Raymond DePaulo, M.D., Helping a Family Member Receive Treatment

Raymond DePaulo, M.D., is Psychiatrist in Chief at Johns Hopkins University School of Medicine.

Is it common for a family member to recognize there is a problem and get someone help?

Yes, it is often a family member who encourages their loved one to seek professional help.

What can a family member do to try to get someone treatment?

There are many things one can do. No one, not even an expert, succeeds every time with every person. My main advice is to offer to help (go with them to an appointment, etc.). Also, be prepared for an initial NO but listen to the person, encourage them to elaborate and put their ideas to work. This will help you build a positive script for the next time you try to persuade them to get help.

What are the best approaches?

The best approach is to tailor the intervention to the person you are trying to help. Be willing to accept alternatives when the situation allows it.

What approaches don't work?

Threats often backfire, especially if the patient is very ill or very suspicious, or both. However, a reasonable response would be "I can't do X (X="send you away to college" or "give you back the credit card") if you won't come with us and get an evaluation". The approach has to be logical, near at hand and delivered in a supportive way.

When someone refuses to get help, what do you recommend family members do?

1. After an initial "no" (from an adult) you want to ask them to tell you what they would agree with (e.g. "If I lost my job" or "if Mary left me"), then go away and rethink how to persuade them next time.
2. Do not hesitate to tell the person exactly what you fear and how this would affect you emotionally. Many loved ones become frustrated in these encounters and find it hard to express how sad or fearful they may be. They can appear more angry than sad, which is not usually helpful.
3. When the situation is life threatening and time is short, go to a doctor's office or an emergency room. Be prepared to advocate for immediate care. Ask for or insist on an explanation if the doctors don't see the same risk and want to send you home.

When do group interventions work?

When there are many loved ones who agree and who together express both their affection for and concern about the ill person.

Are they similar to alcohol interventions?

Yes. Except the tough love part is not useful if the patient is too severely ill (e.g. psychotic).

Where can families get help with an intervention?

Your pastor, rabbi, therapist or doctor. Friends, relatives, and colleagues trusted by the person in need of help.

What is your advice to families?

Talk to each other. Be patient when you can be. Persist but try not to be overbearing. In an emergency, act at once and ask for moral support later.