Friend refusing treatment

My friend (coworker) has recently been having psychosis episodes. She has schizophrenia in her immediate family. She has not been professionally diagnosed, mostly because she refuses treatment and when and episode occurs, she pulls the wool over the doctors eyes and gets released after the 72 hour hold. She is mostly estranged from her family. Her support system is myself, another coworker, and her boyfriend. We have all been trying our best to get her to commit to treatment. The best she’s been in the last two weeks was the first time she was discharged after being on antipsychotics for 5 days. She quickly relapsed as she refuses to take medication. I have been trying my best to communicate using the LEAP approach, but she is a closed book and has difficulty explaining her thoughts and feelings due to disorganized speech and an upbringing that was anti-medication/mental wellness. Today, she left the care center she was admitted to two days ago. She left all her belongings, did not check herself out … simply left the facility without a coat in the middle of winter; trying to walk back home.

She’s supposed to be evaluated again (third time) by a psychiatrist tomorrow … what can I do to encourage her to get treatment?


That is such a hard situation but not uncommon unfortunately. It is really good of you to be willing to help.
Can you take her to the psychiatry appointment yourself? Maybe give the doc a note with specific concerns (you can tell her the note contains your contact info)?
Maybe ask the doc to help get her hospitalized? The sad truth is that you can’t force her to take medication even though she isn’t able to soundly make that decision.
If someone is in a car accident or has dementia, medical staff waive this issue, but in the case of mental illness all reason is lost. Ironic I know.

I advise you to make noise with the hospital she left and/or with emergency staff. Try your best to get help for her. With medication she has a chance of some relief, but without medication I fear that she won’t be able to recover if indeed she does have schizophrenia or one of its cousins.
She may take medication for no reason except to please another or to escape something unpleasant. This could save her.
You can try: “take the medicine and you won’t need to be hospitalized” ( in which case someone has to watch her take it or perhaps have her take an injectable) or “if you accept medication and voluntary hospitalization you can avoid involuntary hospitalization.”
None of these are scenarios that anyone likes but they may be the best you can do to help her.
Perhaps others in this community have more advice (?)


I understand, this is so hard, but don’t give up, You need to know the law for involuntary commitment in your state. Look at Treatment Advocacy Center and then find their “Grade the States”. You are a wonderful friend to have learned this much snd know about LEAP. Keep practicing it and watch for windows of opportunity to use it.


Most likely it will be a long road to get your friend help, I’m sorry to say. And especially as the HIPPA laws are set up to make it hard for you to have any input without her signing papers allowing your input.

I had success eventually after 3 years, more than 40 police involvements, and 4 prior hospitalizations This was despite my own daughter not allowing me to communicate with her doctors. I solved the situation by faxing information to the facilities she could have been admitted to: just giving her history, which drugs were effective and which were not, etc. The very last time she was involuntarily admitted, because of my fax, I was contacted by the hospital, appointed her legal proxy and was allowed to allow the doctors to involuntarily give her a 30 day shot. That shot was the beginning of the end of her psychosis.


You are in an extremely difficult yet critical situation. As others have mentioned thank you so much for being such a great support. Never give up hope and try to have the line of communication open as much as possible. If you can text, ask for a picture and follow all the suggestion to be able to locate and help by reporting to the right resources.

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Does she say why she doesn’t want to take medications? The LEAP approach emphasizes listening, so it has to start there. Does she dislike the side effects or says they make her feel worse? Doesn’t think she needs them? Thinks they’re harmful?


It’s good to know you are educating yourself about anosognosia. This is so hard and difficult for everyone involved. Please keep us posted


This is so common. Bless your heart for your willingness to help her; anosognosia is the trait that doesn’t allow them to see themselves having any behavioral challenges, they can see it in others but since they’re not aware of their own delusions and other ‘strange’ behaviors they don’t think they need help; unless she’s a threat to others or herself she can’t be forced to stay at the hospital. Unfortunately some people learn their lesson fast others don’t.

Hope you can convince her by persuasion.

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Yes, as everyone here has said “most likely it will be a long road”. Unfortunately, reason and logic won’t work in this instance.
Know that as much as it pains you to witness what your friend/colleague is going through, they themself do not realize it and are annoyed that people are intervening in their life.
It’s important to know the law within your geographic area.
My mother was admitted into the in-patient mental health unit Nov 14 and discharged Dec 22nd. She received her first injection of Aripiprazole [Abilify] Dec 8th. Since it was her first, she needed to concurrently take the oral medication for two weeks.
She’s living independently in her own apartment now under a Community Treatment Order [CTO] which is up for renewal every six months. She needed to be hospitalized for 30+ days in order to qualify, or have two hospitalizations within 2 years.
The CTO specifies a monthly injection [administered by mobile nurse as she won’t go to hospital or doctor]. If she refuses, then the following Psychiatrist can request police bring her in for an evaluation.
We shall see how it goes. Sadly, she is unable to comprehend that her life was so much better the 10+ years she voluntarily took a daily dose of Olanzapine and says she is done with medication – doesn’t need it, and everyone else has a problem but she’s fine.
So far, she is maintaining the delusions and hallucinations, but is present, alert and engages with her friends and family – thanks to the Aripiprazole.
She went off medication in April and there was a steady decline leading to the crisis in November.
With the CTO in place, I’m hoping to get help for her faster than waiting for her to be a danger to herself or others [crisis situation].
Certainly your friend being out in winter without a coat is a danger to her own well being. Keep note of this and other instances as testimony to hospital psychiatrist.
Good luck and prioritize your own care, as it can be draining to be so concerned for someone who is sadly oblivious to their plight. Best wishes for 2023.