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18-Year-Old Friend Has Paranoid Delusions & Refuses Help

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A friend of mine who has been very close to me, but recently has had to move a few miles away has been getting paranoid delusions that are progressing over the last year.

He is 18 in a under poverty level household and is convinced he will not be around by his 19th birthday because “they” are going to take him or kill him. He is convinced an organization of “vigilantes” or “spies” have been following him, watching him, coming to his house at night and aggravating him to mess with him. He can no longer go outside because they follow him and they are often disguised as Hispanic people with children and they make their children cry to see what he does. He knows it’s crazy but says that he has seen them and so it is real. He wants to move because he doesn’t think they will follow him.

He has no job or medical insurance so I don’t know the resources he has to get help. He’s shot down a few places that offer free counseling because he believes “they” are there, and that if they find out he is aware of what “they” are doing that “they” will attack him.

He doesn’t think he’ll kill himself. But he insists he will not be around and either dead or missing by next year and that it will be “them” that are responsible. He is scared and doesn’t want to die and wants them to go away so he can live his life.

My main concern is getting him help but I have not found any places suitable for him. He will not talk over the phone because he believes they are listening so it can’t be a hotline or over e-mail. I am worried he will harm himself, or someone else. As unlikely as it is because all he wants to do is please people, I’m concerned he may “attack” someone he believes is a spy in self defense. Thank you for your time.

18-Year-Old Friend Has Paranoid Delusions & Refuses Help

Answered by on -


You are in a difficult predicament. The person who you are trying to help is refusing all of your efforts. That further complicates the situation.

I believe your concerns are valid. Your friend may be experiencing psychosis. Most people with psychosis are not violent but they can be, under certain circumstances, such as in the scenario you have described. Though it is unlikely, that scenario is not outside the realm of possibility.

There’s also the issue of possible suicide. He stated that he knows that he will not be living by the age of 19. That statement might be indicative of a delusion but it could also mean that he is planning to end his life.

Psychosis jumbles the mind. It is a struggle to know what is real and what is not real. Psychosis can be very frightening but it is treatable with medication.

My recommendation is to contact the local mental health crisis team and ask for their assistance. They can come to his home and evaluate his condition and determine if hospitalization is necessary. You can identify if mental health crises services are available in his community by doing a Google search or by contacting the local hospital or health department.

In Florida, an individual is eligible for inpatient hospitalization (even in the absence of health insurance) when they meet at least one of the following criteria:

“An individual is unable or refuses to make responsible decisions with respect to voluntary placement for treatment AND either (1) without treatment, incapable of surviving alone or with the help of willing family or friends, and likely to suffer from neglect or refuse to care for himself/herself that will pose a real and present threat of substantial harm to well-being OR (2) danger to self/others, as evidenced by recent behavior.”

18-Year-Old Friend Has Paranoid Delusions & Refuses Help

Therapists live, online right now, from BetterHelp:

Kristina Randle, Ph.D., LCSW

Kristina Randle, Ph.D., LCSW is a licensed psychotherapist and Assistant Professor of Social Work and Forensics with extensive experience in the field of mental health. She works in private practice with adults, adolescents and families. Kristina has worked in a large array of settings including community mental health, college counseling and university research centers.

APA Reference
Randle, K. (2018). 18-Year-Old Friend Has Paranoid Delusions & Refuses Help. Psych Central. Retrieved on November 24, 2020, from
Scientifically Reviewed
Last updated: 8 May 2018 (Originally: 21 Nov 2014)
Last reviewed: By a member of our scientific advisory board on 8 May 2018
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