Monday, February 23, 2009

Helping Someone With a Psychiatric Disorder

This is another long one, but while all of this information is out there on the interweb, I didn't come across one site that had all the information in one place. So here is my extensive list of tips of how you can help someone you know cope with their mental illness:

Assure them you are there for them if they need you. It might seem obvious and trite, and they may never take you up on your offer, but knowing there are people who care about them can offer great relief.
• "You don't have to go through this alone. I'm here if you need me."
• “You can call anytime you feel like talking.”

Learn about their illness so you can better understand what they are going through.
• Mental illnesses are biological, directly affecting brain function, making it difficult or impossible at times for the person to think, reason, feel, or relate to others in a predictable, normal way.
• Educate others in the family and social circle as well. Remember to also inform any children of what is happening.
• Use this as an opportunity to increase self-awareness, sensitivity, empathy, and maturity.
• Avoid being judgmental. Don’t say, “You need to stop drinking. That’s why you’re doing stupid things.” Instead say, “If you ever want to stop drinking, I’ll do what I can to help.”

Engage them in conversation and listen attentively.
• Remain calm even though they may be experiencing distress. If they are feeling afraid, it doesn’t help if you get caught up in their emotions (folie a deux). Try to find out what the problem is in a non-threatening manner.
• They may experience delusions or hallucinations, but they still need to communicate their experience. However, do not pretend that you believe the delusion is real while at the same time do not discredit them. Just listen and ensure them that they are safe. Over time, treatment will help with symptoms.
• Generally speaking, you shouldn’t ever laugh at their feelings or delusions. However (and I may be executed for saying this), sometimes they know their thoughts are irrational and a kind, quizzical, joke might not only bring them out of their delusion, but also help them laugh. “So, you think I don’t exist because the cat thought me up? Are you sure about that?” A caveat, this will strictly depend on both the individual and the circumstance. If you don’t have a joking relationship with them, now is not the time to start. As well, if humour has worked previously, but you find their agitation is increasing, don’t keep making fun of them.
• Ask them what they need and be patient if they have a difficult time communicating those needs to you. There may be paranoia, confusion, or cognitive defects that make simple things extremely difficult. By talking openly, you are letting the person know you care about them.
• Talk about what you have learned about their disorder and ask how they feel about it.

Help them laugh. There will be times when they won’t be able to laugh and times when they are angry at you believing you are trying to make light of their situation. Remember that this is a part of their illness; they are not being mean on purpose.
• Do something silly.
• Send them a funny comic or article.
• Watch a funny movie or tv show.

Encourage exercise and motivate them by participating if you can.
• Take them out for a walk or hike.
• Encourage them into activities they used to enjoy; dance, sports.
• Go horseback riding.

Encourage other activities.
• Take them to the movies or a concert.
• Encourage them to participate in hobbies they used to enjoy or volunteering.
• Reminders for something as simple as bathing or washing dishes can also be helpful.

Do not be discouraged when your efforts do not take immediate effect.
• Be patient. Despite your best efforts, they may not improve as quickly as you would like and they will quite likely relapse.
• Relax your expectations and remind yourself it is an illness.
• Remember you cannot cure a biological illness with only talk.

Do not put too many demands on them, but also don’t let them let their illness control their lives.
• Allow them to have their personal space. Sometimes a person needs to be alone without having to feel obligated or pressured to be and act a certain way.
• If they say they are unable to do something, respect that.
• Do not pressure them into what you think they should be able to do. Medications might mean they can’t drink alcohol, and though you shouldn’t be pressuring them into a blitz, also don’t nag them to “just have one.” This will not only make them physically ill, but they will also feel as if they are falling short in their social obligations.

Offer practical support.
• Help with household chores like laundry or dishes. A clean house can have a positive impact on their mood, yet they may not be able to carry out these tasks themselves.
• Cook them a meal, or meals for the week they can freeze. Appetite in psychiatric disorders can vary from eating too much to not being hungry at all. Nutrition is very important. If healthy meals are at hand, they will be more likely to eat and to eat healthily.
• Offer to baby-sit, drive them places, or pick up groceries.

Assist with medical needs.
• Encourage them to attend therapy and regular visits with their doctor.
• Encourage them to take their medication and help them organise and keep track of their medications. If they need it, you can organise their medications in a daily container available at pharmacies or you can as the pharmacist to package their medications in a blister pack.
• Help them identify their symptoms. Often times with a chronic illness, the person is not aware of how their behaviours and moods are interfering with their life because it’s all they’ve ever known. As well, depression overshadows the good they’ve enjoyed and they might remember events as unhappy despite how they felt at the time.
• Medical professionals vary in their competence; if you feel one treatment isn’t working discuss this with your loved one, but do not force them unless you think they are in danger. Recovery takes time and the process might make things seem worse at first.
• Make sure they are getting their vitamins. Omega 3 fatty acids from fish or flax oils have been reported to have an affect on mood stability. Insufficient vitamins C and D and magnesium have been shown to have adverse affects on depression. It is also possible that magnesium might have sedation effects and may help temper manic episodes.

Do not ignore the severity the condition may take.
• Help them organise a crisis plan; make a list of numbers they can call and other things they can do besides hurt themselves. Remind them that they can always go to the hospital emergency if they need to. Let them know they can call you.
• Keep the crisis plan somewhere visible. Put it in writing or type it up and post it on the fridge.
• Keep a no-harm contract with them. Put the contract in writing and have both of you sign it. Let them know if they break the contract they will have to donate money to charity or accompany you for coffee. Whatever you decide on, do not make the contract breaking event a punishment, keep it positive.
• Don’t be afraid to ask them if they are having suicidal thoughts and seek professional help if they need it.
• If a manic person is engaging is risky behaviour, let them know you are concerned.

Acknowledge their work and progress.
• Let them know you are aware of the courage and effort they are putting into their recovery and that you are glad to see them working towards getting better.
• Point out their accomplishments; “You are smiling so much today.” “I think it’s great you’ve decided to start drawing again. You’re so good at.”
• Recognise their individuality and support their autonomy. There will be times when they need your help and times when they don’t and you need to back off a bit and let them learn how to cope and take care of themselves.

Take care of yourself. Especially if you are a child of a parent with a mental illness. There may be extra responsibilities put on you, but you have to ensure you are taken care of first.
• Spend time with people whose company you enjoy and do things you like to do.
• Take some time off if you feel yourself getting caught up in their illness or becoming too stressed.
• Talk to others who are going through the same thing, either in person or online.
• Read about how others have coped.
• Seek therapy yourself with a counsellor or in a support group.
• You are not their doctor or therapist. Continue in your usual role in the relationship. Set boundaries if you need to, but make sure you communicate this clearly to them so that they will not be confused. If they are bipolar, for example, you may want to set a rule that they are not allowed to call you after 2am. Also remind them of other available resources for when they can’t come to you.
• Ensure other family members are not being neglected.
• Do not allow their illness to interfere with your school work.

Give physical attention.
• Hug them, hold their hand, rub their back; compassionate touch is very therapeutic.

This is an extensive list, but by no means complete. Each different disorder and each different individual will require different approaches. The most important thing is to be kind. And keep in mind the person you care about is always living with themselves and their illness. Therapy, medications, and concerned family members are all reminders of their illness. If you find yourself becoming tired and stressed dealing with their illness, imagine what they must be going through. Try not to put the focus on the illness.

Instead, help give them a break from being in their head by bringing them out into your world. Don’t feel guilty if you want to talk about your problems and joys. Much of the time it is a reprieve for the other person to not have to think about their own issues. As well, if they feel they have helped you in some way, you have given them a positive and meaningful experience, and that is exactly what they need more of. Support them in their autonomy.


The North Shore Schizophrenia Society offers programs and services for family members struggling to care for a mentally ill relative. Located in Ambleside Village in West Vancouver, 205 - 1865 Marine Drive. 604-926-0856.

A comprehensive list of resources in the Vancouver area.

The FORCE society is a Langley support group for parents of children with a mental illness.

Kids in Control is a psychoeducational group for children ages eight to 13. The eight-week group helps children understand their parents’ mental illness and learn how to take care of themselves. For more information contact the BC Schizophrenia Society at 604-270-7841 or 1-888-888-0029.

Here to Help is a collection of BC mental health organisations. Their site has lots of info, toolkits, and fact sheets.

Explaining depression to children.

Tips for youth of parents with a mental illness.

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