Tag / mental illness

by karentwinem

Bearing One Another’s Burdens: Peer Support for Mental Illness

The Bible asks us to “carry each other’s burdens” (Galatians 6:2). Now people with mental illness have way to do that: peer support. This resource helps both those struggling with their illnesses and those who are well into recovery. And it brings help and hope.

Peer support is a model of care in which individuals who have lived experience with mental illness and/or substance use recovery provide help and encouragement to others struggling with those issues.

The U.S. Substance Abuse and Mental Health Services Administration says peer support workers encourage others to seek treatment, build hope, set goals and stay engaged in care. Because the support is based on shared experience rather than professional distance, it can be powerful.

It is just as powerful for the peer specialists themselves. They have a useful job to do and new purpose in their lives.

What Do Peer Support Specialists Actually Do?

Peer support specialists go through a training process and are often certified to:

  • Offer emotional support during difficult seasons
  • Explain how treatment helped them and encourage seeking it
  • Help individuals set recovery goals
  • Navigate the mental health system (appointments, housing, services)
  • Lead support groups or recovery meetings
  • Advocate for patient needs

They work alongside therapists, psychiatrists and social workers as part of a care team. For caregivers, this means your loved one is not walking alone—and neither are you.

The Evidence: Does Peer Support Really Help?

Yes! Research and national mental health organizations have found that peer support:

  • Increases engagement in treatment
  • Reduces hospitalizations
  • Improves quality of life and social connection

Mental Health America states that peer services strengthen recovery outcomes and help individuals stay connected to care. For families, this can mean fewer crises, greater stability and renewed hope.

When people disabled by mental illness for many years become peers, they start to do important work. If they work part-time, they can keep important disability benefits while having a new purpose. This also allows them to see how much work is possible before symptoms worsen, all while in a supportive work environment. Their mental illness or past addiction is a requirement for the job!

The Current System: Access Is Uneven

Access to peer support depends heavily on insurance coverage. Most states cover peer support through Medicaid. It also can be available through nonprofits, community health centers or local agencies.

However, for older adults and individuals with disabilities—those covered by Medicare—access has historically been limited.

Pay for peer support specialists is low, which makes the practical aspects of transition off benefits difficult. However, part-time work may be the best for the specialists to deal with the stress of this kind of work. Generally that keeps a paycheck low enough to retain disability and health care benefits from Medicare/Medicaid.

The PEERS in Medicare Act: A Promising Step Forward

The Promoting Effective and Empowering Recovery Services (PEERS) in Medicare Act is a bipartisan effort in Congress aimed at expanding access to peer support.

The legislation would require Medicare to cover peer support services across a variety of settings, including:

  • Community mental health centers
  • Rural health clinics
  • Federally qualified health centers
  • Certified behavioral health clinics

This would bring peer support to millions of Medicare beneficiaries—many of whom are currently underserved.

Why It Matters for Families

If enacted, the PEERS Act could:

  • Provide new support options for your loved one
  • Reduce caregiver burden
  • Improve long-term recovery outcomes
  • Expand services in rural and underserved areas

Organizations like National Alliance on Mental Illness and National Council for Mental Wellbeing support the legislation, noting its potential to expand access to “lifesaving peer support services.”

Current Status (2025–2026)

As of now, the PEERS Act has been reintroduced in Congress with bipartisan support but has not yet been passed into law. Its future will depend on ongoing legislative action.

If you are caring for someone with severe mental illness, here are ways to explore peer support:

1. Ask Providers Directly

Inquire whether your loved one’s care team includes peer specialists.

2. Contact Local Organizations

Groups like National Alliance on Mental Illness often offer peer-led programs and support groups for both individuals and families.

3. Advocate for Access

Follow and support policies like the PEERS Act that expand services.

As a caregiver, you are already doing sacred work.

You:

  • Show Christlike compassion.
  • Bear burdens that others may never see.
  • Stand in the gap for someone who cannot stand alone.

Peer support can give you additional voices of encouragement, hands to help and testimonies of encouragement. And, when your loved one begins to recover, peer support can offer an important job to do.

demonstrates person talking to help line
by karentwinem

New Help Line for Mental Health Caregivers

NAMI (National Alliance on Mental Illness) has a free Family Caregiver HelpLine to support caregivers. It’s only available from 10 a.m. to 10 p.m. Eastern time Monday through Friday. But it’s a start.

To reach the HelpLine by phone, call 1-800-950-NAMI (6264) and press “4.” That will connect you to a family caregiver specialist. The specialists have lived experience as caregivers for loved ones with mental illness. They are trained to offer others support, guidance , tools and strategies for dealing with your issues.

Other ways to reach the specialists are:

  • Texting the word “family” to 62640
  • Emailing helpline@nami.org
  • Mailing a letter to NAMI HelpLine
    4301 Wilson Boulevard, Suite 300
    Arlington, VA 22203

Of course, if you have a crisis situation, call 988 immediately.

NAMI Books for Caregivers

NAMI’s “You Are Not Alone” book series now includes a volume for caregivers and parents who have children and teenagers dealing with mental illness.

Child psychiatrist and NAMI Associate Medical Director Dr. Christine Crawford wrote the book. “You Are Not Alone for Parents and Caregivers” discusses how mental health conditions manifest from preschool to high school.

The book is available at Amazon, Target and Barnes & Noble. More information about the book is here.

OnDemand NAMI Basics Class

My husband and I benefited from NAMI’s Family-to-Family classes. We also gained a lot from the support groups. This was particularly helpful in the early days of our child’s schizophrenia diagnosis. Now you can get the information without leaving your home.

The OnDemand NAMI Basics Class is for parents, caregivers, older siblings and other family members who support a child or teenager living with mental illness. This free, online program gives you information and tools for navigating the changes.

You can sign up for the NAMI Basics OnDemand class here. This is a self-paced class that you can access at any time.

If you don’t know what to do, you are likely to make things worse. You must have knowledge of available resources to get the best support for your loved one. NAMI’s resources are getting better all the time. Other books and websites that helped my family are found on the Resource page.

Estimated reading time: 2 minutes

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

The Guide to Staying OK While Caregiving

This blog, Loving Someone With Mental Illness, contains years worth of teaching about caregiving. I’ve stopped posting in the last year because I have had physical health challenges: a failed spinal fusion and the resulting chronic pain. What I experienced reinforced the way to stay OK while caregiving.

What I discovered is that Christian mindfulness … practicing the presence of God in the present moment … is getting me through that chronic pain. It also gets me through the emotional and spiritual pain of loving someone with mental illness.

It is simple and massively effective.

  • Take a deep breath and concentrate entirely on this moment. God is here in the now.
  • Ask the Holy Spirit to join you, to walk with you. Say “Come, Holy Spirit.”
  • Ask God to bless the situation you are in.
  • Love the person in front of you. Give them your entire attention. Listen.
  • Thank God for the experience and move on to the next moment.
  • If your mind runs to the worries of the future or the fears of the past, stop. Take a breath. Start again. This will happen many, many times a day. That’s normal in any Christian mindfulness practice.

Doing this step by step, moment by moment, all day long creates an empowering walk with Jesus through life. Even the terrible parts of it. Only the Lord can give us the strength and endurance to practice this way of living.

If you are reading this, you have a hard life. Mindful Christian Year, my other blog, contains ideas and inspiration for practicing the presence of God. It will help. I plan to resume working on this blog as well. So how have you been?

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.

mother grieving mentally ill child
by karentwinem

Experience God’s Comfort in Ongoing Grief

Bless are those who mourn for they will be comforted.

Matthew 5:4

Grief is always hard. But it doesn’t always involve death. Families dealing with mental illness have an ongoing grief that needs God’s comfort. This type of grief is hard for others to understand. The person you love is alive, but your hopes for their future are not.

This is a situation that only God can truly comfort. It is often too hard for other people to understand.

Let’s take a look at the differences between grief due to death and ongoing grief.

Classic Stages of Grief Due to Death

You may have experienced the classic stages of grief due to death:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

Each person goes through these phases in their own way. You may go back and forth between stages, or skip one or more stages altogether. Reminders of your loss, like the anniversary of a death or a familiar song, can trigger the return of grief.

Experiences With Ongoing Grief

Again, the grieving process you may experience when your loved one is diagnosed is different from the grief you feel when someone close to you dies. For example, you may experience:

Shock and fear

  • Loss of our beloved person’s true personality
  • Loss of our own anticipated future
  • Loss of our loved one’s future
  • Stigma
  • Fear of the unknown

Guilt and struggle

  • Did I do something to cause this?
  • Why him or her? Why me?

Denial, often merged with anger

Isolation and sadness

Can you relate to any of this?

Common Ways to Run from Grief

One way of dealing with ongoing grief is to hide from it. Yet, if we do not fully grieve, we can get stuck. This may create emotional havoc. Some common ways to run from grief include:

Postponement: Delaying and setting aside feelings and expressions of grief, while hoping feelings associated with grief will go away over time.

Displacement: Transferring unwanted or difficult feelings onto other people or things, deeming them the cause of the feelings. This could include being self-critical, fixating on minor issues and blaming others unrelated to the loss.

Replacement: Investing in an activity, such as overworking, intense and obsessive pursuits, or a new relationship.

Minimization: Not allowing ourselves to feel the full weight of the grief, even using faith to avoid it.

Physical illness: Experiencing bodily symptoms, illness or pain that may or may not be connected to real illness.

Three-Step Process for Dealing With Ongoing Grief

No. 1: List the losses that you have not fully grieved. Yes, write out your loss history, starting at the beginning of your life.

No. 2: Lament those losses. Lament is a passionate outpouring of our grief to God. A good example is Psalm 88. The entire psalm is a lament to God. Here is the Message version. 

God, you’re my last chance of the day.
    I spend the night on my knees before you.
Put me on your salvation agenda;
    take notes on the trouble I’m in.
I’ve had my fill of trouble;
    I’m camped on the edge of hell.
I’m written off as a lost cause,
    one more statistic, a hopeless case.
Abandoned as already dead,
    one more body in a stack of corpses,
And not so much as a gravestone—
    I’m a black hole in oblivion.
You’ve dropped me into a bottomless pit,
    sunk me in a pitch-black abyss.
I’m battered senseless by your rage,
    relentlessly pounded by your waves of anger.
You turned my friends against me,
    made me horrible to them.
I’m caught in a maze and can’t find my way out,
    blinded by tears of pain and frustration.

I call to you, God; all day I call.
    I wring my hands, I plead for help.
Are the dead a live audience for your miracles?
    Do ghosts ever join the choirs that praise you?
Does your love make any difference in a graveyard?
    Is your faithful presence noticed in the corridors of hell?
Are your marvelous wonders ever seen in the dark,
    your righteous ways noticed in the Land of No Memory?

I’m standing my ground, God, shouting for help,
    at my prayers every morning, on my knees each daybreak.
Why, God, do you turn a deaf ear?
    Why do you make yourself scarce?
For as long as I remember I’ve been hurting;
    I’ve taken the worst you can hand out, and I’ve had it.
Your wildfire anger has blazed through my life;
    I’m bleeding, black-and-blue.
You’ve attacked me fiercely from every side,
    raining down blows till I’m nearly dead.
You made lover and neighbor alike dump me;
    the only friend I have left is Darkness.

You also can write your own lament. This process can take hours or days. Speak directly to God. Do not be afraid to express anger or disappointment. God already knows how you feel and loves you anyway.

    Finally, ask Jesus to heal your broken heart. This is the sort of heartbreak that only God can heal. I find that sitting before the Lord in silence for 20 minutes or so on a daily basis can open a source of comfort only God can deliver.