About half of the people suffering from mental illness are profoundly unaware — and not just in denial — of their sickness, a visiting expert told more than 100 mental-health providers and consumers in Honolulu yesterday.

"There are 6 million people in the nation with a serious mental illness, and fully 50 percent of them do not believe they are ill," said Dr. Xavier Amador, a clinical psychologist and researcher.

Traditionally, mental-health providers and loved ones have tried to help those people by confronting their "denial" and insisting that they get treatment. That is no longer considered the best approach, Amador said.

"The father-knows-best approach doesn't work," said Amador, who described years of trying to help an older brother with mental illness in just that way. "It just makes people become frustrated, angry and non-compliant," often leading to a refusal to take medications that could control their problems, he said.

Consistent research, confirmed in hundreds of studies, shows that many of the individuals are suffering from problems in the frontal lobes of their brains which prevent them from being aware of their illness, even when it is physically manifested in front of their own eyes, Amador said. The technical term for the problem is anosognosia.

Amador encouraged health providers and family members to adopt a newer approach that creates trust, rather than barriers, between the ill and those trying to help them.

The help comes in the shape of a slow, cumulative process of listening, empathizing, agreeing and building an alliance that empowers the individual to seek help, said Amador, whose work has included participation in the the Theodore Kaczynski ("Unabomb-er"), Elizabeth Smart kidnapping and Zacarias Moussaoui ("The 20th Hijacker") cases.

Yesterday's three-hour talk and training session, on the topic of "I am not sick; I don't need help," was sponsored by the Hawai'i chapter of the National Alliance on Mental Illness.