When to intervene for a family member who has delusions

Hi carers,

I'm wondering how to ensure that my sister receives proper treatment, especially psychotropic medication, when she continues to resist and deny the existence of her mental health illness. I do not wish to wait until a crisis occurs.

- She suffers from symptoms of an undiagnosed schizoaffective disorder (erotomanic delusions, paranoia, and visua hallucinations, not sure about auditory).

- She has received formal diagnoses of PTSD and Bipolar Disorder in recent years.

- She is 'high functionig' with university qualifications and strong work record.

- She is not at acute risk of self-harm or suicide and no history of either.

- She is resistant to any medical or psychological interventions, although she has seen a clinical psychologist a few times but seems to have been unhelpful. No history of psychotroic medications.

- She views almost all events in her life as a theatrical play orchestrated by a Higher Power for the sole purpose of matching her with the man that she is attracted to (this has been going on for around 3 years). I am in communication with this man.

- He has an AVO against her (for stalking and intimidation: she gives him gifts, attends his workplace, and visits him; despite being explicity told not to). She is not physically aggressive, but can be verbally aggressive.

- She has breached the AVO by visiting or giving him gifts to him again. She views the arrest and court proceedings as part of this theatrical play. Therefore, she resists all legal support. She has no prior criminal record.

I've tried many strategies ranging from motivational interviewing, CBT, DBT, attentive listening (active, reflective, empathic), casual brother-sister talks, attachment, conditioning histories, etc etc etc. The usual response to any style or approach that I use is that she is self-sufficient, can self-manage, that she knows what she's doing, etc.

When is the right time to get her involuntarily admitted into a mental health facility? Have events been prolonged for too long or do I wait until a non-family member (i.e., the court) requires her to be involuntarily assessed and then admitted into a mental health unit? Is it worth rupturing family rapport (i.e., trust and comfort; but then repairing it later) in order to stabilise her mental health condition (and therefore keep the man and his family away from my sister's ongoing nuisance behaviours)?

I am leaning more towards gathering family members to be assertive towards her about this issue and for her to see a GP/psychologist, or otherwise rupturing rapport by having the local mental health acute team contact her or otherwise calling the ambulance. I think that being assertive (and benefitting her mental health) but then becoming the enemy is the better choice than being passive (and not benefitting her mental health) but staying as friends.

Thanks all, I really appreciate the feedback.

Jacob