Tag / mental health

what the center looks like
by karentwinem

New Mental Health Care Options

New ideas for helping people with mental health crises are becoming reality around the country. Federal, state and local governments support these programs and centers. They want to reduce the burden on emergency rooms and support rural residents who have little access to help.

These programs range from walk-in crisis care centers to intensive residential programs for children. One of the newest walk-in centers is in my home county: Franklin County, Ohio.

The Franklin County Crisis Care Center opened the first phase of its offerings on September 2, 2025. Open 24/7, the center is like a psychiatric emergency room. It provides immediate care in mental health or substance abuse crises. It is located at 465 Harmon Ave. on Columbus’ west side and accessible by bus lines. Families also can call 988 to get help from the center.

This month (November 2025) Franklin County voters passed a levy that continues funding for the new center and allows expansion of a non-police response to mental illness emergencies. More than 30,000 adults are treated for mental illness and substance issues in Franklin County annually.

Service Offerings

  • 24/7 Walk-In Services: Immediate access without an appointment
  • 23-Hour Observation: A safe and calming space for short-term stabilization and intensive observation for up to 23 hours
  • Community Services: On-site connections to mental health and substance use treatment providers, housing resources and other essential services within Franklin County
  • Substance Use Disorder Treatment Services: Comprehensive services from detox to the initiation of medication-assisted treatment
  • Pharmacy Services: On-site pharmacy with automated medication dispensing system

Improving the Gap Between Hospital and Home

Caregivers have long wanted more help as loved ones move from the psych ward to their homes. These options help people learn how to maintain sobriety and/or improved mental health.

Intensive residential programs give needed support to individuals, especially children, as they transition out of a hospital setting before going home.

Therapeutic boarding schools provide a highly structured environment with therapy for young people who don’t require intensive treatment but need support in a therapeutic setting. 

The availability of common-sense mental health care settings seems to be on the rise. That can only be a good thing for everyone.

by karentwinem

Handling Hypomania and Agitation

Information is from “When Someone You Love has a Mental Illness” by Rebecca Woolis,  “The Complete Family Guide to Schizophrenia” by Dr. Kim T. Mueser and Susan Gingerich and the Palo Alto Medical Foundation.

I’ve found that it’s difficult to get immediate response from my loved one’s treatment team or anyone else when my loved one is dealing with symptoms of mental illness. My first response is to call them. While I’m waiting for a response, I’ve found this advice from the sources above useful.

Responding to Hypomania

Mania and mixed states are a medical emergency, so medical help is needed. If you can’t get a response from the treatment team, consider going to the emergency room or a psychiatric emergency room.

Hypomania can be a common symptom, which your loved one may have to live with repeatedly.

The best advice for those who love them: Don’t take the symptoms personally.  When in the midst of a bipolar episode, people often say or do things that are hurtful or embarrassing. When manic, your loved one may be reckless, cruel, critical and aggressive. Try to remember that the behaviors are symptoms of your loved one’s mental illness, not the result of selfishness or immaturity.

Be prepared for destructive behaviors.  When your loved one is well, negotiate a treatment contract that gives you advance approval for protecting them when symptoms flare up. Agree on specific steps you’ll take, such as removing credit cards or car keys, going together to the doctor, or taking charge of household finances.

Spend time with the person. People who are hypomanic often feel isolated from other people. Spending even short periods of time with them helps. If your loved one has a lot of energy, walk together. This allows your loved one to keep on the move but still share your company.

Avoid intense conversation and arguments.

Prepare easy-to-eat foods and drinks. It’s difficult for your loved one to sit down to a meal during periods of high energy, so try offering them peanut butter and jelly sandwiches, apples, cheese crackers, and juices, for example.

Keep surroundings as quiet as possible. Avoid subjecting your loved one to a lot of activity and stimulation. 

Allow your loved one to sleep whenever possible. During periods of high energy, sleeping is difficult, but short naps throughout the day can help.

Responding to Agitation

Decreasing stimulation can reduce agitation.  You can encourage your loved one to try relaxation exercises, deep breathing or blocking sound using ear plugs.

Responding to Disorganized Speech

Speaking in gibberish is a frightening thing to observe. If you can’t get ahold of the treatment team quickly, you may want to go to the emergency room or the psychiatric emergency room.

Your job is to communicate that you care.  Respond to emotional tone if you can see it.  If you sense fear, talk about how hard fear is to deal with. If you can pick out a sentence that makes sense, you can respond to that.

When one of my loved ones spoke in gibberish, I was able to pick up the tone. I did say that I couldn’t understand what they wanted, which they seemed to understand. We were in an institutional setting so I felt comfortable with this, as I could get help if the frustration spilled over into throwing things.

As I hope I’ve made clear, your treatment team is the best source of information for how to deal with the symptoms of mental illness. If you cannot talk with the treatment team regularly, continue to educate yourself with articles like this and useful books. To see our recommended resources, click here.

a photo showing how delusion might feel
by karentwinem

Dealing With Delusions and Hallucinations

Handling the Symptoms of Mental Illness

Note: The information is from NAMI, Mental Health America, “When Someone You Love has a Mental Illness” by Rebecca Woolis,  “The Complete Family Guide to Schizophrenia” by Dr. Kim T. Mueser and Susan Gingerich, and the Palo Alto Medical Foundation. It also reflects what I have learned through personal experience.

Some questions that I have heard in our support group include:

  • “What do I say when she says someone on television is sending her secret messages?”
  • “What do I do when he gets the locks changed because he thinks the FBI is trying to get into our house?”
  • “What do I do when he disassembles the pipes to find out where the voices are coming from?”

All these questions are related to delusions and hallucinations, which are symptoms of schizophrenia, bipolar disorder (in some cases) and other forms of mental illness. Three factors that can influence symptoms are inadequate medication, substance abuse, and high levels of stress. About half the people with schizophrenia have symptoms most or all the time, even with medication. Symptoms also can be signs of relapse coming.

Of course, we always point people to the experts.  When problems develop, call the treatment team. But it can be hard to get in touch with a social worker or a psychiatrist, whether you have a HIPAA release or not. So I’m providing the information that I have collected and used in real-world situations as support.

Responding to Delusions and Hallucinations

People vary in their sensitivity about their delusions or hallucinations.  Previous medical history is a fairly good predictor of this. Some signs that a hallucination is taking place include when your loved one is:

  • Talking to themselves as if responding to questions or comments, but not in a conversational way, such as: “Where did I put my purse?”
  • Staring into space, or being distracted or preoccupied.
  • Laughing for no apparent reason.
  • Appearing to see something that you can’t see.

Hallucinations and delusions often start out as benign, but can become more troubling over time.

People can learn to deal with hallucinations through therapy (including cognitive behavioral therapy), medication, ignoring the hallucination, telling the voices to leave them alone or playing music loudly. Shifting attention to music or television can help.  Working toward acceptance through prayer also helps.

Principles to Keep in Mind

When you are dealing with a loved one who seems delusional or may be having auditory or visual hallucinations, there are some basic principles to keep in mind.

While the things they say that they see, hear or believe are not apparent to you and may not make sense, they are very real to that person. They actually hear voices and see images.  They believe the things they are telling you. Do not dismiss or minimize the impact of this. Do not get into an argument about whether the voices are real.

Research shows that confronting people about their delusions may result in an initial decrease of belief in them, followed by a rebound that makes the belief in the delusion stronger.  This discredits you. If you are forced to take a stand on this situation, just say that you know the experience is true for them.

People, particularly those who have been in treatment for some time, may not be entirely convinced that the delusion or hallucination is true.  They know that this can be a symptom of their illness.  If they check with you to see if what they are seeing or hearing is true, you can tell them that it is likely that this is a trick that their mind is playing or whatever term is comfortable for them.

Respond to the Emotional State

A variety of emotional states accompany delusions and hallucinations, ranging from pleasure to terror. It’s more important to respond to the emotional state you detect than to the content of the delusion or hallucination.  Use listening skills like paraphrasing and asking clarifying questions to reflect what you hear. Ask: “What can I do to help you feel safe?”

You can ask if the person is seeing or hearing something. Try to get enough information to determine how they are feeling and focus on that.

Do not make fun of the person or try to have a lengthy conversation about the content of the hallucination.

Keep in mind that your statements may be confusing to the person as well.  If a voice is saying that you are going to kill him, and you are saying everything is fine.  You see the problem.

This is the second of a series on handling the symptoms of mental illness with your loved one. Next time: responding to agitation and hypomania. As always, if you can get advice from the medical team treating your loved one, use that advice instead.

handling bizarre behavior and anger in people with mental illness
by karentwinem

Handling Anger, Bizarre Behavior and Negative Symptoms

Information is from “When Someone You Love has a Mental Illness” by Rebecca Woolis, “The Complete Family Guide to Schizophrenia” by Dr. Kim T. Mueser and Susan Gingerich, and the Palo Alto Medical Foundation.

The best answers for how to respond to the symptoms of your loved one’s mental illness come from their treatment team. However, I’ve found it can be hard to get answers from the team quickly. This information below is from respected sources and my own experience to help when you need to respond immediately.

Responding to Anger

First, if you are angry or upset at your loved one, separate until you can calm down. To deal with their anger, you need to remain as calm as you can, and stay in control of yourself. When your loved one is angry:

  • Do not approach or touch your loved one without permission.
  • Give your loved one an escape route out of the situation.
  • Don’t give into angry demands that violate your boundaries.
  • Do not argue with irrational thinking.
  • Acknowledge the person’s feelings.
  • Protect yourself from injury.

If necessary, call 988 to get connected to a mental health team. If you feel you are in immediate danger and can’t get a rapid response, call the police and ask for an officer trained in dealing with the mentally ill.

If angry outbursts become routine, you need to discuss this when everyone is calm and can agree to some steps.  This could include:

  • A medication review
  • Venting energy via exercises, such as hitting a punching bag or yelling in a place where it won’t bother anyone.

Dealing with Bizarre Behavior

Bizarre behavior is a symptom and is often related to delusions. This can include strange rituals and OCD-like activity and unusual beliefs acted out.

If the behavior is harmless, you can ignore it if you wish.  (For example, if your loved one can’t go get ice cream because everyone can read his mind at Graeter’s). Focus on positive behavior, and ignore bizarre behavior.

If it constitutes a problem (running around the neighborhood naked, doing dangerous things, damaging property, etc.), you can ask the person to stop.  They may or may not be able to do this.

Focus on the consequences.  Tell the loved one that the behavior may end up with them being in jail or the hospital.  You can remind them of previous experience, if applicable.

If necessary, call 988. If you feel you are in immediate danger, you may need to call 911 and ask for an officer trained in dealing with the mentally ill.

Dealing with Negative Symptoms

Blunted Affect is a facial expression that’s almost blank and conveys no emotion.  The person still feels emotions, but they don’t show them. Ask how they are feeling.

Poverty of Speech means that the person barely speaks. The person cannot help this.  Do things together where the focus is not on talking: shopping, nature walks, movies.

Apathy and Anhedonia are when your loved one no longer enjoys activities or things. Apathy is a symptom, and not under the person’s control.  At the core of this is a belief that activities will not be fun.

  • Acceptance is the first step. “I know he’s doing the best he can.”  “He’s not lazy; this is a symptom of his illness.” “Difficulty doing things and following through are part of this illness.”
  • Invite the loved one to join you in day-to-day activities (grocery shopping, going to the dry cleaner, etc.).
  • Regularly schedule enjoyable activities (going to a museum, going to get pizza, going to a park).  Lower your expectations.
  • Take baby steps and praise progress.
  • Increase daily structure. 
  • Focus on the future, not the past.

This is the first of a series on dealing with symptoms. More to come soon.

justice scales and gavel on wooden surface
by karentwinem

At Last … Mental Health Courts

It took a long, long time. But mental health courts are here at last.

We can thank Florida for this. Judges there (finally) noticed that people with mental illnesses kept reappearing on the court docket. In 1997, Florida set up four mental health courts. By 2022, we have more than 300 of these courts in nearly every state, according to the Council of State Governments Justice Center.

The purpose of mental health courts is three-fold.

  • To help defendants improve their functioning and lives. (About 20% of people in prison have serious and persistent mental illness. And those prisoners have more repeat offenses than average.)
  • To provide structure for those who need it most. (Prisoners with mental illness spend more time in jail and get less time off for good behavior than other prisoners.)
  • To create an environment that encourages recovery and treatment. (Right now, only 11% of inmates who quality for mental health treatment get it.)

Mental health courts are among those with a specialized docket. These dockets aim to reduce stigma about conditions and break cycles of bad behavior. Other specialized dockets include child support enforcement, domestic violence, drugs, human trafficking, veterans and drunk driving. The council has found that, for every $1 invested in specialized dockets, $27 in taxpayer money is saved.

What Is a Mental Health Court?

A mental health court is a specialized docket for defendants with mental illnesses. It substitutes a problem-solving model for the traditional process of criminal courts. Those whose cases are on the docket have been screened and assessed for mental illness.

The participants also must volunteer to participate in a judicially supervised treatment plan. A team of court staff and mental health professionals develop this plan. It specifies tasks and criteria for success (or graduation) from the program. The plan also rewards adherence and sanctions nonadherence.

For example, Franklin County, Ohio, has two mental health courts: the RISE program and the LINC program.

  • Franklin County Court of Common Pleas started the RISE program in February 2022. Participants are moderate to high-risk felony offenders who have been diagnosed with a serious mental ilness that was a primary factor leading to their arrest.
  • Franklin County Municipal Court has the LINC program for those charged with misdemeanors.

Example: Mental Health Court for Felons

People eligible for the RISE program must have:

  • One or more felony charges.
  • Been competent to stand trial and not under a current finding of Not Guilty by Reason of Insanity
  • A diagnosis of mental illness
  • Entered a guilty plea

They are usually admitted to the RISE program at sentencing or during a probation violation hearing. Those who are not eligible for the program include:

  • Sex offenders
  • A defendant with a child victim or a history of child victim offenses
  • Those with a history of serious or repetitive violence, including domestic violence
  • Those who post a significant risk of harm to the staff or the community

The RISE program is a two-year program with four phases:

  1. Consistent adherence to the treatment plan
  2. Significant improvement in coping skills, healthy communication, boundary setting, emotional process and mood regulation
  3. At least 365 consecutive days of sobriety
  4. Completion of any restitution, fines or court costs associated with the case

The two-year time period is flexible as defendants can finish in shorter or longer time period. The program also includes rewards and sanctions to encourage positive behavior.

Example: Tennessee Mental Health Courts

Tennessee grew from three mental health courts in 2022 to 17 in 2023. The state’s legislature adopted the Mental Health Treatment Act of 2022 to give $5.7 million to run the mental health courts.

The Tennessee Department of Mental Health and Substance Abuse Services reports that, so far, 60% who participate in the recovery court programs improve or maintain employment. Seventy percent improve or maintain housing.

However, the department found that the biggest benefit of the program was an increase in public safety.

Mental Health Court Locator

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services can help determine if a mental health court is in your county.

You can visit the Mental Health Court Locator to find courts for adults and juveniles. You also can call the SAMHSA helpline at 1-800-662-4357.

In Case of Arrest

If your loved one is arrested, talk to your defense attorney about moving the case to the mental health court docket. You also can call the prosecutor and ask to get your loved one’s case into mental health court. Remember: In most cases, your loved one will be required to plead guilty to the charge and will be put in the program after assessment at sentencing.

Mental health courts offer an essential service to keep our loved ones with mental illness out of the revolving door of multiple arrests and prison terms. I’m so thankful this idea is taking hold nationally.

the word relapse reflects the content of the post
by karentwinem

Prepare Ahead for Mental Illness Relapse

Mental illnesses, especially bipolar disorder, schizophrenia and clinical depression, are usually episodic. Symptoms vary over time. When your loved one experiences another episode, it’s called a relapse.

You can help minimize the results when you recognize the early warning signs. Many people have a specific set of signs called a relapse signature. Knowing that in advance can help you prepare. You also can learn to tell the difference between a bad day and a relapse.

First, it’s important to know the difference between a relapse and treatment-resistant symptoms. People who experience persistent symptoms even when the illness is stabilized have treatment-resistant symptoms. When a person’s symptoms get worse, that’s a relapse.

Before a relapse, people often experience changes in feelings, thoughts and behaviors. Those changes are early warning signs. Studies indicate between 50% and 70% of people experience early warning signs over a period of one to four weeks before a relapse.

Looking for early warning signs allows you to start working with your loved one and his treatment providers to minimize the setback. When you are the most frequent contact with your loved one, you are the person who sees these warning signs. The ill person will not be able to see them.

While many warning signs are common, individuals may have their own specific signs or “relapse signatures.”

Common Warning Signs of Relapse

  • Feelings of tension, anxiousness or worry
  • More irritability
  • Increased sleep disturbance (either reported or when you hear them in the night more often)
  • Depression
  • Social withdrawal (more extreme than usual, such as not leaving their rooms to eat)
  • Concentration problems (taking longer to do tasks, having trouble finishing tasks, having trouble following a conversation or TV show)
  • Decreasing or stopping medication or treatment (refusing to go to the doctor or case manager, skipping the vocational program)
  • Eating less or more
  • Excessively high or low energy
  • Loss of interest in doing things
  • Lost interest in the way they look or poor hygiene
  • Being afraid of “going crazy”
  • Becoming excessive in religious practices
  • Feeling bothered by thoughts that will not go away
  • Feeling overwhelmed by demands
  • Expressing worries about physical problems

The most common relapse indicators for schizophrenia are:

  • Restless or unsettled sleep
  • Nervousness or tension
  • Having a hard time concentrating
  • Isolation
  • Feeling irritable
  • Having trouble taking care of routine things
  • Lack of energy
  • Feeling sad or depressed
  • Feeling confused
  • Change in appetite

The most common relapse indicators for bipolar disorder are:

  • Disturbed sleep or insomnia resulting in no sleep
  • Talking quickly and more often than usual
  • Acting reckless
  • Feeling very tired
  • Feeling very depressed

An Off Day or the Start of Relapse?

Everyone can have an off day. You can feel down in the dumps with no energy. Or you can seem a little manic. If a person has had mental health problems, it’s important to consider whether this is an off day or the start of a relapse. The indicators that it is the start of a relapse are:

  • A cluster of changes
  • Happening together
  • Lasting over a period of time
  • Gradually getting worse
  • Following the same pattern as in previous relapses

Your Loved One’s Relapse Signature

If you are reading this, you are probably the best person to decide what the relapse signature is. Think about the last time your loved one got worse. If you keep a journal, go look at what you wrote. Things to consider include:

  • What was the time of year?
  • Did your loved one say how they were feeling physically?
  • How was your loved one’s mood? Ability to concentrate?
  • Did any unusual changes in behavior take place in the weeks before the last relapse?
  • Did your loved one do things that seemed “out of character” before the last relapse?
  • Have the same behaviors preceded other relapses?

Thinking about what was happening in the person’s life when you start to notice these changes can help, too. Many relapses in major mental illness do involve the person stopping medication, experiencing stress or abusing alcohol or drugs.

Here’s 10 things to do when you see the warning signs.

two people talking to each other
by karentwinem

How to Talk to Someone Who Has a Mental Illness

When you love someone who has a mental illness, you talk to them. Or, in many cases, you talk at them. Using elements of therapeutic communications, such as reflective listening and I statements, can make the conversations more successful.

Using I Statements

Many of us have heard about using “I statements.” This approach is less threatening to a person with mental illness, who can easily interpret comments as attacks. Rather than saying “You make me mad” or “You did a stupid thing,” you would first identify your own feelings as you express your viewpoint.

I statements usually follow this format: “I feel … when you do …”

  • I feel sad when you ignore me.
  • I feel glad when you take your medicine consistently.
  • I feel angry because you broke our agreement.

It’s doesn’t hurt to practice these statements with others in the family. You may find that your overall communication improves.

Applying Reflective Listening

Reflective listening is a pattern of communications that social workers and counselors often use. It can help you understand what your loved one is saying. It also allows you to comment on their statements without agreeing with them.

The reflective listening formula has four steps:

  1. Start with a tentative opening. (It sounds like … or What I hear you saying is …) This gives your loved one an opportunity to tell you if there’s a misunderstanding.
  2. Identify the feeling involved. The main categories are mad, sad, glad and afraid.
  3. Use a connection word such as about, because or when.
  4. Identify the thought you see.

So the sentence is:

Tentative opening + feeling + (about/because/when) + thought. Such as:

It sounds like you are feeling sad about what she said to you.

I hear you saying that you are feeling mad because of what he did.

If I am hearing you correctly, you are feeling afraid because your friend has cancer.

You seem to be saying that you are feeling happy because your sister is coming over.

I’m not sure I’m following you. Are you feeling ashamed about wanting to move back with your parents?

Using Body Language

Nonverbal communications is powerful. Most of the impression that someone gets from talking to you comes from your body language. When you are talking to your loved one, you want your body language to convey your caring and concern. Some ways to do that are:

  • Hold the person’s hand.
  • Make direct eye contact.
  • Place your hand on their shoulder.
  • Pat the person’s back.
  • Sit close to the person.
  • Lean forward when the person is speaking.

Ask Good Questions

Some things that you can say to keep the conversation going are:

  • Tell me about what happened to you.
  • Go on. Tell me more.
  • What do you see as the problem?
  • What do you mean when you say that?
  • Give me an example of what you mean when you say …
  • How did it feel when that happened?

I’m not sure what the sources are for this overview, as I’ve used it for years. But this is

PEOPLE WITH MENTAL ILLNESSYOU NEED TO DO THIS
Have trouble with reality.Be simple & truthful.
Are fearful.Stay calm.
Are insecure.Be accepting.
Have trouble concentrating.Be brief. Repeat as needed.
Are overstimulated.Don’t force discussion.
Easily become agitated.Recognize agitation. Allow escape.
Have poor judgment.Don’t expect a rational discussion.
Have changing emotions.Disregard the changing emotions.
Have changing plans.Keep to one plan.
Have little empathy for you.Recognize that as a symptom.
Believe delusions.Ignore it and don’t argue about it.
Have low self-esteem.Stay positive.
Are preoccupied.Get their attention first.
Are withdrawn.Initiate relevant discussion.
ear poking through yellow wall paper
by karentwinem

Listening to People Who Have Mental Illness

Good communications with people who have mental illness starts with listening well. Really hearing someone’s feelings and thoughts is a great gift of love and respect.

People with mental illness could be experiencing auditory hallucinations, overwhelming feelings of depression, intense anxiety, and cognitive disorganization. So we need to avoid arguments and heated communication.

They may feel lonely, inferior to others and disrespected. You may be able to have an influence on these feelings when you demonstrate your positive regard for them. When you show that you accept them and have compassion for them, you offer hope and understanding.  As a positive benefit, they may respond better to your requests.

What Not to Do: Types of Bad Listeners

This list is from Listening for Heaven’s Sake – Class Notes by Equipping Ministries International. Do any of the listeners below remind you of you? Particularly when you are under stress?

Type of ListenerCharacteristics
The InterrogatorAsks lots of questions
Focuses on the details
Satisfies their own need to know
Focuses on facts rather than feelings
The GeneralGives orders
Takes command or control
Assumes responsibility
Focuses on the outcome
The PhariseeBlames and shames
Condemning outlook
Focuses on the person being “bad”
Says “You should” or “You ought to” often
The LabelerOversimplifies problems
Pigeon-holes people
Believes that putting a name to it equals a solution
Has a quick-fix mentality
The Casserole PersonTries to cover over pain with food
Avoids the unpleasant
Expects kind actions to remove pain
The HistorianFocuses on the past
Can’t remain in the present
Speaks triggered memories
Loses focus on the speaker
The Bumper StickerGives trite answers
Oversimplifies problems
Is quick with clichés

Steps Toward Being a Good Listener

  • Relax and be calm.
  • Minimize distractions.  (Can I turn off the TV?)
  • Make eye contact unless it is threatening.
  • Discuss one topic at a time.
  • Ask for opinions and suggestions.
  • Don’t take it personally when it’s the illness talking.
  • Avoid bringing up the diagnosis.
  • Don’t use sarcasm.
  • Speak simply and directly.

Next time we’ll discuss the basics of therapeutic communications: using reflective listening and I statements.

Christmas tree and lights
by karentwinem

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.