A Mental Health Tragedy Unfolds and the System Doesn’t Have an Answer


Most of my clinical time as a psychiatrist is spent helping individuals and families who desperately want my help. There are myriad treatment options to improve the lives of people suffering with mental health symptoms, and they work.

But not everyone with symptoms is willing to receive help. A small percentage of clinic time is spent with a loved one seeking guidance on how to intervene when someone in their family is clearly sick, but refuses help. We talk about how to convince someone they need help, or even how to pressure them in the direction of help when necessary. And yet I know that patients themselves need to be on the team for treatment to succeed. Mental health treatment only works when the patient wants help and participates.

Mental health treatment only works when the patient wants help and participates.

This is on my mind after reading a news story about a person with mental illness who refused help, deteriorated, and eventually (predictably in this case) took his life. The man’s family had been pushing him to get help, which he did not want and rejected.

When we watch news stories about tragic mental outcomes that end in violence or suicide, it is often suggested that more awareness or more dollars will be the solution. But what happens when the sick person truly doesn’t want help, even when he needs it?

Our laws respect each person’s right to choose or refuse treatments, as they should most of the time- until the balance tips (and sometimes it does). Sometimes people really need help and don’t realize it. And while most people who choose sickness over side effects aren’t doing any harm, we don’t have much recourse for the few who trigger serious concerns.

Here in Texas, we can send a person for a few days to a mental health hospital if someone’s safety clearly depends on it, but doing so requires overt threats of harm to self or others, or such severe psychosis that a person cannot remain safe. Hospitalizations are short, and there is rarely time to implement any real solutions. Lasting care is still only available to those who agree to receive it, or those in forced care because they have broken the law.

When I encounter a situation where there exists a chronic safety concern (anything that won’t resolve in a few days), there is rarely a pathway to truly solve the problem without voluntary participation on the part of the sick person.

I tell families that people have a right to live with their symptoms and refuse treatment, if they aren’t hurting anyone. When the signs are apparent that something bad is bound to happen, but things unfold gradually, then the system doesn’t have an answer. The gap here affects only a small number of people, but it’s a big gap when safety is at stake.

Posted on May 14, 2018 .