An irritable, weight gaining, poorly compliant patient may be clinically depressed. Equally high probability is that in his community/society, depression is seen as a weakness. So, he is likely to deny depression and focus instead upon pain and discomfort. His impatience, lack of motivation, inattentiveness and even his increasing obesity are probable signs of depression.
Going to the concept of a community mental health center: County mental health agencies have the capacity to work with the patient and his family, to provide them with counseling services, often group and family counseling as well as to handle his medication.
Importantly, if the patient lives in a rural community, the associated mental health center is aware that his peer group will not readily accept depression as a valid disorder. They can work with him without forcing him to accept that his problem is largely a mood disorder. Also, they are well aware that depressed, rural Americans, often will retreat to alcohol and other substance abuse and can help him guard against using his pain medication (and/or alcohol) as a self-treatment for the depression.
Community mental health centers may be a buffer against the dependency that such patients develop when placed in private mental health care situations. They see such patients on a spaced appointment basis and do not encourage the patient to become solely reliant upon them. They are also cautious with what they prescribe.
Provide the patient with the data that he needs in written form when possible with a copy to a family member if available. Make minimal demands of him and do not personalized his grizzly mood; it is not actually directed at you but at the dependent situation in which he finds himself (and which he may not fully understand).
A firm but kind confrontation may be appropriate: _I want to assist you, but I need you to listen to me rather than battle with me. If you work with me, I can assist you._ This should not be a prolonged or in depth discussion, merely a statement of you goals and his own role in his rehabilitation.