• When we see someone we love in emotional pain, we are keen to help them as best we can – but what if they aren't ready for help?

  • Dr Susan J Noonan offers advice to anyone whose loved one is refusing help for depression

  • We have therapists and counsellors available to support people with depression and mood disorders here 

Some people have a hard time accepting treatment for depression. Your family member or friend may not believe that treatment will help him, may not recognise the need for treatment, or may just plain refuse to go. If you talk him into going, he may go— but unwillingly.

He might also reject offers of help from anyone. Here are some phrases you may be familiar with: “Get off my back.” “Nothing anyone can do will help.” “Nobody understands.” Knowing that someone needs treatment but encountering their strong resistance to it can put you in a difficult position.

Unfortunately, you’ll find no easy answers or concrete solutions for this one— no magic solutions, clinical trials, or official guidelines from academic societies (except in cases of crisis). There are only suggestions based on families’ experiences. Families struggle tremendously to convince their loved ones to seek treatment. It is one of the most difficult things people face.

Adults have a right to decide for themselves what treatment they receive and what happens to them and have the right to refuse treatment. If your family member does not perceive the need for treatment, the conversation becomes one sided.

Reasons for refusing treatment

Why would someone who desperately needs treatment refuse it? There are several reasons. Your family member or friend may believe that seeking help from a mental health professional means he’s a failure. It’s hard for someone who has always been able to deal with his own problems to accept help. It may make him feel vulnerable and inadequate. And because of the distorted, negative thinking common in depression, he may perceive any efforts to help as intrusive.

Your family member or friend who has depression may be concerned about the financial burden of receiving treatment. Or his main concern may be privacy issues: he could be afraid that if his friends, coworkers, or employer find out, he’ll lose his job, his reputation, or those close to him. He might fear being judged unfairly, criticised, or negatively labeled because of his illness and cut off socially. This is known as the stigma of mental illness.

Your family member may also believe that treatment is not effective— at least for him. He may fear becoming dependent on or addicted to medications, dread the side effects they can create, or believe that psychiatric drugs will change who he is. He might also believe the rumours that he will feel like a “zombie” or lose his creativity on medications. 

Perhaps your loved one is afraid of the strong emotions that treatment may bring up. This is a common fear in people with mood disorders. Maybe his concerns are based on mistaken beliefs about depression and its treatment.

What can you do?

What can you do when your family member or friend rejects your help or refuses to go for treatment? Begin by emphasising that you love him and are concerned about him. Try to calmly explain exactly what you see in him that is different from his usual self and provide specific examples. Approach the topic by saying, “You seem to be more down than usual in the past few weeks, and I notice you’re not sleeping well. I’m concerned about you. I think this may be a good time for you to speak with Dr. Jones. He can help.”

Tell him why you think it’s important that he seek help. Mention symptoms of depression or bipolar disorder that he has, that they are symptoms of an illness and point out that treatment may help relieve them. Make him aware that these symptoms and his problems will not improve on their own and that some savvy help may be necessary for him to feel better. Emphasise that you’re recommending he get treatment for his own health and wellbeing. It may be the only way he can realise his dreams of finishing school, getting back to work, enjoying himself with friends— whatever parts of life he’s missing out on. You might mention that having an evaluation doesn’t mean he has to decide on or agree to treatment; seeing treatment as an option rather than a foregone conclusion may make him feel more inclined to go. Try to be firm, steady, and persistent.

If misinformation about mood disorders and treatment is behind his reluctance to see a mental health professional, provide him with accurate information about his illness. Once you know his concerns, you or his PCP can address those worries with facts. Gaining information is a powerful tool to counteract resistance. Having knowledge about his illness makes things less scary and may help reverse your family member’s resistance to treatment.

Help your loved one understand the reasons he might be refusing treatment. He might just feel fatigued and overwhelmed by the idea of seeing a mental health professional. This is where you can help by calling to schedule appointments and arrange health insurance coverage, if required. Search out the names of a few mental health providers in your area and let him decide which ones he will interview. If he’s anxious about going the first few times, offer to go along and sit in the waiting room. You might suggest that he prepare for the appointment by organising his questions and issues on paper or on a smartphone ahead of time. Do whatever you can to discourage his excuses, remove any obstacles, and make it easier for him to go.

You cannot force an adult into treatment unless he is in crisis or, in the rare case, you need to take legal steps to ensure his safety. While it’s difficult to do, respect his right to refuse your help or treatment unless you believe he could harm himself or others. Then you must call for professional help or dial 999 immediately, regardless of his preferences.

Try not to take your loved one’s resistance to therapy or other help— and to your own efforts to help him— personally. You may feel resentful, angry, or frustrated, as these are natural responses to the situation. Take a deep breath, go for a walk, talk to a friend, or get professional help yourself. This can be in individual therapy or by going to a support group for family members. Coping in this situation means paying attention to your feelings, managing your stress, and getting the help you need, too. 

Susan J Noonan is the author of Helping Others with Depression: Words to Say, Things to Do

Further reading

How to keep healthy boundaries with a friend in need

My journey with chronic depression and therapy

5 things that help me cope with depression

Understanding and managing a depression relapse

My depression is harming my relationship – what can I do?