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Caring for someone with a mental illness
For the person experiencing it, being diagnosed with a mental illness is a frightening and confusing period. It can also be a difficult period for that person’s family, relatives and friends.
A Carer is someone who helps his/her relative/friend with a mental illness on their journey to recovery. This information sheet aims to outline some of the issues affecting a carer, and discusses how they can better help their loved one. It also gives suggestions on where to go for further help and assistance. Learning how mental illness is affecting their relative, and understanding what they are going through, is perhaps one of the most important aspects of a carer’s role. Very often, the behaviour of someone with a mental illness is misunderstood. One such misconception is that ‘ people with a mental illness are lazy and weak, and if they tried hard enough they could ‘snap’ out of it’. Fear about the onset of the next episode, confusion about the illogical, at times irrational nature of their inner world may be some of the feelings experienced by someone with a mental illness. They may also experience anger and bitterness due to the manner in which the mental illness is affecting every aspect of their life. They may be hypersensitive to criticism and feel as if others, including their carer and mental health professional, do not understand them or what they are going through. They may feel rejection from friends and relatives and consequently isolate themselves. They may experience an overwhelming sense of despair, loss of interest, lack of energy or motivation. Angry outbursts may be demonstrated by somebody with a mental illness. This can be due to delusions or hallucinations, inner frustration and conflict, or an inability to manage anger. It is important for the carer to understand that they can seek assistance in terms of respite or other residential care. You may also like to advise your relative’s case manager or doctor of the difficulties you are experiencing. HOW TO HELP YOUR RELATIVE Realistic expectations – It is normal to feel the loss of what your loved one was able to do before the onset of mental illness. He or she may also be experiencing similar feelings of loss and sadness. Many carers envisage that ‘recovery’ for their relative is being able to function as they were before the onset of the illness. This can be true for some, however, for others having this attitude or expectation may mean that they fail to see the small signs of progress that their relative is making. Such an expectation may carry over to the person with the mental illness who may also feel that they are not progressing. Expectations of employment, or schooling may simply be inappropriate at certain periods, while a possibility at other times. Some realistic signs of progress could simply be when your relative starts eating with the family, or having daily showers. Positive outlook – One of the most important ways a carer can help is by instilling hope of a more positive future for their loved one. Often the person experiencing the mental illness may not be able to foresee ‘better days’. Helping them have a more positive outlook in life can also show him/her your support and may further assist those who feel that they are ‘burdening’ the family as a result of mental illness. Communication – Conversation and communication can at times become challenging when carers feel that their relative is not ‘hearing’ what they have said. At times this could be because s/he is preoccupied with other thoughts or because the relationship between the carer and relative has deteriorated to the extent where communication has become difficult. Some hints for improved communication are:
• Face the other person and maintain eye contact Problem solving – it is often tempting to make decisions for your care recipient rather than to encourage them to come to a decision for themselves. Encouraging them to use problem-solving techniques will help empower them and give them some sense of control over their life. Eg Relative:“ I am not sure whether to attend the support group today”. Instead of saying, Its good for you, you should go”, you could say “What did you think of the session last time?” ... and / or “How did you feel after the last meeting”. In this example, helping your loved one see the benefit of attending a support group is better achieved by them thinking through it themselves rather than you ‘telling’ them. Learn to reduce stress – Encourage your relative to practice stress reduction strategies. Excessive stress may make someone with a mental illness more vulnerable to relapse. Good stress reduction strategies may even help reduce some symptoms of mental illness eg. anxiety, depression, lack of motivation etc. Some simple ways to reduce stress are: Be empathic and sensitive - A person who is experiencing an acute episode of a mental illness may feel very unwell, just as we do when we are experiencing an episode of physical illness. Avoid making comparisons to friends, colleagues’ and relatives’ success at work, school or relationships. Such comparisons may belittle your care recipient, where s/he may feel far behind others in terms of success, achievements etc. Also remember that those who haven’t experienced a mental illness cannot fully understand what it is like for those that have. Encourage compliance in taking medication – There could be times when your care relative refuses to take medication. This may be due to the side effects they are experiencing or because they feel that the medication is not positively benefiting them. Simply saying to them to take their medication because “its good for you”, often will not convince him/her. In fact they may feel that you do not understand their feelings. Keep in mind that he or she has reasons they believe why they should stop taking their medication. Some things you can do to encourage compliance with medication are: • When your relative is looking and feeling better, suggest that the medication may have played a role in them feeling better.
• If he/she is refusing to take their medication because of side effects, ask them to write down all the things they are experiencing and encourage them to make an appointment with their doctor to discuss the side effects. Also encourage them to ask the doctor what sort of things will help alleviate the side effects.
• If your relative feels that the medication is not helping him/her, then encourage them to ask their doctor how long it takes before the medication takes effect. Also bring up the issue of regular intake of medication. Help him/her understand that regular intake of medication is important, as it is for any other medical condition eg. Uncle Fred taking daily medication for diabetes.
• Bring up the topic of medication when your relative is more receptive, and more open to discussion – even the time of the day may make a difference eg. Some people with a mental illness may be more anxious or experience more symptoms at night, so daytime may be a better option for discussing medication.
(If your relative suggests that they do not need to take medication because there is ‘nothing wrong with them’, discuss this with his/her doctor, and options such as community treatment orders and community counselling orders). Learn: A more informed carer is better resourced to help their loved one.
NEEDS OF OTHER FAMILY MEMBERS
Caring for someone with a mental illness can affect the dynamics of a family. Often, the caring role drains the majority of the caregiver’s time, energy and patience. Grief may be involved, as in the loss of the loved one’s former personality, achievements and contributions; as well as the loss in family lifestyle. This grief can lead to unconscious hostility and anger. Other family members may also start contributing towards caring, and neglect their own needs: Children – Children often do not fully comprehend what their relative is undergoing. They can often gauge the stress that the family is experiencing, but not actually ask what the matter is. They may withdraw, or pretend that the change in family dynamics does not exist. Alternatively, they may start contributing greatly towards the household. They may show signs of ‘growing up too quickly’. Other children may demonstrate anger and irritability, and choose to spend more time away from the home and the family. Relationships – Personal relationships of wife/husband/partner are also greatly affected by mental illness. This is especially true if the carer’s partner is the person with the mental illness. The needs of the relationship change. The carer may also experience loneliness in terms of the lack of attention from his/her spouse and the dramatic increase in responsibilities.
Caring for a child with mental health problems can also create friction in the carer’s relationship with his/her partner. There are issues of lack of attention to the needs of the partner. At times there can be issues of blame between partners in terms of responsibility for their child’s mental illness.
Attending to the needs of other family members: • Allocate time that you will spend with another family member and seek assistance or respite, if needed, to attend to your relative with mental illness. LOOKING AFTER YOURSELF Most carers, once they adopt their caring role, fail to address their own needs. This may be by giving up paid work, stopping socialising with friends, neglecting their own health, and even simple things like not allowing themselves time to read a book or go for a walk. Carers sometimes persist with their caring role to the point of exhaustion, frustration and breakdown. Sometimes, they unconsciously start doing too much for their relative, to the point where he/she fails to take on board their own responsibilities. Along with the caring role, often there are issues of guilt and blame. Sometimes carers feel directly responsible for their loved one’s mental illness and ill health, or they feel that their relative is suffering because of shortcomings in their caring. They may think that taking ‘more’ or ‘better’ care of their loved one will help them recover from their mental illness. As can be imagined, some carers take on a huge responsibility. This often leads to their own mental and physical ill health. Neglecting one’s own needs and health can lead to a tired, exhausted, frustrated and emotionally drained carer. Being in such a position can adversely affect the decision making process of a carer and, in turn, their caring capacity. It may even adversely affect the relationship between the carer and their relative. A carer who cares for him/herself is able to better care for their loved one. How to care for you WHAT SORT OF QUESTIONS SHOULD I BE ASKING? Caring for someone with a mental illness is a new experience for most people. Often it is a role they never expected or imagined they would need to take. It is often an area that is new to them, and they are unsure of the types of things they need to know and the types of questions they need to be asking. Mental Health Professional Team – The Psychiatrist, Psychologist, Case-manager or GP can provide information to you in terms of what your relative is experiencing. Sometimes because of confidentiality, mental health professionals will not be able to discuss some of the issues affecting your relative. However, you can still let him/her know of your concerns. In your capacity as a carer, you may have information and insight that could assist the health professional better care for your relative. Some useful questions to ask mental health professionals:
• What are the side effects of the medication? Relative – In your role as a carer, it is often easy to forget to simply ask the person you are caring for if they are happy with the assistance you and others are providing. It is easy to start ‘telling’ the person what they ‘should’ be doing. This approach or attitude may negatively affect your relationship. To prevent this just ask for their opinion. It is often a good idea to bring up some of the following issues when the person is well and willing to talk. • Are you happy with the mental health worker? Would you like a second opinion?
HOW TO HELP SOMEONE EXPERIENCING A PSYCHOTIC EPISODE • Remove any immediate danger eg. sharp objects and ensure that your relative is in a safe environment. WHAT TO DO IF YOUR RELATIVE IS SUICIDAL People with a mental illness sometimes think and talk about suicide. Such thoughts are not uncommon for someone experiencing an acute episode of a mental illness. It does not necessarily mean that they will harm themselves. However it is important that your relative discusses his/her thoughts with their doctor as soon as possible. You may also like to attend suicide prevention workshops and suicide awareness presentations to learn how to identify risk factors associated with suicide and learn the necessary actions that need to be taken. If there is a crisis: You may also like to inform the health professional treating your relative or friend. They have a duty of care to provide advice and support. WHERE TO GO FOR HELP • Mental Health Information Service 02 9816 5688 or toll free 1800 674 200 (Outside Sydney metro) - Telephone information and referral service.
When your parent has a mental illness
In Australia it is estimated that there are 27,000 children affected by having a parent who has a mental illness. (Cowling, McGorry & Hay, Medical Journal of Australia, 163(7), 1995:119-120)
If your parent has a mental illness What are the challenges? You may not always be able to receive the care and support from your parent that you need or would like. There are likely to be disruptions to the family when your parent becomes ill and needs to stay in hospital. If you do not understand your parent’s illness, and even if you do, you may feel guilty that somehow through your behaviour or the things you say, you are the reason they become ill. When a parent has a mental illness, seeking and holding down a job can be difficult. A recent survey showed that 92.06% of mentally ill parents surveyed in the South West (of Sydney) were unemployed. Being unable to get work can push the family income below the poverty line. This puts even more stress on everyone.
What might your needs be? You may not understand what is happening at the times when your parent is ill. Finding out about your parent’s illness can help you make sense of what’s going on. It is okay and important for you to talk to someone, other than to your parent about your fears, guilt and confusion. You may need to meet and talk with other young people who also have parents who have a mental illness. How you can help yourself WHERE TO FIND HELP • Youth Health Centres (see ‘Community Help’ in white pages) Diet change strategies: The best place to get quality supplements is from a natural healthcare provider. There are dozens of supplements marketed on supermarket shelves today, but many of these do not receive standardization. It is important if you decide to use supplements that you get the best quality supplement possible. • Black Cohosh – This may affect one’s hormones, which may be one cause for symptoms of some mental health disorders. • Damiana – Often used to help lessen depression, but may cause mania in people with bipolar disorder. • Ginseng – May help provide more energy to people who feel fatigue during depressive states. • Gotu Kola – May help address symptoms of anxiety. • St. John’s Wort – One of the most popular of herbal supplements supported with scientific research that may help lessen mild depression. Again, one should use with caution and can interact with other medications including antidepressants.
Vitamin & Nutrient Associations
If you suffer from mental health disorders, it is important you eat well to nourish your body. Deficiencies of vitamins and minerals can contribute to your symptoms. Deficiencies of vitamins and minerals in anyone can contribute to symptoms including anxiety, depression and poor health. A good quality multivitamin is a good start, especially if you do not have a history of eating well. Even if you do eat well, not all people absorb the vitamins and nutrients from their foods completely, so a multivitamin may help correct any shortages. Many therapists recommend patients with bipolar disorder take extra B vitamins because these vitamins may affect our moods. A deficiency in vitamin B of any type may result in symptoms of depression or anxiety. B vitamins are also often recommended to people to help lessen fatigue. For most, B vitamins help energize the body. There are many forms of B vitamins, so your best bet is a complex tablet containing all the B vitamins. For your information, here is a breakdown of the B vitamins by category. • B-1 – Also known as “Thiamin.” This may impact anxiety, irritability and improve blood circulation in the brain and body. • B-6 – Also known as “Pyridoxine.” This B vitamin may help reduce irritability. Doctors sometimes recommend it to patients with premenstrual irritability and agitation. You can take too much however, so be sure you consult with your doctor. • B-12 – This vitamin helps convert what you eat into fuel for your body. It is most helpful for reducing drowsiness. • Folic Acid – Important for preserving the body’s systems and biochemical balance. Careful however, as this supplement may interact with some of the more commonly prescribed mood stabilizers including Depakene. Other vitamins that may prove helpful may include vitamin E, which may combat the risk of seizures often associated with the use of traditional medication therapies. Here are some other supplements and nutrients that may prove useful for combating the symptoms of mental health disorders. • SAMe (pronounced Sammy) – This supplement may affect levels of dopamine and serotonin in the brain, but carries with it a risk of mania. • Tyrosine – Often used in combination with B vitamins, this amino acid is a precursor to dopamine and norepinephrine, important neurotransmitters in the body. What this means is your body needs tyrosine to make norepinephrine and dopamine. • GABA – May help relieve some symptoms including anxiety, insomnia, racing thoughts and tension in patients with bipolar or related disorders. • Essential Fatty Acids – Essential fatty acids are important for our entire body to work properly. They nourish the brain and may help reduce symptoms of depression. You can get essential fatty acids by eating more fatty fishes and flax seed or by taking a supplement. Some healthcare providers recommend as much as 5,000 I.U. or more for patients with severe depression. Be sure you check in with your doctor. Most over-the-counter supplements contain only 1,000 I.U. per serving. • Lecithin – This substance may help stabilize mood swings. If you plan to use this supplement, you should do so while working with a natural health care provider. • Calcium – Calcium is a mineral our bodies need for proper neurotransmitter production. Look for a supplement with calcium and magnesium to heighten the effects. A lack in magnesium can often lead to insomnia and anxiety. • Zinc – This important and often ignored mineral is often lacking in many people’s diet. It can help combat colds and may help reduce some symptoms of depression or other mental disorders. Remember, as with herbal supplementation you should embark on vitamin and nutritional therapy under a skilled practitioner’s guidance. Even when we try to eat well, we're disadvantaged. The nutritional content of most food has been compromised over the years, not only by deficient soils and modern production, transportation, storage and processing methods, but also by the enormous amounts of chemical and artificial substances added to promote growth, storage life, taste and appearance. It's for this reason that more and more medical authorities are advocating the use of vitamin and mineral supplements. However, finding them in the right combination can be both confusing and costly. As Aloe Vera Juice is a refreshing and anti-bacterial drink, you might find that taking this daily, diluted in some filtered water will not only refresh you like ‘a shower inside you’ but also assists in dealing with any digestive issues you may also be experiencing. Taken with Flora-Fiber tabs it will cleanse your digestive system and improve your immunity levels overall. You may find benefit from our information on detoxification as well as a bit about detoxing because of change of diet You can visit our health food products page here: Herbalife Health Nutrition Supplements and learn more about our core nutrition program, the Cellular Nutrition Advanced Program and also check out these targeted products, Florafiber to replace your healthy flora and Aloe Vera Juice to help cleanse your system.
Most mental health disorders are complex and often misunderstood, that affects millions of people every year. It is important that patients understand their disorder is one that they can live with, and even learn to enjoy life with. There are many misconceptions surrounding mental health disorders. There are times when a patient’s symptoms may become very serious. In cases like this it is critical a person seek professional care and guidance. A mental health disorder can manifest in many different ways. It can for example, manifest as a mild disorder with mild mood swings, or a major mood disorder with swings that are very extreme. There are many approaches to treating a mental disorder. A patient should always work with a competent doctor or other healthcare provider they can rely and trust on in times of need. Also important to one’s health is his or her ability to build a supportive wellness team. Your wellness team can help you during the tough times, offering support and helping you make critical decisions when you may not be up to it. The most important step a patient can take, the one that will ultimately lead to their success and fulfillment, is to take a proactive role in their recovery and in their care. To do this, you must first embrace and accept the fact that you have a mental health disorder. Once you do this, life gets a lot easier. You can then help manage your disorder by working actively with each member of your wellness team as well as with members of your family and your healthcare team to create an action plan that allows you to live a happy, healthy life. Many people live with mental health disorders. Your job is to learn to not only live with, but also learn to enjoy life with bipolar disorder or any serious ailment. Congratulations on taking a step in the right direction, one that will lead to your long-term recovery and happiness. We wish you well in your search for solutions to this problem and your movement towards better health in all areas.
The information provided is to be used for educational purposes only. It should not be used as a substitute for seeking professional care in the diagnosis and treatment of mental health disorders. Information may be reproduced with an acknowledgement to the Mental Health Association NSW. This, and other fact sheets are available for download from www.mentalhealth.asn.au. This fact sheet was last updated in Summer, 2002.
Mental Health Problems If the tension gets too much for us to cope with, however, it can cause us to "break down" emotionally or mentally, that is, not be able to carry on our lives in health. At these times, we may need to ask for help or support while we adjust. Many people live with disability, including physical illness or mental illness, and cope in a healthy way. The challenge for all of us is to search out new ways to cope.
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