I have a 21-year old sister who was diagnosed with manic depression a little over a year ago. She responded well to medication, but now says she is fine and refuses to take anything. She believes her depression was caused by severe negative events that happened in her life. Some of the time she just sits and watches television or stays in her room, but sometimes she “blows up” and threatens our mother. What can we do when she refuses treatment?

People either decide to “voluntarily” participate in their own mental health treatment or if they display an imminent risk to themselves or others, may need to be “involuntarily” hospitalized. This process is called civil involuntary detention. If your sister becomes an immediate threat to your mother’s safety, it would be best to call 911 for emergency police assistance. Law enforcement personnel, under the police power authority, may apprehend a person they believe to be harmful to themselves or others and transport them to the nearest Emergency Room. If the situation is not an immediate emergency, the civil involuntary process may make the most sense for your family. Any person can file an application for detention, evaluation and treatment. This is filed with the probate division of the circuit court in the county where the person is currently located. Missouri state regulations Chapter 232RSMO provides the statutory authority to provide involuntary treatment under certain conditions. Staff of the Access Crisis Intervention (ACI) System, the 24-hour crisis hotline, can assist you with the civil involuntary detention process. By calling the toll-free 24-hour ACI crisis number in your area, you can speak to a mental health counselor to fully assess the current situation and determine if your sister might meet the necessary criteria for involuntary commitment. The judge can issue a court order for your sister to be taken by the police authority to the hospital designated for an initial 96-hour period.

Renee Ludwigs, M.Ed., LPC
Clinical Manager
Behavioral Health Response
Crisis Hotline:  1-800-811-4760

Many family members of persons diagnosed with mental illness report similar experiences with loved ones. There is simply no easy answer to your question. It involves understanding the nature of mental illness; understanding that the illness itself can cause the person to have a “lack of insight” into their illness; knowledge about where to go to for treatment; and understanding of how to communicate with someone who has a mental illness. Distance the person from their illness and utilize “I” statements. Instead of saying, “You are ill; you need to see Dr. Jones,”  try saying, “I understand that you are fine right now;  however, I would feel better if you would go to see Dr. Jones.”  Additionally, some family members have offered rewards to their loved one for getting treatment--such as cigarettes, help with monthly rent, etc.  As a last resort, some families have filed in probate court for involuntary commitment procedures to force their loved one into treatment. The best answer for family members who find themselves in this situation is education. One helpful book to read is entitled, “I Am Not Sick; I Do Not Need Help.”  For information about this book and NAMI St. Louis (National Alliance for the Mentally Ill) programs and support groups that can help, call 314-966-4670.  

Jacqueline A. Lukitsch
Executive Director, NAMI St. Louis

Want to see other Open Mind columns?  Click here for Archive Index.