My brother is very similar to yours, although he has other habits that also make him seem like an overgrown five year old (which is what has kept me coming back despite how poorly he treats everyone).
I and my family know he’s never going to have accurate perceptions of what people are doing because of his disease. That being said, the only things we HAVE to do for him are make sure he is physically safe and taken care of. Because he’s unable to emotionally regulate or control what he does, overall, almost everyone in my family has gone limited contact only. He gets visits with supervision or in public places where available, but none of us after years of dealing with some of his worst bouts of paranoia and psychosis, feel safe enough to be left alone with him for long.
What makes it even more difficult is that he’ll regularly complain about hating people, and everyone else around him, and then complain about how lonely he is and why doesn’t anyone see him? ect. Self reflection is NOT possible for him, so we only put up with it so far as it doesn’t impact our own emotional health or any of the children in the family. By and large that means they understand what his illness is, and why we only visit him a few times a month. (Twice minimum but more often the other cousins at least try to get him involved with simple things like games or crafts.) The kids witnessed what he was like without meds and without proper care, so there’s no particular stress in that regard to having one of them being convinced that he’s not really ill.
Having read other peoples stories where their family members don’t acknowledge the Dx, especially after multiple rounds of testing, it’s one of the things we watch carefully. When it comes to health reforms, other religious or “Help” groups (ie cults) that may gain access to assisted living facilities as volunteers, we have very low tolerance for people assuming him moving back will help his situation. Thus far, FINALLY getting him into assisted housing has been the best thing we’ve ever done.
My parents went of a vacation, not just a daytrip, for the first time in 20+ years. I’ve had time to get work and attend college, my cousins have all had more freedom to move for their work opportunities, and my extended family is relieved to finally not have to worry about where or if my brother is wandering around their homes or the neighborhood at night.
On his end, he’s taking meds, if reluctantly. Last week although he still yells at me on the phone, the report from the nurses is that some of his chronic septic ulcers have healed. He’s finally consented to using stronger antibiotics that will help close the skin wounds and thus make him able to walk, move, or shower without pain. My cousin visited him and he was able to get a walk in on the community grounds and they did some painting. The place he lives encourages residents to do things like gardening and some of their own house chores with helper staff if they can, and so my brother’s little apartment room was clean. He has his blankets and gifts safely kept away, and has started making a few friends despite some of their odd behaviors, that are nicer than most of the drug dealers he called “friends” on the street.
This is pretty much the closest thing to a miracle that I have ever experienced in my life. His prickliness hasn’t really gone away and he still hates his meds, but he’s safer and more functional without having to trash or get kicked out of another apartment. As “Community Based Care Facilities and outreach” goes, it failed him until getting such an involved level of care. If it comes from us, we’ve learned, familiarity breeds his discontent, so the fewer people he recognizes or that he feels “control” him, the better. The facility knows this and thus, has him work with different staff and telehealth professionals familiar with his case, so that he won’t start decompensating again. There will never be a time, thanks to a ton of legal paperwork, that he will be without medication or some sort of monitoring. It’s rough but again, much better than having him live or wander where ever he pleases in whatever state he pleases, with no means of finding him again.