The key here is "refusing help". In the US it's pretty well one of our basic rights unless we're a danger to ourselves or others. There are really only 2 choice

The key here is "refusing help". In the US it's pretty well one of our basic rights unless we're a danger to ourselves or others. There are really only 2 choices, establish enough trust to encourage the person to receive help, or wait until their behavior violates the law, at which point they've forfeited certain rights and treatment of some kind can be mandated. This process has mostly been used on addicts and alcoholics (treatment or jail, drug courts), and sometimes works. Here in Key West, you can also get a bus ticket somewhere else, presumably where the person has more of a support system (family, friends)... if you agree not to return. This solves the problem for Key West, anyhow :)