When Someone You Love Refuses Psychiatric Help: What You Can Do

When an adult you love refuses psychiatric help, you usually cannot force treatment, but you can still change the odds. The approaches with the best support teach family members to listen more than they argue, reward steps toward help, step back from consequences that protect the problem, and keep a clear plan for the moment safety is at risk.

New York law allows involuntary evaluation only when someone's mental illness makes serious harm likely. Below that line, your influence comes from the relationship. This guide covers both: how to keep influence over months, and what to do if things become dangerous.

If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

First, sort out what kind of refusal this is

"Refuses help" covers very different situations, and the right approach depends on which one you are in.

If your relative has never seen anyone and is generally willing to talk, start with how to help an adult family member start psychiatric care. This article picks up where that one leaves off: when the answer keeps being no.

CRAFT: the best-studied method for substance use

Community Reinforcement and Family Training (CRAFT) teaches the concerned family member, not the person who is using, a set of behavior change skills to use at home. In a randomized trial of 130 family members of people with alcohol problems who were not seeking treatment, CRAFT led to treatment engagement for 64% of the drinkers, compared with 13% for Al-Anon facilitation and 30% for a confrontational family "intervention" meeting. In the same trial, most family members prepared for the confrontation (70%) decided not to go through with it.

A later review of four randomized trials found that CRAFT produced about three times as much treatment engagement as Al-Anon or Nar-Anon approaches and about twice as much as the confrontational model, with roughly two-thirds of people entering treatment, typically after four to six sessions with the family member. Family members improved in their own well-being whichever approach they received.

What CRAFT asks you to do

• Notice patterns: when, where and with whom use happens, and what it does for the person.
• Reward sober or healthier time with things they value, such as your company, a shared meal or an outing.
• Stop cushioning the consequences of use, such as calling in sick for them or cleaning up, while staying warm.
• Communicate positively: short, specific, "I" statements, offered when they are not intoxicated.
• Pick your moment to suggest treatment, often right after a consequence they regret or when they mention wanting to change, and have a specific option ready to go that week.
• Keep yourself and others safe, and step away if violence is a risk.

CRAFT is usually learned with a trained therapist. The trials were in substance use, not psychosis or depression, so do not assume the same numbers apply elsewhere; the principles of positive communication and well-timed offers still translate. For options once someone is ready, see medications for alcohol use disorder and when you need an addiction specialist.

When the illness hides itself: psychosis, mania and insight

In some conditions, especially schizophrenia and bipolar disorder during an episode, people may be genuinely unable to recognize that they are ill. Clinicians call this lack of insight, or anosognosia. Arguing about whether they are sick rarely works, because to them it does not make sense.

A widely taught communication approach for this situation is LEAP (Listen, Empathize, Agree, Partner), developed by psychologist Xavier Amador to help families, clinicians and first responders build trust with people who do not believe they are ill. Its evidence base is thinner than CRAFT's, so treat it as a sensible framework rather than a proven treatment. In practice it looks like this:

• Listen: ask about their experience and goals, and reflect back what you hear without correcting.
• Empathize: acknowledge feelings, including frustration at being pushed toward treatment.
• Agree: find what you can genuinely agree on, such as "you have not been sleeping" or "you want people to stop bothering you."
• Partner: work toward a shared goal, for example "let's see someone about the sleep," rather than "you need antipsychotics."

If this is a first episode of hallucinations or delusions, act quickly: what to do after a first episode of psychosis explains early specialty programs in New York.

Be ready for the moment they say yes

Openings tend to be brief: after a bad night, a scare at work or a conversation that went well. If the next step takes weeks to arrange, the moment often passes. A little preparation now shortens that gap.

• Keep a shortlist of two or three clinicians or programs, with how to reach each one, whether they offer telehealth and how they handle insurance.
• Keep a dated log of what you observe: sleep, eating, spending, substance use, statements about hopelessness or harm. Specific observations help any clinician who later evaluates your relative.
• Write down a list of current and past medications, diagnoses and hospitalizations you know about; preparing a psychiatric history shows what is useful.
• Agree in advance with other relatives on one consistent message, so the person is not hearing five different demands.
• Offer the smallest possible first step: one appointment, a sleep or primary care visit, or a telehealth call from home.

If your relative agrees, move quickly but let them keep control of the details they care about, such as who they see and whether you come along. Feeling in charge of the decision makes it more likely they will go back for a second visit.

Things that usually backfire

• Ultimatums you will not carry out. They teach the person that limits are negotiable.
• Diagnosing out loud ("you're bipolar"). Describe behavior instead.
• Arguing with delusions or with a hangover. Neither leads anywhere.
• Bringing a group to confront the person without warning. In the trial above, this approach engaged fewer people than CRAFT.
• Secretly adding medication to food or drinks. It is unsafe and destroys trust.
• Promising to keep thoughts of suicide a secret. NYC's crisis guidance advises against it.

What New York law allows if danger rises

New York's Mental Hygiene Law sets a high bar for involuntary steps, and families often misunderstand where it sits. Being unwell, refusing medication or making poor choices is not enough on its own.

For emergency admission, a second hospital psychiatrist must confirm the finding for the person to be held beyond 48 hours. Parts of sections 9.41 and 9.45 are scheduled to change on July 1, 2027, including who may report to the director, so check the current text before relying on a specific detail.

In New York City, the practical route for a family is usually 988, which can send a mobile crisis team to assess the person at home. Those teams may direct police or EMS to take someone to an emergency room against their will only if the person has, or appears to have, a mental illness and is a danger to themself or others. If someone is in immediate danger, call 911.

Kendra's Law: assisted outpatient treatment

Assisted outpatient treatment (AOT) is court-ordered community treatment, created by Kendra's Law in 1999, for adults whose history shows they struggle to stay safe without close monitoring. A court can order it only if every criterion is met, including that the person:

• is 18 or older and has a mental illness;
• is unlikely to survive safely in the community without supervision, based on a clinical determination;
• has a history of not following treatment that led to at least two hospitalizations in the past 36 months, or to serious violent acts, threats or attempts of serious harm to self or others in the past 48 months, or to a previous AOT order that expired within the last six months;
• is unlikely to take part in outpatient treatment voluntarily because of the illness, needs treatment to prevent a relapse likely to cause serious harm, and is likely to benefit.

The state advises families who think someone may need AOT to contact the county, or New York City, mental health director, who manages the local program and can help decide whether the person meets the criteria. An order must include care management or an Assertive Community Treatment team and may include medication, therapy and other services. AOT is a tool for a specific, repeated pattern, not a way to start treatment for someone who has simply declined it. The current AOT section carries a scheduled repeal date of June 30, 2027, so check whether it has been extended.

Safety while you wait

If your relative has had thoughts of suicide, the most effective thing a family can do at home is make the environment safer. NYC's guidance is direct: remove means such as guns or stockpiled pills, do not promise secrecy, and help the person make a safety plan with trusted people or professionals. 988 suggests five steps for anyone worried about someone: ask, be there, help keep them safe, help them connect, and follow up. You can contact 988 at any time for help if someone you care about is struggling. How a safety plan works covers this in detail, and where to go in a psychiatric emergency in NYC lays out each crisis option.

When your relative is well, it can be worth talking about what they would want next time. A psychiatric advance directive or health care proxy lets them record their wishes in advance; see psychiatric advance directives in New York.

Looking after yourself

Long stretches of refusal are exhausting, and family members' own health matters to the outcome. In the CRAFT research, family members' functioning improved whatever approach they were taught, which suggests that getting support is worthwhile even before your relative changes.

• NAMI New York City runs a helpline at 212-684-3264, weekdays 10 am to 5 pm, and offers free peer-led classes for individuals and families.
• SAMHSA's National Helpline, 1-800-662-4357, is free, confidential and open 24/7, and gives referrals to treatment, support groups and community organizations for individuals and family members; it does not provide counseling itself.
• Your own therapist can help you hold limits, grieve what is happening and learn CRAFT-style skills. You do not need your relative's permission to get help for yourself.

Where an outpatient practice can help

An outpatient practice cannot bring in someone who refuses care, and it is not a crisis service. What it can do is be ready when your relative says yes. Dr. Lewis's practice offers psychiatric evaluation, medication management and psychotherapy including CBT and DBT, with psychiatrists, psychiatric nurse practitioners and psychotherapists on one team. Care starts with a free discovery call by phone or text to ask about care options, scheduling and insurance. All of the practice's clinicians are out of network, so if you need in-network care, ask the team on the discovery call about options. More decision guides are collected in the guide to choosing psychiatric care.

Frequently asked questions

Can I make my adult child see a psychiatrist?

Not unless the narrow legal standards for an emergency evaluation or a court order are met. Below that line, your influence comes from the relationship: listening, offering specific choices and timing your suggestions well.

Is a family intervention like the ones on TV a good idea?

In a randomized trial with families of people with alcohol problems, a confrontational family meeting engaged fewer people in treatment than CRAFT, and most families prepared for the meeting chose not to hold it. CRAFT-style skills are usually a better first approach.

My relative has stopped their medication and is getting worse. What should I do?

Contact their prescriber, who can at least hear your concerns. If you see signs of danger, such as threats of suicide, violence or not eating or drinking, call 988 or 911. Medication decisions should be made with the prescriber.

Will the psychiatrist tell me what is going on with my relative?

An adult controls their own health information. Clinicians can generally listen to what you share, but they may not be able to tell you much without your relative's permission, except in specific situations such as serious and imminent danger.

Can I request a mobile crisis team if my relative does not want one?

Yes. In NYC you can call 988 to request a team for someone you are worried about. Teams look for a voluntary solution first; they can involve police or EMS against the person's will only if there is danger.

How long does it take to get an assisted outpatient treatment order?

It involves a psychiatric examination, a written treatment plan and a court hearing, so it is not an emergency tool. Contact the county or New York City mental health director to ask whether the person might qualify.

Should I call the police?

Call 911 if someone is in immediate danger. For a crisis without immediate danger, 988 and a mobile crisis team are usually a better fit.

Sources

1. Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology (PubMed 10535235), 1999. pubmed.ncbi.nlm.nih.gov
2. Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment. Addiction (PubMed 20626372), 2010. pubmed.ncbi.nlm.nih.gov
3. Help Someone Else. 988 Suicide & Crisis Lifeline, 2026. 988lifeline.org
4. Mobile Crisis Teams. NYC 988 (City of New York), 2026. nyc988.cityofnewyork.us
5. New York Mental Hygiene Law Section 9.39. New York State Senate, 2025. nysenate.gov
6. New York Mental Hygiene Law Section 9.41. New York State Senate, 2025. nysenate.gov
7. New York Mental Hygiene Law Section 9.45. New York State Senate, 2025. nysenate.gov
8. New York Mental Hygiene Law Section 9.60: Assisted outpatient treatment. New York State Senate, 2025. nysenate.gov
9. Relationships: Where Treatment and Recovery Begins (interview with Xavier Amador). NAMI, 2013. nami.org
10. Assisted Outpatient Treatment: Court Ordered (Kendra's Law brochure). NY State Office of Mental Health, 2021. my.omh.ny.gov
11. Helping Friends or Family in Crisis. NYC 988 (City of New York), 2026. nyc988.cityofnewyork.us
12. NAMI New York City (home page). National Alliance on Mental Illness of New York City, 2026. naminycmetro.org
13. SAMHSA's National Helpline. Substance Abuse and Mental Health Services Administration, 2026. samhsa.gov

Educational information, not medical, tax or legal advice. Decisions about diagnosis, medication and treatment belong with a clinician who knows your history.