It’s hard to know what to do when a friend or family member has a mental illness.

All of us know that the support of family and friends is an essential element in the recovery process. 

But how to give that support is outside the experience of most people. We want to do something, but we feel our hands are tied.

Actually, there’s a lot you can do. This post is rather long, but it offers a wealth of information to help your friend, your family member — and you under these headings:

• How it feels when you first learn of your friend’s or family member’s mental illness
• Do not abandon your friend or family member in their time of crisis
• How to talk to your friend or family member about mental illness
• Support strategies you can use
• What to say if your friend or family member is unreasonable or delusional
• When your friend or family member is not manageable or is out of control
• For more information

How it feels when you first learn of your friend’s or family member’s mental illness

Grief, confusion, anger are normal emotions

When you hear of or suspect that one of your friends or family members has a mental illness, you may experience emotions such as shock, grief, sadness, anxiety, confusion, guilt, shame, and anger. It is important that you accept your feelings as normal, and to not feel ashamed of them. While you work through these feelings, please remember that:

• It is essential to understand that neither you nor the person with the mental illness are to blame for it. There’s nothing that either one of you could have done to prevent it.
• Many of these feelings are the result of the negative associations that mental illness carry in our society. It is imperative that you break through this stigma in order to give your friend or family member the help they need and deserve. It isn’t easy, because our daily language, the assumptions we grew up with, and the media are saturated with it. I have written a series of posts entitled, “Scapegoating and the Stigma of Mental Illness, Part 1” and Part 2 that can help you do this.

Often, friends or caregivers of the mentally ill do not know what to do for themselves, either. It is easy to become stressed out and lose sight of your own needs when you become deeply involved in helping a friend or family member. I have written a post entitled “How to Take Care of Yourself When Your Partner Has an Anxiety Disorder” to address just these sort of issues. Though it has specific help for partners and Anxiety Disorders, there’s a lot of general help for friends and other family members, too.

Do not abandon your friend or family member in their time of crisis

Do something, even if just a phone call

Above all, it is important that you not abandon your friend or family member in their hour of greatest need due to your own emotions or the stigma of mental illness. It is all too common for people, in their confusion about what to do, to do nothing to help or support them. Many of the mentally ill are simply abandoned by friends and family, or as bad, treated as if nothing were wrong at all.

When I had “the big breakdown” some years ago, I was totally abandoned by friends and my extended family. Perhaps they did not know what to do, or were negatively affected by the stigma of mental illness. Needless to say, they were not there for me in my time of greatest need. I cannot tell you how much this hurt or how alone I felt in the morass of mental illness. I can say without question that it lengthened my recovery time a great deal. It also has distorted our relationships since — that is, if our relationship survived it at all.

Please, if you have a friend or family member who needs help, break through your reluctance and give them support, even if it is just to call to let them know that you are thinking of them. 

How to talk to your friend or family member about mental illness

Show your friend or family member that you care

It may feel awkward, embarrassing, or intrusive, but don’t avoid having a conversation if you suspect your friend or family member has a mental health problem. It’s important to talk about it, so they know that they have nothing to be ashamed of. It’s possible they are already being treated and didn’t know how to tell you. In that case, you have an opportunity to offer your support. If they haven’t yet been diagnosed, your concern and encouragement might be just the thing they need to seek professional help.

The most important thing you can say to a friend or family member when beginning this conversation is that you care. Make it clear that you want to help them. Keep in mind that this conversation isn’t about offering advice. Rather, it’s about listening to them without being patronizing, judgmental, or trying to solve their problems yourself. Remind them that you care, you want to support them, and that mental illness is very treatable. 

Here are a few ideas to get you started:

• “I’ve noticed that you seem a little down lately. Is there anything I can do to help?”
• “I feel as though you’ve been distracted the last couple times we’ve seen each other. Do you want to talk about it?”
• “I’m concerned about you. If something is wrong, I’d like to help.”
• “Because I know you well, I can tell when something seems different. Can we talk about it?”
• “Our relationship means a lot to me. I know when I need help, you’re here for me. It seems like you could use some help right now, and I want to do whatever I can.”

Support strategies you can use

You need to be proactive

There are many things you can do to help your friend or family member — and yourself, too. Most of the following suggestions start with you. You need to be proactive in helping your friend or family member, not only in your dealings with them, but in your personal preparation as well.

Following is a list of tips for things to you can do to help your friend or family member, and yourself:

• Accept your feelings. You may find yourself denying the warning signs,worrying what other people will think due to stigma, or wondering what caused your family member or friend to become ill. Accept that these feelings are normal and common among others in your situation.
• Avoid being judgmental. Keeping an open mind will help to create a safe and comfortable environment for your friend or family member.
• Develop a positive attitude. It will help you to provide better support for a friend or family member with a mental illness, and will help you through your own difficult emotions.
• Educate yourself. Learn about the diagnosis, symptoms and available treatments. Mental health associations, public libraries and the internet are all good resources. (See list below)
• Recognize and accept that symptoms may come and go, and may vary in severity. Everyone has a different rate of recovery. Varying levels of support will be required at different times throughout recovery.
• Be compassionate. Recognize that your family member or friend may feel scared and confused after receiving a diagnosis. Although some people are relieved to get diagnosed and actively seek treatment, it may be devastating to others.
• Motivate. Encourage your friend or family member to learn about what treatments and services will promote recovery. Help them follow through with medication and the instructions their therapist will give.
• It takes time. Recognize that finding the right treatment or services can take time, and can involve a process of trial and error. It can be very frustrating. Be patient, and encourage your friend or family member to be patient, too. 
• Talk about what they find helpful. Make conversations about their mental health difficulties easy and open. Try asking about what helps them when things are tough. By talking openly, you are letting the person know about your love and support for them. You may like to talk about what you have read and ask how they feel about it.
• Practice “active listening.” Listen to your family member or friend and express your understanding back to them. Acknowledge the feelings they are experiencing and don’t discount them, even if you believe them to be symptoms of the illness.
• Understand the challenges of medication. Although treatments have improved tremendously in the past decade, they can also lead to side effects that can make your family member or friend want to stop taking the medicine. There are many psychiatric medications, and sometimes it takes a while to find the right one with the least side effects. Encourage them to speak immediately to their health care provider about any problems related to medications. And urge them to keep taking their medication until a better one is prescribed.
• Recognize that feeling better, getting better and staying better are distinct stages in recovery. Your friend or family member may feel better relatively quickly, but if they do not continue treatment until they get better and stay better, a relapse is almost certain. Urge them to keep taking their medication and seeing their therapist until they are released.
• Recovery from mental illness isn’t only a matter of “just staying on your medications” or regularly visiting a therapist. Self-esteem, social support and a feeling of contributing to society are also essential elements of recovery and should be supported.
• Offer practical help. Offer to drive or accompany your family member or friend to medical and other appointments. And, if they want you to, discuss the treatment, side effects or other issues with the doctor and treatment team. You may need to do other things they are unable to do, such as shop, run errands or clean the house.
• Give respect. Always respect the individual’s need for and right to privacy. People with mental illnesses have the same right to be treated with dignity and respect as anyone else.
• Respect your friend’s or family member’s limits. There may be times when they say they are not able to do something because of their illness. It is important that you respect this and don’t put extra pressure on them. For example, people who are taking medication often are not able to drink alcohol. This may make it hard for them in certain social situations. If you know they are unable to drink, it may be helpful when you socialize with them to choose to do something that doesn’t involve alcohol.
• Recognize your limits. No matter how hard you try, there will be times when you just don’t understand your friend or family member, or don’t know what to do next. You get tired and frustrated, too. Sometimes it is best to just step away a short while and take some time for yourself.
• You should decide what level of support and care you are realistically able to provide. Explain this to the friend or family member with the mental illness as well as the health professionals involved in their care. Don’t commit to things that you know you cannot do.
• Make sure that you have contact numbers. Having the contact numbers of people like their psychologist, doctor or psychiatrist is often important in helping your friend or family member through a crisis. It means that you can contact someone who knows them should they be in a situation where they are unsafe.
• Maintain hope. There is hope for recovery, and with treatment, many people who have mental illnesses return to productive and fulfilling lives.

What to say if your friend or family member is unreasonable or delusional

Approach from their point of view

If your friend or family member is paranoid or having delusions, don’t argue with them. Instead, approach the topic from their point of view: “That must be scary. I’d like to help,” or “I can understand why you’re upset. Can we figure out together how to make this better?” Be supportive and respectful and offer to help find someone they can talk to about their state of mind.

What to say:

• “I’m bringing this up because I care about you.”
• “Nothing you could tell me would change our relationship.”
• “I’m here for you if you want to talk.”
• “If you were sick with an illness like cancer or diabetes, I’d be concerned. A mental health problem is no different.”
• “What can I do to help?”

What not to say:

• “You’re acting really emotional lately.”
• “Lighten up!”
• “What you should do is…”
• “All you need is an antidepressant and you’ll be back to normal.”
• “I know you would be embarrassed if anyone knew about this, so we’ll keep it just between you and me.”

When your friend or family member is not manageable or is out of control

When medication and coping strategies don’t work

For those who have a mental illness, there may be periods of time when things are simply not manageable. Harder times may be triggered if your friend or family member has been over-stressed, if there has been a traumatic event, or there has been a change in medication. These things can generate difficult symptoms that are very hard to control, particularly if they haven’t had time to learn coping strategies.

If you are concerned that your friend or family member is getting beyond their ability to manage their mental illness, it is important to encourage them to talk to a trained professional they trust, such as their doctor, psychologist or psychiatrist. Remember, you should keep a list of contacts either with you or in an easy-to-access place for emergencies.

If you think that your friend or family member is out of control or likely to hurt themselves or others, find help immediately, even if they don’t want you to. Do not try to handle it alone. Stay calm and call the appropriate numbers on your list of contacts. If you need to, do not be afraid to call 911. 

The National Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service available to anyone in a suicidal crisis. If you need help call 1-800-273-TALK (8255). You will be routed to the closest possible crisis center in your area.

For more information

A wealth of information is available

There’s a wealth of information available by phone, mail, and online. For online searches, Google is your friend. But remember that there are a lot of quacks, hucksters and snake oil salesmen just waiting to take your money with claims of a cure. See my post “Can Anxiety Disorder and Panic Attacks Be Cured” for more information. Watch out for sites sponsored by drug companies, or those who have an axe to grind. Look for sites that are peer-reviewed or have stated resources for their information.

Who can you trust, then? Three of the best online resources for general information are:

• Mayo Clinic 
• National Institute of Mental Health (NIMH) 
• Brain Explorer 

The following are grassroots organizations devoted to promoting mental health and reducing the stigma of mental illness. They both offer general information, and have helplines:

Mental Health America

2000 N. Beauregard Street, 6th Floor

Alexandria, VA 22311

703-684-7722

800-060-6642

MHA Helpline: 800-273-TALK (8255)

Web site 

National Alliance on Mental Illness (NAMI) 

200 N. Glebe Road, Suite 1015

Arlington, VA 22203-3754

703-524-7600

NAMI Helpline: 800-950-NAMI (800-950-6264)

Web site 

What do you think?

• Do you have any further suggestions to help your friend, family member or yourself?
• Have you ever been in a position to help a friend or family member with their mental illness?
• Do you have any good information sources you could add?

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Resources used in this post:

Better Health Channel. (2007, July). Mental illness — family and friends. Retrieved October 6, 2008 from Better Health Channel Web site: http://www.betterhealth.vic.gov.au/BHCV2/bhcarticles.nsf/pages/Mental_illness_family_and_friends?open

Koenig, Vicki. (2006). Mental Illness — Information for Families. Retrieved October 6, 2008 from Sanctuary Psychiatric Center’s Information Network Web site: http://www.spcsb.org/articles/mental_illness.html

Mental Health America. (2007, May 16). Supporting Friends and Family Who Have Mental Illnesses. Retrieved July 1, 2008 from Psych Central Web site: http://psychcentral.com/lib/2007/supporting-friends-and-family-who-have-mental-illnesses/

Reach Out. (2007, June 30). Supporting a Friend with Mental Health Difficulties. Retrieved October 6, 2008 from Reach Out Web site: http://www.reachout.com.au/default.asp?ti=277

Support a Friend Iowa. (2008). How to Begin a Conversation. Retrieved October 6, 2008 from Support a Friend Iowa Web site: http://www.supportafriendiowa.com/HelpaFriend/Howtobeginaconversation/tabid/76/Default.aspx

For further reading:

What a Difference a Friend Makes web site 

Rosalyn Carter’s book, Helping Someone with Mental Illness: A Compassionate Guide for Family, Friends, and Caregivers

©2008 Anxiety, Panic & Health. All rights reserved.

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Something is wrong, but you don’t know what it is.

It may take months or years for you and your family members to finally realize that you have an Anxiety Disorder. 

But those months and years have put a strain on relationships, household routines, and maybe even finances. Even with a diagnosis, some strain often lingers, and recovery can be a long process.

Partners and family members may want to help may not know how. They may do all the wrong things at the wrong time. As one commenter on this blog said, “I try and tell them to just leave me — I leave the room when [Anxiety and Panic] kick in — but people will not.”

This post will help you understand the strains on a family when one of its members has an Anxiety Disorder. It will also give you positive suggestions to help you help your family member.

Anxiety Disorders take a toll on the family

Anxiety Disorders can take a real toll on family and friends. They can be as disruptive as physical ailments, and sometimes more so. Among the strains the family may experience are:

Normal family activities

• Household routines and plans are disturbed.
• Special plans or allowances may need to be made for the Anxiety sufferer.
• Family members must often take on the full burden of handling responsibilities such as bills, shopping, and driving the kids to their activities.

Finances and employment

• The person with the Anxiety Disorder may find it difficult to get or keep a job.
• There may be serious financial strains that create major hardships for the family.
• Family members may have to step in to help financially support for the family, often a stressful role that they do not wish to have.

Social life

• The person with the Anxiety Disorder may be reluctant to participate in routine social activities, which can have a negative effect on family dynamics.

• Special plans for vacations and social events may have to be modified or cancelled.

• Partners of the person with Anxiety Disorder often feel isolated, since couples often spend their time with other couples.

Emotional well-being

• The family’s emotional state may suffer due to the family upheaval and economic hardships that an Anxiety Disorder may cause.
• Family members and partners may feel sad, depressed or scared for the family’s well-being. They may feel angry or resentful, and guilty for feeling that way.
• Family members, and especially children, may feel abandoned, neglected or frightened. 

How can you support a family member with an Anxiety Disorder?

If a family member has an Anxiety Disorder, you can make their improvement and recovery easier by providing support, encouragement and creating an environment that promotes healing. Below are some everyday tips that will help:

• Learn about the Anxiety Disorder. Some resources are listed at the bottom of this post.
• Encourage treatment, and help the person keep appointments and take medications.
• Be flexible and try to maintain a normal routine.
• Aim for positive reinforcement of healthy behavior, rather than only criticizing irrational fear, avoidance, or rituals (“Catch them doing something right”).
• Recognize and praise small accomplishments.
• Modify expectations during stressful periods.
• Measure progress on the basis of individual improvement, not against some absolute standard.
• Help set specific goals that are realistic and that can be approached one step at a time.
• Don’t assume you know what is needed. Ask how you can help. Listen carefully to the response.
• Acknowledge that you don’t understand if you’re never personally experienced a panic attack or other form of irrational anxiety.
• Understand that knowing when to be patient and when to push can be challenging. It’s a fine line. Achieving a proper balance often requires trial and error.
• Remember, recovery requires hard work on the part of the individual, and patience on the part of the partner and family. It may seem like a slow process, but the rewards are well worth it.

Conclusion

The challenges to the family with a person with Anxiety Disorder can be daunting. 

Family members and partners may feel understandably overwhelmed and burned out from bearing most of the burden for family activities that often come so easily to other couples and families. It is also important for family members to keep in mind that the recovery process is stressful for them, too.

Family support is essential to the recovery process. But it is not the cure. Getting better and staying better takes hard work, mostly from the person involved. And it takes patience from everyone, family and friends alike.

But it is important to remember that with treatment, people with Anxiety Disorders can go on to lead a normal, productive life that include a successful career, thriving social lives and busy schedules.

What do you think?

• Do you or have you had a family member with an Anxiety Disorder?
• How have you coped?
• Can you make any additions or suggestions to this post?

As always, your comments are welcome!

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Resources used in this post:

Anxiety Disorders Association of America. (2007, June). When Your Partner Has an Anxiety Disorder. Retrieved July 16, 2008 from Anxiety Disorders Association of America Web site: http://www.adaa.org/gettinghelp/MFarchives/MonthlyFeatures(june07).asp

Anxiety Disorders Association of America. (2007). Helping a Family Member. Retrieved June 27, 2008 from Anxiety Disorders Association of America Web site:http://www.adaa.org/GettingHelp/HelpAFamilyMember.asp

Resources for the family

Anxiety Disorders Self-Test for Family Members – Anxiety Disorders Association of America

Anxiety Disorders Association of America  

Caregiver.com  

How to Take Care of Yourself When Your Partner Has an Anxiety Disorder 

Search for Specific Anxiety Disorders – Mayo Clinic  

National Institute of Mental Health Anxiety Disorders Overview

Strength for Caring  

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All couples have their share of challenges. 

But when one half of a couple has an Anxiety Disorder, partners face a whole new set of challenges. And the issues associated with Anxiety Disorders may exacerbate many of the normal issues that couples face.

One partner may not know how to help his or her significant other and becomes frustrated, angry, resentful or feel guilty, sad or hopeless about the situation. Over time, this will severely hamper your ability to care for your partner with a Anxiety Disorder.

It is important that you understand that you need to take care of yourself. Immersing yourself in your partner’s Anxiety Disorder can be debilitating, and you are not being selfish to want to have a break.

How can an Anxiety Disorder affect a couple’s relationship?

An Anxiety Disorder can take a major toll on a couple. A study done by the Anxiety Disorders Association America in 2004 reveals in great detail how a couple’s relationship is affected. Although it only studied people with Generalized Anxiety Disorder (GAD), it likely holds true for people with other Anxiety Disorders. 

The study found that a couple’s relationship suffered the most compared to other personal relationships, such as friends and family. People with GAD were twice as likely to have at least one relationship problem, and three times more likely to avoid being intimate with their partner. In addition, 75 percent said that they felt their disorder impaired their ability to perform normal activities with their partner, such as going out and social activities.

How can you help yourself if your partner has an Anxiety Disorder?

Living with an Anxiety Disorder is associated with a great deal of personal distress. But it can be equally hard for a partner. The reality of living with a partner with an anxiety disorder is not how most people imagined their lives would turn out.

It is extremely important — and not selfish — for the partners of individuals with an Anxiety Disorder to take care of themselves as well as for their partner. Here are some tips to help you cope:

• Don’t give up your own life and interests. Engaging in outside interests and hobbies can provide a much-needed break from the stress of your daily life. You will be more energized, happier, healthier and better prepared to face challenges. It is important to take this time for yourself and not become completely consumed with your partner’s disorder.
• Have your own social life. Whether it’s going out to eat with a friend, singing in the church choir, or going to club meetings, it is essential that you get out and away from your partner from time to time.
• Keep active and exercise. Regular exercise can help you feel more positive, and gives you energy and stamina. It will help you get out of the house and get your mind off your stressful situation. 
• Eat healthy. Having a balanced diet will not only help the way you feel, but will help the way you think.
• Maintain a support system. Having friends and family to confide in and count on — as well as assist you emotionally, financially and in other ways when your partner cannot — is vital for an individual whose partner has an Anxiety Disorder. You can feel isolated and overwhelmed by problems sometimes, and having someone to talk to helps greatly. There are support groups for caregivers in many communities.
• Relax. Take the time to relax just for yourself. You may have a favorite activity such as reading, gardening or listening to music. Or you may just enjoy sitting and enjoying the scent of a candle. The important thing is that you regularly take time for yourself.
• Express yourself. Our creativity often goes unnoticed, even by ourselves, much less given a regular outlet. Find a way to express your emotions and needs on a regular basis, such as journaling, blogging, painting, writing or some other method.
• Set boundaries. Decide where your limits lie and inform your partner of those. These might be emotional, financial, physical, etc. For example, if your partner is not working and is not doing anything to try to become well such as seeking treatment, you may need to have a serious discussion about your expectations and how to move forward to improve the situation. Couples therapy can often help with this.
• Seek out professional help for yourself if necessary. The recovery process can be stressful for partners of people with Anxiety Disorders. Your well-being is just as important as your partner’s. If you need someone to talk to, or you think you may be suffering from symptoms of anxiety or depression yourself, you should talk to your doctor or consider visiting a mental health care professional yourself.

What do you think?

If you are the partner of someone with Anxiety Disorder, you know how hard it can be sometimes. You should not feel guilty or selfish for regularly taking the time and energy to take care of yourself!

• Are you the partner of someone with Anxiety Disorder or another mental disorder?
• What have you learned about taking care of yourself?
• Have you experienced emotions such as frustration, guilt or anger? How have you overcome them?

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Resources used in this post:
Anxiety Disorders Association of America. (2004). New Survey Reveals How Generalized Anxiety Disorder Interferes with Ability to Maintain “Healthy” Relationships. Retrieved April 29, 2005 from Anxiety Disorders Association of America Web site: http://www.adaa.org/aboutADAA/newsletter/newsurvey04.htm

Anxiety Disorders Association of America. (2008). When Your Partner Has an Anxiety Disorder. Retrieved July 16, 2008 from Anxiety Disorders Association of America Web site: http://www.adaa.org/gettinghelp/MFarchives/MonthlyFeatures(june07).asp

Framingham, Jane. (2007, October 23). 10 Tips to Help Yourself. Retrieved June 27, 2008 from Psych Central Web site: http://psychcentral.com/lib/2007/10-tips-to-help-yourself/

Further reading:

Caregiver.com 

Strength for Caring  

Well Spouse Association   
©2008 Anxiety, Panic & Health. All rights reserved.

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