At this moment every family in our land has at least one member with a mental health problem. Think of this, right now, someone you love is experiencing mental distress and he or she may be ill! So how should families and friends respond when confronted with this problem? There is no easy answer but one thing is certain. How families and friends react will have a significant effect on the individual’s recovery and on their ability to return to a fulfilling life.
Depression is very common and it is likely that 1 in 5 of us will have a depressive illness at some stage in our life time. Mental health difficulties collectively make up the largest burden of ill-health experienced by families in our country. In addition to depression these include, bipolar mood disorders, schizophrenias, eating disorders, addictions, (especially alcohol abuse problems) and other anxiety disorders such as phobic disorders and OCD.
In the words of one service user who has written about this problem,
“There are really only eight kinds of people affected by mental illness. It’s a very small list, but we all know someone on it: someone’s mother, daughter, sister, or wife; someone’s father, brother, husband or son. In other words people just like us.”
Mental illness is an issue for families and friends.
Let us consider our responses to depression and anxiety under two headings, firstly how do we support the person with depression and secondly how do we mind ourselves?
What should families and friends do to support those with depression and anxiety?
The first step is recognition and this requires acknowledgment of the issues and hopeful understanding. The signs and symptoms of depression and anxiety are already well described elsewhere but once we recognise that the depression exists it is essential to keep in mind that the person you are supporting can be helped if the right treatment is accessed. Raising the subject with that person will take some sensitive planning and thought, but communication does not cause depression. Depression and anxiety are often present at illness levels for more than ten years often long before any effective step is taken to provide help. The biggest single gap in our response to mental distress and mental illness is our apparent inability to communicate with each other about these issues.
So how should families and friends communicate with someone in mental distress? Consider the following practical points: ask yourself when is the person most likely to be attentive; where is he or she most comfortable and at ease; where is the place you both feel most safe, when you will have plenty of time and where will you not be interrupted
Choose your time. Timing is everything. For some it may be more helpful to have this conversation as early as possible in the day, before symptoms and the demands of day to day life take over . When you do communicate, try to talk sensitively. Let the person know that you are concerned about them but talk in a non-accusing way and without blame. Talk about the changes you have noticed and express yourself in a concerned way, even if you may have been tired and frustrated about these changes.
It’s worth emphasising that because of the stigma that surrounds mental health issues and also because someone may simply not be aware of or are frightened about what is happening to them it’s not unusual for the person to deny the issues and to insist that no problem exists. He or she may become awkward, irritable or non-communicative. In these circumstances it’s best to stay calm, firm, fair and consistent in your approach. Nothing is gained by conflict. You may have no choice but to withdraw for the time being and return to the issues another time. You may want to leave behind some reliable information for the person to read. Organisations such as Aware, Grow, Pieta House are all great sources of reliable local information.
Your aim is to encourage and support the person in seeking help for themselves, but it may be worthwhile to gently explain how the experience of depression is affecting you or other members of the family. Sometimes a trusted friend or relative is more likely to be listened to. In circumstances where the problems are severe and persisting you may need to ask the family doctor to become involved.
In many cases the person with depression will feel a sense of relief and open up and agree to seek help either through a counsellor or the GP. In those circumstances family and friends can still be useful by being supportive and involved with the person’s permission all the time while respecting their rights including rights to confidentiality.
Family members and friends can be helpful in maintaining momentum for recovery and by being proactive in seeking the best care supports for their loved one.
Family members and friends can be key to relapse prevention and key to working towards a recovery plan. Simply being present at times of setback or relapse is very valuable and this is when family and friends may need to share the load as advocates, supporters and sometimes as spotters of signs of relapse.
Encouraging and supporting someone can be a very fine balancing act but we do know that telling people who are unwell to just “get up”, “go for a walk”, “do mindfulness” can seem like you are telling them to pull themselves together which can be very counterproductive. Instead, try asking them if they’d like to come downstairs for a cup of tea or if they fancy going out for a short stroll and if they don’t just let them know that it’s no problem and that you are there for them.
How should families and friends care for themselves when someone has depression?
Families typically experience a powerful set of emotions when one member becomes mentally ill. Grief and shame, fear and bewilderment, anger and guilt may be jumbled up in a cascade that feels like a roller coaster. Once a loved one is doing well these feelings may be substituted by emotions of hope and optimism, but these positive emotions may be dashed at times of relapse and replaced with feelings of devastation and despair. This is very common and very understandable but however hard it seems, it does pass.
In addition to this emotional burden there is also the practical effect that mental illness can have on any family and any friendship. Objectively with mental illness the practicalities of everyday life become more challenging for everyone. There is a particular sense of loss that comes with mental distress especially when that distress is chronic and enduring. There may be loss of the person as perceived before the illness and also loss of anticipated goals and aspirations, disruption of relationships and family life. There may even be the breakdown of relationships between partners and children or the loss of home, ending of friendships and all that comes with homelessness.
All the features of grief may be experienced and these are noted in the families of those with mental illness; shock, denial, anger, bargaining, depression until ultimately, hopefully acceptance and understanding appears.
Each family member or friend will have their own way of coping, but because of the stigma attached to mental illness it can be difficult for families to be open about their need for support. The evidence suggests that where families can find a way towards acceptance of these challenges, then the outcome is best for themselves and for the person who is experiencing the mental health difficulty.
Each member of the family may be affected in a distinct way. Parents, spouses, siblings and children are all influenced and involved when one person has a mental illness. The evidence is that a willingness to listen to each other and be supportive of each other is the most helpful tool to have in the box. This is the approach most likely to help the person with the mental distress and the whole of the family. Young children may need reassurance that they are not responsible for a parents or older siblings mental distress.
It’s important to take care of your own needs. The best illustration of this principle comes from the familiar advice given to us by the flight attendants when we take a journey on an aircraft. “In the unlikely event of a sudden drop in cabin pressure” they say “put on your masks in this way”. Then they say “and for those travelling with young children always remember to take care of your own needs first” The same principle applies to families and friends of those in mental distress.
Practical measures to keep yourself well are worth thinking about. Like taking exercise. Go for a walk or a run. Practice meditation and if you have a faith now is the time to look to it. Think mindfully. It’s very important to keep in touch with friends. Take breaks. Remember to ask friends or family to provide you with Respite. Keep reading. Enjoy pets. Don’t feel guilty about accepting help from trusted others. Consider relaxing break or a massage. Let go of the need for everything to go just right. Delegate chores. Stay with routines. Enjoy nature, hobbies and a good diet. Set limits. Remember to celebrate the good times!
Other suggestions may be helpful so here are some suggested Do’s and Don’t’s
- Don’t be afraid to reach out and ask for help- from friends, support groups, your own GP, counsellors. If you are linked in with community mental health services, the team members for example as nurses and social workers are a huge resource in terms of providing information and support to families as well as service users.
- Do be patient with yourself- give yourself time to adjust to a significant change
- Do acknowledge and share your feelings with supportive people
- Do be good to yourself, make time, continue to do the stuff you enjoy
- Do recognise your limitations, don’t overburden yourself with responsibility. Remember that you can’t support someone else if you are not well yourself!
- Do consider writing a journal or diary, this helps many people
- Do try to maintain a healthy balanced lifestyle with links to the rest of your family
- Do remember that no one is to blame for mental illness, neither you nor the family nor the person experiencing the immediate problems
If you are experiencing a mental health difficulty or are worried about a friend or relative, please make contact with St Patrick’s Support & Information Service.
This service is staffed by experienced mental health nurses from 9am-5pm Monday to Friday with an answering and call-back facility outside of hours. The number of the Support & Information service is 01 249 3333, or if you would like to email your query to firstname.lastname@example.org, we will endeavour to get back to you within these hours.