Dear Eric: Our 63-year-old sister “Josie” has always been naive, gullible and more of a follower than a leader. She does not have a college education but always seems to fall into a job that pays well. In the past seven years, she has reunited with a friend from a previous job, and this is when we noticed a dramatic change in her mental state. The family has been dealing with her conspiracy theories and beliefs of aliens living under Walmart; Josie states that she is a star seed from another planet.

She took an antidepressant years ago but weaned her way off of it. She has admitted to anxiety recently but will not go back on a pill due to having no trust in Big Pharma who makes them.

Josie has a daughter who lives out of state and does not know the level of concern that we have for her mental state. My niece asked me to join her mom in visiting her, but I cannot take more than two hours with Josie, let alone a week. Do we let her live her life in LaLa Land or suggest that she needs an intervention or counseling?

– Concerned Sisters

Dear Sisters: While it might have initially seemed that, by linking up with an old coworker, Josie was following a misguided way of thinking, the sudden change suggests that she could be experiencing a mental health crisis. Intervention could help keep her safe.

Talk to your niece about your concerns and see if she shares them. You can be honest that an extended trip isn’t something you can do, but consider a shorter visit with the intention of getting a better idea of what’s going on with Josie. Open communication amongst the family about what you’re witnessing, reasonable expectations and what you can do to help is key. You can find resources for having these pre-conversations and additional support on the Substance Abuse and Mental Health Services Administration website (samhsa.gov).

Write down what you’re observing when you hear from Josie. Listen to Josie without judgment and reflect back what you’re hearing, also without judgment. This will make it easier for her to trust you when you offer support or suggest that she seek professional help.

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Send questions to R. Eric Thomas at [email protected] or P.O. Box 22474, Philadelphia, PA 19110. Follow him on Instagram and sign up for his weekly newsletter at rericthomas.com.