Tag / mental illness

by karentwinem

Dealing With Your Own Anxiety

Sources for this article include NAMI.org , va.gov (U.S. Department of Veterans Affairs), adaa.org (the Anxiety and Depression Association of America) and caregiver.org. Other sources included the U.S. Department of Health and Human Services, “Identifying and Addressing Family Caregiver Anxiety” by Karen O Moss, PhD, RN, CNL; Colleen Kurzawa, MSN, RN, MFA; Barbara Daly, PhD, RN, FAAN; and Maryjo Prince-Paul, PhD, RN, FPCN. The article “Hidden from view” in Breathe magazine, issue 57, also provided insight.

Are caregivers vulnerable to anxiety?

More than one in five Americans today are caregivers, providing care and support to an adult or child with special needs. That is 21.3 percent of the population.

A study of family caregivers cited above found roughly 38 percent find their situation extremely stressful. Caregivers are a vulnerable population for psychological distress, including anxiety. In fact, the caregiver’s anxiety can even exceed the levels that their loved one’s experience. This study covered caregivers of people with cancer and dementia, but I’m sure the statistics for families dealing with mental illness are similar or even worse.

How anxious are you feeling? Are you managing too many responsibilities? Strain because you can’t control your own life? Fear for a loved one’s well-being? Deal with financial and healthcare coverage stressors? As a caregiver, you may spend many more hours a week providing care than in a regular job. Caregivers report employment problems, health issues, lack of sleep and little time to do the things they enjoy. 

What is anxiety?

Anxiety is the most common form of mental illness in the U.S., affecting 14% of the population. That includes 18% of adults and 8% of children and teenagers. (These figures are from the National Institutes of Health.)

It is a common emotional response to a perceived threat, often accompanied by tension, worried thoughts and physical changes like high blood pressure and insomnia.

Severe and persistent anxiety typically has these aspects:

  1. Extreme fear and dread, even when there is nothing to provoke it
  2. Emotional distress that affects daily life
  3. A tendency to avoid situations that bring on anxiety

How is anxiety different for mental health caregivers?

As we see above, anxiety can be extreme fear without reason. Caregivers for people with mental illness have plenty of reasons to experience fear and ongoing grief, including:

  • Fear of living life without the personality we loved.
  • Grief over our loved one’s lost potential and possible future.
  • Fear of being overwhelmed by the issues surrounding mental illness.
  • Fear of future pain.
  • Fear of losing your own identity and life.
  • Grief over lost plans for retirement.

Once my primary care doctor said to me: “If you weren’t anxious, I’d be worried that you didn’t understand the situation you are in.”

While some caregivers probably do have generalized anxiety disorder, many caregivers are just plain anxious. The study I read was focused on caregivers for people with cancer and dementia, but many of the aspects are the same.

I once attended a retreat for mothers of children with severe mental illness led by Kay Warren. She said: “We receive wounds of many sorts. Some forms of pain and loss we just don’t get over. A soul wound damages the architecture of the soul. What is grief, if not love persevering? The “natural order of things” and the depth of the love impact the grief.”

What are the symptoms of anxiety?

sleepless man

Signs and symptoms of anxiety are similar to the symptoms of depression. They can co-exist.  Among caregivers, the symptoms are:

Neurological: Trembling/shaking, restlessness, headaches, dizziness, apprehension, numbness, tingling, fatigue, poor concentration, nervousness.

Cardiac: Increased pulse rate, chest pain or discomfort, palpitations.

Respiratory: Dyspnea

Digestive: Diarrhea, loss of appetite, nausea, dry mouth, indigestion.

Mood: Nervousness, irritability.

Musculoskeletal: Muscle tension.

Sleep: Insomnia

Skin: Sweating

Urinary: Frequency, urgency.

Do you have high functioning anxiety?

Daily anxiety can affect your health long before it affects your productivity. High functioning anxiety means that you suffer internally from anxiety without it affecting your productivity. People with high functioning anxiety may become more irritable, withdraw socially or self-medicate through alcohol use.

See if these questions reflect things happening to you:

  • Do you worry every day?
  • Are you a perfectionist?
  • Do you suffer from sleep disturbances and muscle tension most of the time?
  • Do you find that your mind is always “on the go,” preventing you from living in the present moment?
  • Are you tired or mentally exhausted most of the time, even after a good night’s sleep?
  • Do you sometimes forget what you were saying or doing?

How to manage your anxiety

Be sure that your doctor knows that you are a caregiver for a person with mental illness so they can test for and monitor anxiety. Many caregivers do not seek out help for anxiety because they are concentrating on their loved ones, giving themselves little or no care.

Remind yourself it’s normal to have fears and anxious thoughts in our situations.

Talk to others who understand. Sharing your fears to a support group helps us realize we are not alone. Therapy can help with marital problems, changed relationships or family issues as a result of the change.

Take care of your body. Caregivers should exercise, get enough sleep, eat healthy meals, take their own medications and get regular check-ups. Walking, biking, yoga, swimming and running can reduce anxiety.

Rest in God. God wants you to experience his compassion during this time. Jesus himself was overwhelmed and deeply shaken as he faced his coming suffering and death at Gethsemane. He said, in Mark 14, “My soul is overwhelmed with sorrow to the point of death.” He knows.

Increase your times of prayer, maintain regular church and small group attendance, and read uplifting materials. “Humble yourselves, therefore, under God’s mighty hand, that he may lift you up in due time. Cast all your anxiety on him because he cares for you.” (1 Peter 5:6-7)

So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand. (Isaiah 41:10)

Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid. (John 14:27)

people in a revolving door
by karentwinem

What Is Assisted Outpatient Treatment?

Assisted Outpatient Treatment is an attempt to stop the revolving door of hospitalization-release-hospitalization-release for some people with mental illness. This court-ordered treatment is usually for individuals with mental illness who have a pattern of noncompliance with medication.

The first Assisted Outpatient Treatment law, called Kendra’s Law, was in New York. It became law after a person with untreated several mental illness killed Kendra Webdale by pushing her in front of a subway train in 1999.

Some form of this law is on the books in 47 states and the District of Columbia, but it’s not really available everywhere that it’s legal. Connecticut, Maryland and Massachusetts do not have Assisted Outpatient Treatment at all. If you live in any other state, the Treatment Advocacy Center can provide information about your state’s resources.

Since I live in Ohio, I am going to quote from my state’s Civil Commitment criteria (State law 5122.01 (8) (1) to (5). Mentally ill individuals can be subject to court-ordered treatment if they:

  • Represent substantial risk of physical harm to themselves or others OR
  • Are unable to provide for their own basic physical needs OR
  • Have behaviors that create grave and imminent risk to the rights of themselves or others.
  • Are unlikely to survive safely in the community without supervision.
  • Have a history of treatment non-adherence that has led to either:
    • Two hospitalizations in the last 36 months spent in the community OR
    • An act/threat/attempt of serious violence in the last eight months spent in the community
  • Are unlikely to voluntarily participate in treatment
  • Need treatment to prevent relapse or deterioration likely to result in substantial risk of serious harm.

A judge orders Assisted Outpatient Treatment in civil court. The judge also becomes the primary motivator due to the Black Robe Effect. Because they command respect as a symbol of authority, the judge motivates both the treatment system and the individual. Treatment usually takes 12 to 18 months.

If either the treatment professionals or the individual do not adhere to the treatment plan, the judge can:

  • Extend the length of time in the program.
  • Increase the frequency of appearance in court.
  • Order reviews of the treatment program.
  • Pick up the individual for evaluation.
  • Rehospitalize the individual.

Pathways to Getting Assisted Outpatient Treatment

The best way to get someone into the Assisted Outpatient Treatment program is to start talking to doctors when a loved one is in the hospital, especially if the loved one has had an involuntary hospitalization. Ask the doctor to file an affidavit with the court requesting Assistant Outpatient Treatment. Family members also can file an affidavit for mental illness treatment at the probate court.

Another good time is during a transition from jail or prison to the community. Ask the doctor at the jail to initiate this.

Assisted Outpatient Treatment works. The program began in New York, where it is used most extensively. Study results show that those in the program has a 87% decrease in incarceration, a 74% decrease in homelessness, an 83% decrease in arrests and a 77% decrease in rehospitalizations. More information is available from the Treatment Advocacy Center.

by karentwinem

Ways to Improve Compliance

Getting a loved one with mental illness to actually comply with a treatment program … that’s hard. Here are some suggestions from NAMI, Mental Health America and others on ways to improve your chances of success.

Use the LEAP method.  Listen. Empathize. Agree. Parter. This method developed by Dr. Xavier Amador has a research-tested, proven success rate. You can learn more about it on Dr. Amador’s site here. Following the LEAP method, openly discuss the loved one’s complaints about treatment and medication. Try to “normalize” medication issue with our loved ones.

Encourage injectables as treatment.  When your loved one takes an injectable as treatment, they only have to make the decision to take their medicine once a month. With pills, your loved one will have to make that decision every day or, sometimes, several times a day. With injectable, the doctor knows when they don’t come in for the medicine.  Cost can be a big issue, however. 

Avoid calling the medication a treatment for “your mental illness.”  They may take the medicine more easily if you say the medicine “helps you sleep” or “helps you deal with stress.”

Have a workable plan for monitoring medications if your loved one is not dependable about taking them. If your loved one is living with you, you can monitor the medication. Ill people may be too disorganized to do this themselves. Managing their own medication is a higher level skill for independence. Be the one to call in and/or pick up the prescription, have the pharmacy use your phone number, count pills, etc.

Educate the patient.  If your loved one will agree, help them understand how medications work and why it’s important to take them.

Keep a written record of the medications your loved one has taken, the dosages, the results and the side effects. As caregivers, we are the best “historians” of the illness.  This is important when our loved ones change doctors, nurse practitioners, case managers or social workers.

Get a HIPPA release OR call the psychiatrist to tell them what’s happening.

If your loved one is refusing to take medication,  prepare a crisis plan.  Remember that sometimes a relapse is the way for them to understand that they need help.

Medication Adherence Tips and Tricks (from NAMI)

Here are some tips for making medication adherence easier from NAMI.

  • Take medications at the same time every day.
  • Set an alarm on your cell phone.
  • Pair medications with something you do every day. (drinking your first cup of coffee, brushing your teeth, putting in contacts, etc.)
  • Put medication in a weekly pill box.
  • Enroll in your pharmacy’s automatic refill program. Use your phone number.
  • Have the prescriptions mailed to your house.
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.

cartoon of person with upset brain relating to a caregiver
by karentwinem

Helping Them Cope

Note: This post is adapted from information I learned in the NAMI Family-to-Family program. We highly recommend attending this program to learn more about mental illness.

Having a mental illness and dealing with the world takes enormous courage and determination. As we have previously written, many people develop defensive coping strategies.

These negative behaviors are actually typical for any person with a life-changing or life-threatening illness. (They include irritability, denial, abusive language and resistance to treatment.) For people with mental illnesses, the behaviors are even more counter-productive. This can be very upsetting to you.

So what’s the best way to react? Here are some suggestions from NAMI:

  • Respect and protect your loved one’s devastated self-esteem. Don’t criticize them. Keep nagging and negative remarks to a minimum.
  • Punishment, argument and pressure make things worse.
  • Ignore as much negative behavior as you can. Praise positive behavior as much as you can. People with mental illness are more likely to improve when they can see behaviors earn them approval and recognition.
  • Accept the symptoms of the illness. You don’t punish a child with a stomach virus for vomiting. Know what the symptoms of the illness are, and try to separate that from the person’s behavior. You cannot argue someone out of a depression or delusions.
  • Accept that your loved one may not be able to fulfill a normal role in the family. Reduce your demand for emotional support and “carrying your weight.”
  • Make these allowances, yet treat the person as a regular member of the family.
  • Encourage independent behavior. Allow them to do what they can, which can vary from time to time. But, again, don’t push.
  • Live in the present. You have a right to grieve, and you may need professional help to do so. But don’t live in the past or focus on “what could have been.” One of the best things you can do for your loved one is to accept that they have an illness that makes life harder, but not impossible. This is how it is.
  • Be patient. When our loved ones take steps toward more independence, it’s very scary for them.
  • Be kind to yourself and the rest of the family. This is hard. Don’t criticize yourself or others when you make a mistake. Give everyone in the family some grace.

how the mentally ill cope
by karentwinem

What It’s Like to Have a Mental Illness

Note: Information in the following article came from namigc.org)

It’s difficult to understand what someone with a mental illness experiences, but you can get a better idea by trying this empathy exercise.

Have you ever:

  • Gone for 24 hours without sleep? 48 hours?  Longer?  How did you feel about being awake this long?  How did you look?
  • Dozed off for a second, awakened with a start and didn’t know where you were?  How did you feel? What would it be like to feel that way for a day, a week, several weeks?
  • Lost your sunglasses or car keys and no matter what you did, you couldn’t find them?   Did you feel like screaming?
  • Been driving down the road when suddenly your directions got mixed up?  Say, you confused or reversed north and south. How did you feel?
  • Had a funny little tune going through your mind for a couple of hours or a whole day and, no matter what you did, you couldn’t get rid of it.  How would you feel if that same tune went through your mind for three days, a week or a month?

Now let’s put three or more of these items together.  Say you’d hadn’t slept for three days, you heard the same music going on and on in your head, and you couldn‘t find your keys.  How would you feel?  How would you look?

All these things are experiences from the inner world of people struggling with serious brain disorders.  By thinking deeply about these symptoms, we can feel more empathy and understanding toward those who experience them.

The fact is, even in remission and even when properly medicated, chronic mental illness leaves its sufferers in a devastating limbo.  Many people with mental illness are effectively cut off from the predictable, rewarding, self-fulfilling live involvements that make existence meaningful.  They suffer deeply from their inability to be competent and successful in their daily lives.

This life-constriction threatens our loved ones’ psychological integrity.  It sets up a process where the people with mental illnesses feel they must protect their “core self” at all cost.

Many behaviors that result – refusing medication, rejecting family support and community programs, and disrupting family life, for example – don’t make sense to us. These behaviors are directly related to their struggle to maintain some dignity and self-respect in the face of stigma, failure and shame. It would be kind of us to appreciate that many of our relatives’ behaviors are driven by the need to protect their own fragile senses of self-esteem. 

Psychological Traumas Associated with Any Serious Chronic Illness

Whenever a person has a serious chronic illness …. COPD, emphysema, chronic heart disease, or a mental illness … two things happen to their sense of self.

First, they lose their protective belief that they are exempt from harm. Much of our sense of safety and our willingness to take risks in life rests on a belief that serious harm or real trouble will never happen to us. This has been called “evolutionary delusion” because it’s responsible for a large chunk of human progress. Young people especially have this sense.

Second, they lose their sense of a predictable, dependable future. This results in the use of defensive coping strategies.  These are self-management techniques that are basically maladaptive.  They don’t help people get what they really want, but they do provide temporary psychological refuge when confidence and self-image are taking a nose-dive. Let’s look at some defensive coping strategies.

Defensive Coping Strategies

  • Self-absorption
  • Irritability
  • Haughtiness
  • Controlling behavior /Manipulation
  • Anger
  • Rejections of friends and family
  • Blaming others
  • Defensiveness
  • Drug and alcohol abuse
  • Doing nothing
  • Resisting change
  • Refusing help
  • Denial
  • Apathy
  • Bargaining
  • Withdrawal
  • Suspicion
  • Dependency
  • Envy
  • Running away
  • Refusing medication
  • Quitting a job
  • Abusive criticism of others
  • Sleeping excessively

From time to time in daily life, all of us will use one or more of these behaviors.  If we are criticized at work … snubbed by someone we thought was a friend … having a fight at home … we may use one of these behaviors if we feel momentarily crushed.  We complain or attack.  We “need a drink.” We get fed up and call in sick.

For us, these are temporary responses when we feel temporarily defeated.  We normally pull out of them quickly.  We turn to our social and personal life structure, finding comfort and reassurance.

Defensive Coping Strategies in Mental Illness

The situation for people with serious mental illness is drastically different.  Their social and personal life structure is vastly diminished. They are facing poverty, stigma, disability, joblessness, and social rejection. They are trapped on a runaway train going the wrong way.

The negative coping strategies become a familiar and reliable way to protect themselves from becoming even more diminished.

It’s impossible to conceive what mental illness is really like without recognizing the fundamental problem of psychological demoralization.

It takes enormous courage and determination to pull up out of these defensive postures of reacting to mental illness.  But it can happen.  Next time we’ll talk about how we can help.

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.

older person's hand and young adults hand
by karentwinem

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:

Alcohol and Suicidal Thoughts

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!