When a person with mental illness fails to attend appointments, take medication, or follow other instructions given by the professional it becomes necessary to deal with the lack of progress. Do not rescue the individual with mental illness from the consequences of inappropriate behavior, unless there is a serious threat of life. The caregiver should ask the individual with mental illness how they feel about the lack of progress. As necessary, review specific examples of the individual’s failure to follow the recovery plan established by the professional. If the individual is receptive and motivated, continue to strengthen them in following the professional treatment plan. If the individual refuses or is unable to engage in appropriate self-care, select an appropriate intervention.

There are six alternatives for caregivers to consider. They are: consult with the professional providing treatment; get a second opinion; consult with the clergy; conduct a family support group intervention; legally force the individual to receive mental health care; and accept the severity of the illness and exercise patience. Those helping should prayerfully select the appropriate combination of interventions.

Consult with the professional providing treatment. Consult with the individual’s mental health professional when further information and direction are needed. (As noted earlier the individual will need to sign a release of information form at the professional’s office before the caregiver can receive information from the professional.)

Get a second opinion from another professional. As with any medical condition consider obtaining a second opinion about the individual’s mental illness and the treatment plan. Assign the individual with mental illness and responsible family member to review the table Professional Resources (see page 9) to locate a professional to obtain a second opinion.

Consult with the clergy. When the caregiver is not clergy, the caregiver should provide feedback to the clergy about concerns. Discuss the various available interventions.

Conduct a family support group intervention. A family support group intervention brings together the individual with mental illness, the family, caregivers and others, to confront the individual. The purpose of the intervention is to give the individual with mental illness an ultimatum to engage in appropriate coping behavior. A caregiver can act as the facilitator. The following are guidelines to help conduct a family support group intervention.

Forcing mental health involvement. In the United States there are two ways to force an individual with mental illness to participate in mental health services. Both methods involve the court. First, if the person with mental illness is involved with the criminal court (regardless of the charge) the judge can order participation in mental health services as part of the sentencing phase. Professionals, family members or others can contact the judge and inform him/her of the mental illness concerns. The second way to mandate mental health involvement is a civil commitment procedure. The specific laws differ from state-to-state but generally a person must have a diagnosed mental illness and be a danger to self or others. If this is the case, then a hearing can be held and a judge can order an individual to participate in mental health services. Professionals, family members or others can initiate the civil commitment process by completing specific paperwork typically available at the local community mental health center and/or county court house. Forcing mental health involvement is usually pursued after all other interventions have failed and the situation is life threatening.

Accept severity and be patient. For some individuals the severity of their mental illness is serious enough to prevent any significant progress regardless of intervention. Case management by the local community mental health center is the intervention of choice for those with chronic mental illness. The caregiver and family members must be accepting and patient while recognizing the person with the illness may have already achieved the highest level of functioning.

Even though persons with mental illness have been involved with proper mental health and medical care, they are not always capable of change. Effects of mental illness can be severe and resistant even to professional interventions. The caregiver can remain involved by giving support and encouragement during brief contacts. Caregivers need to periodically evaluate the need to decrease their involvement.

Direct the individual with mental illness and the family to rely on mental health professionals and community support groups. After the caregiver’s involvement has decreased, continue periodic contact offering encouragement and support to follow-through with the professional treatment plan.