Ten Tips for Reaching Loved Ones
Who Won’t Accept Treatment


Abstracted from an article written by Dr. Ronald J. Diamond for RELAPSE, a magazine about persistent mental illness published at Yale. This information can be used by family members or doctors. Don’t assume your doctor knows all this; share a copy of the following with him or her.

When someone “resists” treatment, it may mean that the treatment is not “tailored” to the goals of the patient.Psychiatrists, therapists and family members need to begin by listening to the patient’s own aspirations and discuss how treatment and taking medication may help the patient to meet these goals. Even if a patient says “I want to be an astronaut” it is possible to begin a dialogue about the steps that it may take to work toward that goal.The purpose here is to form a collaboration with the patient so that they see others as helpful. A large body of evidence has established that forming such a collaborative alliance with the patient results in improved outcomes.

  1. Start with the patients’ own agendas. Take seriously what they say they want for their own lives.

  2. Put treatment in the context of the patient’s lives. Be concrete about what they will gain by taking the prescribed medicines.

  3. Be concerned about whether patients follow through with agreed-on treatment plans. Ask specific questions designed to open up dialogue rather than put patients on the defensive.

  4. Involve patients as much as possible in decisions about their treatment. Provide information about treatment options and resources that patients can use to solve problems and enhance their lives.

  5. Make sure patients, families, and involved agencies are kept informed about the treatment options and plans. Be sensitive to the agendas and prejudices of these people and try to work with them.

  6. Be willing to involve friends, families, landlords, clergy and others as confidentiality allows and as it fits into the patients’ own goals and agendas. People in support systems exert considerable influence in patients’ decisions.

  7. Be willing to be tenacious when necessary. Be flexible about how you engage patients. If they decline meds, focus on the “safe” topics first.

  8. If warranted, connect medication compliance with continued community involvement. If necessary, try linking medication use with activities the patient wants and needs, such as obtaining spending money or obtaining transportation.

  9. Accept the fact that some patients refuse treatment, or parts of treatment, despite all efforts. Offer what you can, be it bowling or lunch. Patients may be more willing to comply with treatment once a relationship is established.

  10. Plan for anticipated crisis. Use them to build trust. Following through on promises will strengthen the therapeutic alliance.

For more information, contact The Alliance for the Mentally Ill of Greater Chicago
1536 West Chicago Ave., Chicago IL, 60622
312-563-0445 - Fax: 312-563-0467