How do I get a delusional friend to seek professional help?

Question

I have a good friend who has recently lost the ability to take advice or criticism and has become extremely delusional as a result. It's clear that he has a mental disability of some description and although we (me and other close friends) have tried to accommodate him and give him the support he needs, he has started doing things that are detrimental to his social image and is convinced that anyone that says anything negative about him is "just a hater" or "doesn't know what they're talking about".

He does not have good family support, so trying to go to a family member of his will not work in this situation. He is not getting help from anybody else and if he is left to his own devices he will probably end up in jail or addicted to drugs.

To put into perspective some of his delusions, he is convinced he is a rap god and will become the new Eminem and at one stage he believed he had superpowers. When he said he had superpowers he literally disappeared for 6 months when we said we don't believe him, abandoned all his old friends (including me), and then went homeless for a short while. I kind of lost touch with him before that situation (as he didn't actually tell me he had superpowers, but other people in our friend group) and I only recently got back in contact with him after he moved home.

The guy has a heart of gold and would never hurt anyone, and he was pretty normal up until about 4 years ago. He used to be quite extroverted but in the last year he has been spending a lot of time alone, and is quite shy in most situations now. He was diagnosed with "ADHD" a few years ago, but there were a few inconsistencies in his story when he told me this. I think he may have been diagnosed with something else and told us that it was ADHD. But that's just a hunch and I don't have any way of backing it up.

How can I tell him he needs to get professional help, without making him think that I'm "one of the haters"?

Answer 1

I have a friend with schizoaffective disorder (definitively diagnosed); the delusions and superpowers sound very familiar. This is a very difficult problem. All you can do is be enough of a friend so that he may come to trust you as much as he can trust anyone, which is not much, and this may require more of you than you can manage, and even so come to nothing.

I think you are unlikely to be able to help until your friend is on meds, which will probably not happen until he is committed as a threat to himself or others (as @threetimes noted). When -- if -- he is on meds, your support and friendship may help him stay on his meds, or it may not.

It's good that you want to help, and you can try to be a reliable friend, but there is not much you can do unless your friend wants help.

I know this sounds defeatist, and it is not what you want to hear. I am not an expert in mental illness, but I do know that it is not unusual for people with these kinds of disorders to go off their meds: they don't think they are sick.

Answer 2

Something that I have tried in the past when dealing with a friend who I think needs help is to talk about how helpful I found therapy. I have never tried it on someone who is delusional like your friend, but I have used it with some success on friends who seemed depressed or anxious.

I usually frame the suggestion that they see someone by saying things like "Wow talking to someone about stuff really helped. Even mundane things, like frustration with x situation were made easier." After a while of establishing that it was helpful in ways beyond treating an actual illness, it is easier to say "Why don't you try it?" In this way it doesn't come out as "I think you are sick and need help." It's more like "you should try this great new optional thing that even non-sick people can do." Once you get past saying the actual suggestion you are free to try to convince them to go and you can even offer to help set up the appointment. All under the pretext that "it's just nice to have someone to vent to".

You may seem annoying, but it will seem harmless because you are not letting them know your true motives. If you are able to get them to go, that is when the professional will take over. They may go in, thinking they are just going to bitch about the haters to a neutral ear, but if their behavior is truly as obvious as you say it is, the therapist will notice and they will deal with addressing the actual problem.

The set up and convincing could take some time. You don't want to rush it or it will be too obvious.

If none of the concerned friends have seen a therapist before, you might still be able to say "so-and-so went and they really liked it, I'm thinking of trying it, you should too". The important part is to frame therapy as something normal that even you have done/want to do. Most people think you can only do it, if you have an actual illness, but you can do it just to organize your thoughts and feelings. Letting your friend know this will make it seem like a more approachable idea, without them having to admit that something is wrong with their behavior.

Answer 3

If you think this is due to a recent-onset mental condition, you could use the above comments to start your own research on his behavior, and then consult a professional yourself (saying 'I have a friend') on how you've observed him change. I suspect a practicing (not research) mental health professional could:

• provide specifics on identifying the condition,
• recommend how to communicate with your friend, possibly to get more information,
• suggestions on what kind of professional help would help them, and/or
• how to get them to seek/obtain that kind of professional help

This way you can move things forward, and if he becomes receptive later, you can provide this background so he doesn't have to start from square one.

Answer 4

So much kind-hearted responses here.

You cannot offer help to someone who does not want it.

In some states, one can get an involuntary, 72-hour "psych hold" in a hospital for someone posing a danger to themselves or others. The slang for this where I live is a "5150". The patient is admitted and evaluated for medications or an additional stay. Obviously the potential for abuse is high, and should only be used in emergencies.

The sudden onset is concerning. In my experience and readings, a mental health professional will screen for changes in sleep patterns and unreported drug use- even too much caffeine can disrupt a person. A physical exam could look at everything from a tumor pressing against the brain or spine, to abcessed teeth and crumbling metal fillings from night-grinding.

Just to illustrate that the fixes are far outside what a concerned friend can preform, and the next, best step is a medical evaluation. You may have saved a life.

Answer 5

This sounds like your friend has serious problems. And while I'm sorry to say it seems like only professionals can help your friend.

While talking your friend into seeking professional help would be best this has been discussed in other answers. What I'm describing here is the worst case scenario - when the only way to get your friend help is actually forcing them. Keep in mind that this answer is from a European perspective (Poland specifically) where there are public health services.

Your last resort is actually calling an ambulance. Set up a meeting. If your friend has visible delusions during the meeting discreetly call 112 (or 911) and tell them about it. Keep your friend in check and in place until the ambulance gets there. This way once your friend gets to the hospital he should get a psychiatric consultation or might even be taken to a psychiatric hospital. Be warned: this might harm your relationship. But if other solutions don't work this will at least get your friend some help.

Also, to reiterate: this is based on my understanding of the public health system in Poland and the assumption it works similarly in most of Europe.