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  • Authored by Pat Potter

The Long Game

Updated: Nov 26, 2023

Behavioral health interventions can often be complex and challenging, particularly when dealing with patients resistant to treatment.


Understanding the Challenge

Patients who refuse treatment pose a significant challenge in the field of behavioral health. Their resistance might stem from various factors such as fear, denial, past trauma, or a lack of trust in healthcare providers. Overcoming this resistance requires more than just medical knowledge; it requires strategic thinking and patience. As a practitioner I fall back on my years of training and the variety of interventions I've conducted in various theaters. Utilizing almost militaristic principles, I've developed strategies that work.


The Role of a Tactician in Behavioral Health

When I reference a tactician in this context, it's simply someone with a specific means of accomplishing goals. A strategy is an overall plan for achieving something. Tactics are the steps taken to carry out the strategy. If someone is skilled at developing tactics, they are a tactician. So, in this context, I draw upon a diverse skill set of tactics to achieve the goal - convincing the resistant person to be admitted to a facility voluntarily. There are ethical methods and unethical methods. And so we are clear about what I believe is essential about ethics vs non-ethics.


It is important to emphasize that using unethical methods to coerce or manipulate someone into going to treatment for their mental health or substance use issues is not only morally wrong but also potentially illegal. Respecting an individual's autonomy and consent is paramount in healthcare and mental health treatment.

Unethical methods to force someone into treatment might include:

  1. Deception: Providing false information or misrepresenting the nature of the treatment or consequences of not attending to manipulate the person's decision.

  2. Coercion: Applying direct pressure, threats, or intimidation to make the person comply with treatment against their will.

  3. Manipulation: Playing on the person's emotions, vulnerabilities, or fears to manipulate them into seeking treatment.

  4. Withholding Information: Not providing the person with accurate information about their rights or alternatives to treatment.

  5. Invasion of Privacy: Violating the person's privacy by disclosing sensitive information about their condition to others without their consent.

  6. Forced Confinement: Physically restraining or confining the individual without their consent.

  7. Financial Exploitation: Taking advantage of the person's financial situation or resources to compel them to seek treatment.

  8. Emotional Blackmail: Using emotional tactics, such as guilt-tripping or threatening to sever a relationship if they don't comply with treatment.

Ethical methods for encouraging someone resistant to going to treatment for mental health or substance use issues involve respecting their autonomy and well-being while offering support and information. Here are some ethical approaches:

  1. Open and Non-Judgmental Communication: Engage in honest and empathetic conversations with the person. Listen actively to their concerns and feelings without judgment. Create a safe space for them to express themselves.

  2. Provide Information: Offer accurate and unbiased information about the benefits of treatment, available treatment options, and potential outcomes. Ensure they understand the nature of the treatment and what to expect.

  3. Respect Autonomy: Recognize that individuals have the right to make decisions about their own health. Encourage them to be active participants in their treatment decisions. Respect their choices, even if they choose not to seek treatment at that moment.

  4. Offer Support: Let the person know that you are there to support them, whether they decide to seek treatment or not. Offer emotional support and be available to help with practical matters if needed.

  5. Involve a Trusted Professional: Encourage the person to consult with a mental health or substance abuse professional who can assess their condition and provide expert guidance. A therapist or counselor can offer a neutral perspective and discuss treatment options.

  6. Respect Privacy: Maintain the person's confidentiality and privacy. Do not disclose their condition to others without their consent unless there is a risk of harm to themselves or others.

  7. Highlight Positive Outcomes: Share stories or testimonials from individuals who have benefited from treatment. Hearing about others' positive experiences can be encouraging.

  8. Address Stigma: Discuss and challenge any stigma or misconceptions the person may have about seeking treatment for mental health or substance use issues. Normalize the idea of seeking help for these conditions.

  9. Set Boundaries: If the person's resistance to treatment is causing harm or danger to themselves or others, establish boundaries to ensure safety. This may involve involving appropriate authorities or seeking emergency help.

  10. Long-Term Support: Even if the person chooses not to seek treatment immediately, continue to offer your support and encouragement over time. Let them know that you are there whenever they are ready.

Remember that, ultimately, the decision to seek treatment must come from the individual. Ethical approaches prioritize their autonomy and well-being while providing the necessary information and support to make informed choices about their mental health or substance use treatment.


How I develop the long game intervention.


1. Building Trust: Establishing a rapport with the patient is the first step. This requires patience, empathy, and consistent effort. You've got to delve deeply into their background and the family system. You must learn their triggers and capitalize on their passions and likes, such as food, music, or activities.


2. Understanding the Patient's Perspective: A tactician must seek to understand why the patient is refusing treatment. Is it fear, misunderstanding, or past experiences? Understanding their perspective is crucial for effective intervention. When I'm called in it's always after others have failed. In the rare cases where I'm the first interventionist, I must be even more diligent in fact-finding.


3. Tailoring the Approach: Each patient is unique, and so should be the approach. As a tactician, I will customize the treatment plan to suit the patient's needs and concerns. From clothing to food, I stay on as the case manager to ensure they receive seamless transition from detox or stabilization facilities. I will hand-hold them to continue to support them as they enter treatment and through the first month. In most cases, I stay on as the case manager to ensure they receive seamless treatment transitions.


4. Implementing a Step-by-Step Approach: Gradual engagement can often be more effective than direct approaches. This might involve small, non-threatening steps towards treatment. I've used a merid of techniques like visiting the patient daily, or encourage them to go on vacation for instance, the use of a honeypot can yield incredible results.


5. Collaborating with Others: As a tactician I often work in a team, coordinating with other healthcare providers, family members, or community resources. The use of assets like therapist, a brother or a sister, perhaps a child or even a best friend can be the magic needed to turn a tide in our favor.


6. Adaptability: Strategies may need to be adjusted as the intervention progresses. A good tactician is always ready to modify the plan based on the patient's response. I always try to keep the circumstance fluid. Once we head down a one way or dead end street that's all we got - keeping the circumstance fluid allows for improvisation, a change to the plan, or an entire new direction.


Case Studies

Real-world examples can illustrate how a tactician's role is pivotal. For instance, a patient with severe anxiety who refuses to leave their home might benefit from initial telehealth sessions, gradually building up to in-person visits. Another example could be using motivational interviewing techniques for a patient who is in denial about their substance abuse.


The Long Game

Behavioral health interventions often require a long-term commitment. A tactician is prepared for this journey, understanding that progress can be slow and non-linear. They remain committed, constantly seeking new ways to engage and support the patient.


In Conclusion

The role of a tactician in behavioral health interventions is crucial, especially when dealing with patients who refuse treatment. Their strategic approach, combined with patience and empathy, can make a significant difference in the lives of those who might otherwise remain untreated. In the complex world of behavioral health, sometimes the long game is the only game that can lead to real change.

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Incorporating a tactician's perspective in behavioral health interventions is not just beneficial; it's often necessary for the most challenging cases. Their strategic mindset and a deep understanding of human behavior can pave the way for breakthroughs in treatment where traditional methods fall short.

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