Christmas tree and lights

The Mental Illness Holiday Survival Guide

The holidays can be some of the worst days of the year when your family is dealing with mental illness.  Not only is it TOO DARN DARK AND COLD, but it’s also a time when expectations of being Merry and Bright can seem especially hard for your family.

Why the holidays can be hard

Having a mental illness makes you extra vulnerable to the demands, pressures and expectations of the holidays. We deal with:

  • The demands of the culture, like parties, shopping, baking, cleaning and entertaining.
  • The changes of schedule, which can be really challenging for a person who has a mental illness.  Getting out of normal routine can lead to forgetting meds and getting self-care out of balance.
  • Family functions and crowds that trigger anxiety.
  • Financial stresses because your loved one is not being able to participate.
  • A pronounced sense of the passing of time. Gathering with cousins, friends and family reminds your loved one of all the “normal” parts of life that seem out of reach to him.
  • The noise, which can make the noise in their heads worse.

The stress can make your loved one have more symptoms. In fact, a NAMI study found that 64% of people with mental illness report that their symptoms are worse during the holidays. And that can make you even more anxious.

Make your loved one a priority in planning

Yes, you can make the holidays a little less stressful for your loved one with mental illness. Their health comes first. And you may be surprised to see that this helps your mental health as well.

Any family member who is inconsiderate or otherwise difficult to your loved one should be kept away. I banned a brother-in-law for horrible comments during a holiday dinner. We didn’t make a big deal of it; we just never invited him again. He’s now dead, and I’m still glad I did it.

Set expectations

Let your loved on know the plans ahead of time. Make the holiday as consistent as you can.

For you, accept that your holidays are different now.  If you can get rid of your unrealistic expectations and be honest with your loved one and all the other family members, it will go better. Just remember: You can’t force anyone to be happy.

Know your loved one’s limits … and your own

Is being around family a trigger? Are crowds? You need to be aware of this.

Acknowledge your feelings.  If someone close to you is suffering from a mental illness, it’s normal to feel sadness and grief. If it’s a child, a sibling or a parent, Christmas can hold a lot of memories.

Avoid feeling guilty.  Around the holidays, many people want to be many things to loved ones. We don’t want to hurt anyone’s feelings. So we put pressure on ourselves.  Pleasing everyone is unrealistic. 

At the same time, let participation be your loved one’s decision.

Keep your routine

Try as much as possible to maintain routines like:

  • Sleeping
  • Regular meals and good nutrition
  • Exercising
  • Taking medication
  • Keeping appointments with mental health professionals
  • Attending support groups

Think about the warning signs of relapse.  If you start to see them, encourage them to retreat to a normal routine.

Provide dignity

Help your loved one to keep her dignity. Provide a gift fund or another way to allow her to give gifts, so she won’t feel left out if she has no money.

If crowds or frenzy are a problem, encourage them to shop online. Or offer to help pick up the things they need.

Consider volunteering. The satisfaction of giving to others can help you put your own problems in perspective.

Scan every situation that’s coming up to make sure that your loved one won’t get unwelcomed attention.

Keep the celebration small and safe

Hey, it’s a good excuse to keep the unofficially crazy family members away.  You want a small gathering of your own family.  Period. Otherwise it’s too stressful for your loved one.

Identify what they really want to do.

Don’t overschedule. Pick and choose.  If your loved one will be uncomfortable in a situation, it’s ok not to go.

Encourage your loved one to keep connected and not be isolated.  Spending time with a friend or family member … even just one … can help.

Keep it short. Keep it informal.

If you have to do the Big Family Thing, let your loved one stay home. Big groups can be too much for your loved one, especially when you have to Put On a Happy Face. If you have a large family and lots of traditions, you can encourage your loved one to pick her favorites and let go of the rest.

Setting specific times for family traditions, like baking special food, decorating the house, wrapping gifts or attending community celebrations, gives the person something to look forward to.

If any of your extended family members really want to see your loved one, they know your phone number and where you live. Something private is better.  And try not to be bitter if no one asks. (There’s a reason God chose you to be this person’s lifeline. Not everyone can deal with this.)

When people ask

The best answer I’ve found to the question … How is he? … is “About the same.” That’s tough enough for you to answer.  So please don’t put your loved one in a situation where he or she has to answer the question.

During this time, we may find ourselves at extended family gatherings or at parties with people who do not understand the illness. Some people may be uncomfortable and not know what to say to you. Others may say hurtful things or offer cliché advice out of ignorance. It is helpful to prepare by knowing who may be at a gathering.

When the event is at your house

If you are having an event at your house, discuss it in advance with your loved one so he or she knows what to expect. Accept his limits.  Accept her choices. Acknowledge his feelings. 

If the person wants to be more visible during the holiday, brainstorm some things in advance.  What will he say when asked how he is? What will she do during the gathering? Is there a quiet place to retreat if needed?

Work out a plan. The loved one can walk a dog, or go outside.

If someone offers to help you with any holiday preparation, ACCEPT. 

Finally, don’t drink alcohol, especially if you are around family.

When you go to other people’s houses

Don’t overschedule.  Ensure that the person will be able to do their regular nightly routine.

Tell the person whose home you are visiting what you may need in advance. 

Go in multiple vehicles or take other modes of transportation so you can leave when you need to go.

Please don’t put yourself in a position … helping cook at someone else’s home, for example … where you can’t leave with little notice. If you are stuck, have someone … a sibling or spouse … available to get the person home if needed. 

All your great preparation may result in your loved one refusing to participate at the last minute. And that’s OK. 

Have yourself a merry little Christmas

When you make out your own Christmas wish list, ask for things that will reduce stress, whether it’s a massage, a day trip, a cleaning service or a gym membership. 

Eat right. Avoid the alcohol. Sleep. And write out a list of things that you are grateful for this year.

Live in the now.

I also create my own holiday rituals that are 100% under my control. I celebrate Advent, with a creche, a reading plan and activities that mean a lot for me.

Advent is a time of waiting. We are all waiting for the days when our loved ones will be well, whether here on Earth or in Heaven. You can lift this thought up as you celebrate.

older person's hand and young adults hand

New Resources to Help Families

For Addiction, Eating Disorders and Mental Health Issues

SouthJerseyRecovery.com is a free web resource providing information about addiction, eating disorders, and mental health issues.

Studies have found that when someone with a depressive disorder abuses alcohol, both disorders are impacted and often become more severe. In the same vein, major depressive disorder is the most common co-occurring mental health condition among those with alcohol use disorder.

To spread awareness to the public, the organization recently published a guide covering depression and addiction where we expand on the connection between depression and drug addiction, treatment options, FAQs and more.  You can find it here: https://www.southjerseyrecovery.com/treatment-programs/dual-diagnosis/depression/

Suicide and drinking are linked, and it is important to be able to tell when someone who drinks may be at risk of killing themselves. You can find that information here:

For Children’s Mental Health

We’re previously recommended Nationwide Children’s Health’s programs for families dealing with childhood mental illness, including the On Our Sleeves campaign. The pandemic has worsened the situation, with one in 5 children experiencing mental health issues in a year.

If you would like to learn more addressing the policies and problems that are making it difficult to help children with mental illness, visit the Collaboratory for Kids & Community Health website.

The collaboratory focuses on four main areas:

  • Improving neighborhoods.
  • Addressing inequities.
  • Creating population health strategies to address the national shortage of providers to care for children’s mental and behavioral health.
  • Developing value-based care programs for those with limited financial resources.

For Seniors and Their Caregivers

Caring for seniors, no matter how much we love them, comes with a lot of challenges, including higher levels of psychological stress. This becomes worse when the senior has mental health issues. We will be covering this issue soon on Loving Someone With Mental Illness.

Meantime, caring.com has a caregiver’s guide that covers burnout and stress, including how to identify and manage each. We also discuss respite care options and share a list of helpful resources for caregivers. 

You can see them here:

If you know of other helpful resources, feel welcome to let me know. Thanks!

ipad with medical record

Keep Your Own Record

Even today, it’s hard for medical institutions and doctors to piece together a medical record. So it can be helpful to create your own medical treatment record for your loved one with mental illness. That way you have something ready when you need to provide information.

The excellent book “When Someone You Love Has a Mental Illness” by Rebecca Woolis suggests that your record contain information about:

  • Your loved one’s level of functioning before becoming ill.
    • Highest level of school attained
    • Work history
    • Level of basic life skills (cooking, cleaning, money management, experience with independent living)
    • Social skills and relationships with peers
    • Significant achievements
  • Their symptoms.
    • What they are
    • When they began
    • Worst episodes with dates
    • Most effective treatment so far
  • Treatment history.
    • Dates of psychiatric hospitalizations
    • Diagnosis
    • Types of medication used and their effectiveness (with dates if possible)
    • Types of therapy used and their effectiveness (with dates if possible)
  • Your loved one’s level of functioning between hospitalizations and treatments.
  • The names, addresses, phone numbers and emails of all members of the treatment team (psychiatrist, therapist, social worker or case manager).
  • Medical insurance information.

When you are dealing with mental health professionals, you want to appear credible. You make the best impression when you are courteous and respectful of their time. Try to understand that these professionals are under constraints such as:

  • Not being able to be effective with those who refuse treatment.
  • A heavy caseload.
  • Lack of adequate funding.
  • HIPPA and other confidentiality regulations.

Even if the illness is decades long, try to go back through your documentation to create a medical record. It will probably be more helpful than the record that the treatment team has.

alpha invite

Ask Anything

Loving Someone With Mental Illness is a support group for friends and families of those with severe and persistent mental illness. Meeting twice a month on Zoom, we share our stories, learn more about dealing with mental illness and pray together.

During October and November 2022, we are holding a series of conversations about things we question in our lives. This is a judgment-free space to connect and process questions about things, such as “Why did God allow my loved one to get sick?” and “Does God heal?” These discussions are part of our Alpha series.

Here’s a video about the Alpha series.

If you’d like to join us at Loving Someone With Mental Illness, contact karentwinem@gmail.com.

a therapy session for mental health treatment

Treatments for Mental Illness

Navigating the mental health system can be quite difficult. But once you have your loved one there, what happens?

For severe and persistent mental illness, the best practice is to use traditional psychotherapy or “talk therapy” with medication. If the brain is not functioning correctly, all the therapy in the world can do little good. So stabilizing the brain is the first priority.

What types of medication are used?

  • Antipsychotics reduce or eliminate delusions and hallucinations by impacting the brain chemical dopamine.
  • Antidepressants improve depression by impacting the brain chemicals associated with emotion: serotonin, norepinephrine and dopamine.
  • Antianxiety medication reduces the emotional and physical symptoms of anxiety. This includes meds like Xanax and beta-blockers.
  • Mood stabilizers are medicines that treat and prevent mania and depression. They are most commonly used for bipolar disorder. Examples include carbamazepine (Tegretol), divalproex sodium (Depakote), lamotrigine (Lamictal) and lithium.

What types of treatment are used?

Once the medications are working, doctors and social workers have a variety of options for psychotherapy. In each case, the person works with a therapist in a safe, confidential environment to understand their feelings and behavior, while learning new ways to cope. These types of treatment may include:

  • Cognitive Behavioral Therapy (CBT) is based on the relationship between thoughts, emotions and behaviors. The therapist works to uncover unhealthy patterns of thought that cause self-destructive behavior and beliefs. Once those patterns are identified, the patient can identify them and learn to find more constructive ways of thinking and responding. Used for depression, anxiety, bipolar disorder, eating disorders and schizophrenia.
  • Dialectical Behavior Therapy (DBT) combines CBT with teaching skills in mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. It emphasizes validation, or accepting uncomfortable thoughts, feelings and behaviors. The therapist helps the person find a balance between accepting themselves and changing by learning new skills and coping methods. Originally developed for people with borderline personality disorder, it is now used for other illnesses as well.
  • Eye Movement Desensitization and Reprocessing Therapy has the patient focusing on two things at once: emotionally disturbing thoughts and an external stimulation, like eye movements. For PTSD.
  • Exposure Therapy involves gradually exposing the patients to their phobia or the cause of their anxiety without causing them any danger. For obsessive-compulsive disorder, PTSD and phobias.
  • Interpersonal Therapy focuses on relationships by improving the patient’s interpersonal functioning. For depression.
  • Psychodynamic Therapy includes free association and open-ended questions. For depression, anxiety, borderline personality disorder and other illness.
  • Mentalization-Based Therapy combines psychodynamic, CBT, systemic and ecological therapies. It’s used for borderline personality disorder because the illness often causes feelings of emptiness or unstable self-image. Mentalizing allows the patient to consciously perceive and understand their own feelings and thoughts. It also allows them to understand more about the feelings and thoughts of others.
  • Therapy Pets help reduce symptoms of anxiety, depression, fatigue and pain.

Next time we’ll cover the best ways to work with mental health professionals and how to keep a treatment record.

parents and child at therapist

How to Check on a Child’s Mental Health

An urgent public health crisis. Yes, we’ve had quite a few of those lately. But that is exactly what the U.S. Surgeon General’s office called the state of children’s mental health, starting in 2021.

It’s easy to understand why. The national statistics about mental health in children were getting worse before the pandemic. The Center for Disease Control and Prevention announced this year that more than one-third (37%) of high school students reported poor mental health in the pandemic and 44% reported that they felt persistently sad or hopeless during 2021.

And it’s not just the teenagers. ADHD, anxiety, behavioral issues and depression are the most commonly diagnosed mental disorders in children.

1 in 6 children aged 2-8 years has a mental, behavioral, or developmental disorder

Bar Chart: Mental disorders by age in years - Depression: 3-5 years: 0.1%26#37;, 6-11 years: 1.7%26#37;, 12-17 years: 6.1%26#37; Anxiety: 3-5 years: 1.3%26#37;, 6-11 years: 6.6%26#37;, 12-17 years: 10.5%26#37; Depression: 3-5 years: 3.4%26#37;, 6-11 years: 9.1%26#37;, 12-17 years: 7.5%26#37;

Nationwide Children’s Hospital in Columbus started the On Our Sleeves campaign to encourage families to talk with children about mental health issues. One aspect of this campaign is Operation: Conversation, an excellent way to start the school year.

Asking the right questions

By asking important questions and listening carefully, parents, grandparents and others can detect the signs of positive mental health as early signs of emotional problems. Some of the conversation starters include:

  • Did you talk to anyone new today?
  • Did anything happen at school today that you weren’t expecting?
  • What’s your favorite song right now. How does it make you feel?
  • What animal do you think is most like you?
  • What made you proud today?
  • How did you cope with hard emotions today?
  • What is a problem you solved today? How did you do it?
  • What do you do when you want to cheer up?
  • When you feel worried, sad or any, what is going through your mind.

The free, expert-developed resources for starting these conversations, talking with kids about mental health and giving advice are found here.

Although the number of problems are going up, most parents do find indicators of positive mental health, such as:

  • Affection
  • Resilience
  • Positivity
  • Curiosity
  • Persistence
  • Self-control

If you hear something that worries you, you are not alone. (Information about early signs of mental illness in children is found here.) Don’t ignore it. Seek help. If you work with reputable people, you can help your child learn techniques for dealing with difficult thoughts. You also may find a brain chemistry issue so early that it can be treated, allowing your child to experience a happier life.

Columbus-Area Respite for Caregivers

Columbus-area caregivers now have a free program that helps both the caregiver and a loved one with mental illness. ADAMH, Concord Counseling Services and NAMI have teamed to provide this respite program for caregivers to all Franklin County, Ohio, residents.

Please Google “mental health respite programs” to find similar programs in your area.

A respite program allows a trained professional to spend time with your loved one so you can do other things. You’ll get a three-hour block per week to yourself so you can enjoy self-care and tend to other responsibilities. Even better your loved ones with mental illness get to enjoy activities they pick and interact with other people safely, with a trained mental health professional nearby.

This video explains the Concord respite program that’s free to all residents of Franklin County, Ohio.

The mental health specialist spends up to three hours a week or 12 hours per month between 7 a.m. and 9 p.m. with your loved one. They can do activities at home or out in the community. Flex funds are available to help pay for the activities. There’s no waiting list at this time.

For more information about the Concord respite program, call 614-501-6264 or click here.

988 is new suicide prevention hotline number

Now Open: 988 Suicide Hotline

A new national suicide hotline number is now open. Call 988 when you want to prevent suicide.

In Ohio, the 988 number connects to one of 15 designated lifeline call answering points. Trained mental health specialists answer the calls, providing both counseling and direction to resources for mental health care.

The new number is based on the success of 911, which has been used as an emergency number for all types of crises since 1968. Officials hope that sending suicide calls to 988 will take pressure off the 911 system, which sends police and/or paramedics to a scene.

The 988 calls connect people immediately to mental health crisis services. It also improves the information provided. Until the hotline opened this month, more than 40 percent of Ohio’s suicide prevention calls were answered by people from other states who didn’t know the Ohio system and could not give advice about accessing its resources.

The Department of Mental Health and Addiction Services is implementing the new line with federal startup funds of $400 million.

In addition to the designated call line, NAMI Ohio is also asking for the development of a better, more thorough crisis response system, allowing the specialist to help direct people to housing, rehabilitation services and employment services. I agree with this, although I know it will be difficult to get the funding. After all, it doesn’t help much to answer the phone if you can’t direct people to the help they need.

nurse and doctor comfort patient

Who’s Who on a Mental Illness Team

The United States does not have a well-organized system to treat substance abuse and mental illness. Sometimes it’s hard to know who to turn to for your needs. This overview answers the question: Who does what?

Primary care physicians can prescribe and monitor medication, but often prefer that you work first with a psychiatrist.

Psychiatrists are licensed medical doctors with medical and psychiatric training. They can diagnose and prescribe medication.  Some provide therapy.

Psychiatric nurse practitioners have a master’s or PhD and specialized training. They can assess, diagnose, prescribe medication and do therapy. You can usually get an appointment with a psychiatric nurse practitioner more quickly than with a psychiatrist.

Clinical psychologists with doctoral degree make diagnoses and provide individual and group therapy.

Psychiatric or mental health nurses, depending on education and licensing, can assess and treat illness, do case management and provide therapy.

School psychologists can make a diagnosis, provide therapy, and work to provide healthy school environment. My personal experience is that school psychologists do not have enough bandwidth to do an effective job with children who are struggling.

Counselors can help find better ways of thinking and living, as well as help people develop life skills. Some can diagnose and treat.

Clinical social workers has a master’s degree in social work. They make diagnoses and provide counseling, case management and advocacy.

Peer specialists are individuals who have experience with a mental illness and can help others with recovery.

Social workers with a B.A. or B.S. can provide case management, inpatient discharge planning and placement services.

Psychiatric pharmacists have doctoral training and residence training to provide comprehensive medication management. They usually work in a health care system like Veterans Affairs, hospitals, clinics., etc.

abandoned mental hospital interior

Our Mental Health “System”: A Shameful History

When you are navigating the mental health system, have you felt:

  • Confused?
  • Frustrated?
  • Angry?
  • Insulted?

To say that the United States does not have a well-thought-out mental health system is a great understatement. Here’s a brief review of how we got here:

In the 1700s, mental health treatment began to move from the horrific asylums to hospitalization. By the first half of the 20th century, mentally ill people were usually either at home or in institutions.

The year 1954 introduced the first antipsychotic drugs, which improved functioning for many people.  So many thought that people with mental illness could live outside of hospitals.

In the early 1960s, the Kennedy administration introduced a plan for more humane mental illness treatment.  In 1963, President John F. Kennedy signed the Community Mental Health Centers Act. The program proposed closing the hospitals and replacing them with community mental health centers, where the mentally ill could be treated in homelike settings.  This included strict standards so only individuals “who posed an imminent danger to themselves or someone else” could be committed to a state psychiatric hospital.

Mental hospitals began to close in the mid-1960s. But Congress never approved the funds needed to open the equivalent number of community mental health centers.

President Jimmy Carter’s Mental Health Systems Act of 1980 was passed to continue federal funding for mental health programs.  In 1981, President Ronald Reagan, in The Omnibus Budget Reconciliation Act , repealed that act, eliminating the money needed for these centers.

In 1955, 558,239 severely mentally ill patients were institutionalized at public hospitals (Torrey, 1997). By 1994, by percentage of the population, we have 92% fewer hospitalized individuals (Torrey, 1997).

Today, community mental health centers do provide mental health services. But many people released under deinstitutionalization became their families’ responsibilities.

They also became homeless (26% of homeless have mental illness, according to HUD). Many of them are in prison. People with mental illnesses are overrepresented in prison. It’s estimated that 55 percent of male inmates and 75 percent of female inmates have mental illnesses.  Meantime, the CDC says there are 5.7 million emergency department visits with mental illness as the diagnosis annually.