Your husband’s symptoms are concerning. I can’t diagnose him over the Internet but his symptoms might be indicative of psychosis, which is a break with reality. Psychosis is associated with schizophrenia, bipolar disorder and other related disorders. His last psychological screening was five years ago and a lot could’ve changed since then.
He has substance abuse problems but you didn’t say what he was using. Substance abuse can contribute to psychosis. It could explain his behavior.
You suggested to your husband that he seek psychotherapy but a psychiatrist might be a better option. Traditional talk therapy is often not an effective treatment for psychosis. A psychiatrist can prescribe medication which can reduce or eliminate symptoms of psychosis. Once the psychosis is treated, he might then benefit from talk therapy.
The aforementioned discussion assumes that your husband is willing to participate in treatment. Thus far, he has not been willing and therein lies the problem. Some people with psychosis don’t believe they are ill and subsequently refuse treatment. Their unwillingness to participate in treatment makes it exceedingly difficult for family members to effectively intervene. They are left with few options.
I would recommend the following: ask if he would be willing to see a psychiatrist. If he’s hesitant, offer to go with him for support but if he’s suspicious of you attending the appointment, let him go alone.
If he adamantly refuses any form of treatment, then I would recommend contacting the local mental health crisis team to ask for their advice. Another option is to contact your local mental health community center.
You correctly recognize your husband’s need for treatment. It’s also important for you to recognize that you are not a mental health professional and thus are not equipped to treat his condition. Leave this to the professionals. If he’s unwilling to seek help, then you should consult a mental health professional because it would help your understanding of the situation and of your options.
Also be aware of the potential risk that he may pose because of his anger, accusations and substance abuse. People under the influence of illicit substances, who are psychologically unstable, can be aggressive and unpredictable. You must protect yourself from this potential risk and call the police if you feel that you are in danger or that your husband might be a danger to himself. Understandably, you may not want to call the police but there exists the realistic possibility that illicit substances can lead people to behave in ways that can be dangerous.
Finally, contact the local National Alliance For Mental Illness (NAMI) support group. NAMI is an advocacy organization that assists people with family members who have mental illnesses in knowing how to navigate the mental health system. Their services are free and typically available in every community. You can find them on the Internet by doing a Google search for the terms “NAMI” and the town in which you live. If you have additional questions, please don’t hesitate to write again. Please take care.
Dr. Kristina Randle