

My cousin also owns several guns.

You're really burying the lede here. If, as appears to be the case here, she's suffering from serious untreated mental illness, she should under no circumstances have access to firearms.

(IANAD, IANAT, etc.)

Hopefully your aunt has an idea of how many and what types of guns, and if it is at all possible, inasmuch as whatever course of action you take will exacerbate her already irrational condition, I'd strongly suggest that, once you resolve on a course of action, you take away the guns shortly before (and as soon as possible). And if you speak to a professional about her, you should absolutely include the datum that she currently has access to guns, because that changes the risk factors both for her and everyone around her considerably.
posted by jackbishop at 6:14 AM on December 25, 2012 [5 favorites]

If your aunt knows where the guns are, she should remove them when your cousin is out. I wouldn't let guns be in my house with a family member who has serious untreated mental illness. Your cousin might react badly to their being removed and your aunt may need to be prepared for that. Maybe she can say that she's afraid of guns or doesn't want them in her house or that she thought they weren't properly registered.

Regardless, she should place the guns with someone else (without kids) or put them in safe-deposit box, anything to get them out of her house.
posted by shoesietart at 7:42 AM on December 25, 2012 [2 favorites]

Consider an intervention. It's pretty easy to dismiss one person's opinion, but when you find yourself surrounded by people who love you, who are concerned for your health, and all who can articulate the same concerns, it's a lot harder to just ignore what is being said. There are books on how to do interventions, mostly intended for people who have loved ones suffering addiction, but those books should also offer suggestions that you can apply to your circumstance.

All the best to you and your cousin. One of the harder things about mental illness is that it doesn't seem like illness to the people who have it, and so they can go pretty far down the rabbit hole without ever thinking they need help. One of the things that schizophrenics often need to be taught is how to recognize their symptoms, which tells you just how hard it is for the brain to accept that what its experience isn't reality. But there are plenty of people with schizophrenia who know they have something that needs to be addressed, address it, and successfully live with the illness, and it generally helps to have a supportive family.
posted by Bunny Ultramod at 10:24 AM on December 25, 2012

An intervention? Oh my god, no. Your cousin needs to know that people are looking out for her, but it is all too easy for her at this point to mistake concern for "I am trying to control you, just like everyone else is." An intervention would probably lead her to believe that EVERYBODY she currently trusts is out to get her at once.

My husband has a good friend who has unmedicated schizophrenia; the friend has very few family members who are in direct contact with him because he trusts them so little (following at least one hospitalization). His mom checks up on him through friends like my husband. My husband can look out for him because the friend trusts him and tells him where he lives, where he's working, if he has money, all that.

To some degree, then, your cousin's family and friends may have to choose someone to be the "bad cop" in this situation. The rest of you can and absolutely should support that person (the bad cop) in private. But in order to continue a relationship with your cousin -- including watching out for her and providing support -- you may have to play along a bit with her delusions, or ignore them, so that she can continue to trust you.

I don't mean this in an enabling sense. But you are the people who can make or break her health here. It's just that there are no easy answers. I'm sorry.

The NAMI suggestion is spot-on.
posted by Madamina at 11:35 AM on December 25, 2012

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