Coping

Mental Illnesses are treatable medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are biologically based brain disorders. Mental illnesses affect about one in four adults and one in ten children, and seriously affect about 1 in 17. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD) and borderline personality disorder.

Mental illnesses can affect people from all walks of life, regardless of age, race, religion, political party or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing. People with mental illnesses are not inherently violent or dangerous. Most people who live with a mental illness are not violent and most people who are violent do not have a mental illness.

Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan. However, in some cases mental illnesses can be disabling, preventing people from working and carrying out the basic activities of daily living without support. There are a number of effective treatment regimens designed to assist people with mental illnesses in their recovery. Medication, therapy (such as cognitive behavioral therapy and interpersonal therapy), peer support groups and other community services can all help foster recovery. The availability of transportation, a healthy diet, safe affordable housing, regular exercise, sufficient sleep, friends and meaningful work (paid or volunteer) also contribute to the overall health and wellness of people living with mental illnesses.

People with mental illnesses need access to basic mental health treatment. Some need services like case management or care coordination to help them find and maintain mental health and support services. Still others need more intensive, flexible services to help them live in their communities. The consequences of untreated mental illnesses can be staggering both for the individual living with the illness and their family and society at large. Without access to appropriate treatment, support and services people with serious mental illnesses often cycle between hospitals, jails and homelessness. Children and adolescents with unaddressed mental health needs struggle in school, are more likely to be truant or drop out and often wind up in the juvenile justice system. The economic cost of untreated mental illness is more than $100 billion each year in the United States.

Early identification and treatment is vitally important and the treatments available today are highly effective as long as people have access to them. Between 70 and 90 percent of individuals significantly reduce their symptoms and improve their quality of life with a combination of pharmacological and psychosocial treatments and supports. Ensuring that people with mental illnesses can access appropriate treatment and services is essential so that they can live healthy, stable and productive lives.

1. Use short, clear direct sentences. Long, involved explanations are difficult for people with mental illness to handle. They will tune you out.

2. Keep the content of communications simple. Cover only one topic at a time; give only one direction at a time. Be as concrete as possible.

3. Do what you can to keep the “stimulation level” as low as possible. A loud voice, an insistent manner, making accusations and criticisms are painfully defeating for anyone who is experiencing the symptoms of mental illness.

4. If your relative appears withdrawn and uncommunicative, back off for a while. Your communication will have a better chance of getting the desired response when your relative is calmer and in better contact.

5. Assume that a good deal of everything you say to your ill relative will “fall through the cracks.” You will often have to repeat instructions and directions. Be patient; you will be rewarded in heaven.

6. Be pleasant and firm. If you do not “waffle” or undermine what you are expressing, your relative will not as readily misinterpret it. Communications are our “boundaries” in dealing with others. Make sure your boundaries are sturdy and clear.

(Taken from Class 8 Handout #1 8.17 - Family to Family Class - Version 2014)

A poet has defined mental illness as the “crippling of the organ of reciprocity.” Certainly one of its most characteristic aspects is the difficulty, even breakdown, of communication between the stricken person and others. What follows is some practical advice on the subject of communication.

Communicating effectively does not solve all problems or make your relative well. It usually makes things better. It won’t make as much difference as you wish it would.

Communicating in specific ways is very important for the mentally ill who are confused, don’t understand, or misinterpret. Indirect speech is often misinterpreted. (Example: “Do you think you could take out the trash?” Answers: “I don’t think about the trash at  all.” Or “Of course I think I could do it,” followed by not taking out the trash).

Clearer communication is an efficient change to make, in that small changes will make noticeable differences. Individuals with psychiatric disabilities often have difficulty sorting out incoming messages. This requires you to communicate in special ways if you wish to be understood.

Persons with a Psychiatric Disability at Times Can:

• 􀁸 have trouble with reality

• 􀁸 be fearful

• 􀁸 be insecure

• 􀁸 have trouble with concentrating

• 􀁸 be overstimulated

• 􀁸 easily become agitated

• 􀁸 have poor judgment

• 􀁸 be preoccupied

• 􀁸 be withdrawn

• 􀁸 have changing emotions

• 􀁸 have changing plans

• 􀁸 have little empathy for you

• 􀁸 believe delusions

• 􀁸 Have low self- esteem and lack motivation

We Must be Willing to:

• 􀁸 be simple & truthful

• 􀁸 stay calm

• 􀁸 be accepting

• 􀁸 be brief

• 􀁸 limit input & not force discussion

• 􀁸 recognize agitation & allow escape

• 􀁸 not expect rational discussion

• 􀁸 get attention first

• 􀁸 initiate relevant conversation

• 􀁸 keep to one plan

• 􀁸 recognize their lack of empathy as a symptom of their disability

• 􀁸 ignore, don’t argue

• 􀁸 stay positive

Making positive requests in a direct, pleasant and honest way helps you get what you want and need from others. Requests are different from demands. 

Demands annoy people. Requests made in a positive way help you build cooperative  relationships in which each person’s contributions are respected and valued.

1. Look at the person.

2. Say exactly what you would like them to do.

3.  Tell them how it would make you feel.

Use phrases like:

• “I would like to...

• "I would really appreciate it if you would...

• "It’s very important to me that you help me with...”

Expressing Negative Feelings:

Highly emotional expressions, blaming, threats (especially of withdrawal of love), and character assassination are damaging to all, but especially detrimental to people with mental illness. Research links these communications to re- hospitalizations! The goal is to state calmly the behavior you are unhappy about, giving an acceptable alternative and communicating a continued acceptance of the person.

1. Look at the person. Speak firmly.

2. Say exactly what they did that upset you.

3. Tell them how it made you feel.

4. Suggest how the person might prevent this from happening in the future.

Use phrases like: 

“I feel angry that you shouted at me, Tom. I’d like it if you spoke more quietly next time.”

Setting Limits:

Be clear, specific, and firm about what is acceptable versus unacceptable behavior. Remaining calm but firm increases the chances that the person will comply and not become more upset. Sometimes you should make calm, clear demands. Example: “Set down the knife,” or “To live at home you must take your medication.” Use this technique very rarely and only in situations which are very important. You have only a certain number of limits you can set. Use them wisely.

Praising (Seeing the Glass Half Full):

Use praise to encourage any progress, no matter how small. Praise can be attention, physical affection, expression of interest, and commendation. Notice any improvement or effort and ignore flaws in performance. Be specific about what you liked. Don’t sugarcoat a punishing remark. (e.g.: “Thanks for doing the dishes, but you put the plates in the wrong place,” etc.)

(Taken from 8.23 - Family to Family Class - Version 2014)

• Don’t criticize. People struggling with mental illness can’t defend themselves against personal attack. Respect and protect shattered self-esteem.

• Don’t press; don’t fight; don’t punish. You may not fight; keep your voice down and stay calm.

• Ignore negative behavior as much as you can and praise positive behavior every chance you get. Criticism, conflict and emotional pressure are most highly related to relapse.

• Learn to recognize and accept the primary symptoms, and the residual symptoms, of a person’s brain disorder. You can’t jumpstart a person in depression, shoot down a person with mania, or argue with schizophrenic delusions. Support relieves guilt and anxiety.

• Don’t buy into the stigma all around you. People with mental illness are not “bad” or ill because of some failure or character. They do not try to disgrace, frustrate, or embarrass us. They are simply ill.

• Lessen your demand for support from your ill relative. People with mental illness become very “self” involved when so much of their identity and self-respect are at stake. They often cannot fulfill normal family roles.

• Having made these necessary allowances, treat people with mental illness, day-to-day, just like anybody else. Expect the “basics” we require to get along together and set the same limits and expectations for reasonable order that would exist if they were well. All persons require rules of conduct and cooperative standards to live by.

• It is important to encourage independent behavior. Make short-term plans and goals and be prepared for changes. Progress in mental illness requires flexibility. It means giving up our zeal for progress measured by normal standards. There is more danger in pushing than in waiting. When they are ready, they move.

• Don’t cling to the past or dwell on “what might have been.” The best gift we can offer is to accept that mental illness is a fact in the life of somebody we love and look ahead with hope to the future. Mental illness makes life difficult, but not impossible. People get better. Most people with mental illness do struggle on and rebuild their lives. When a person “gets better” and shows improvement, for them it means that they are moving back into a risk position.

• Be patient in wellness as in illness. People recovering from mental illness still have the awesome task of accepting what has happened to them, finding new meaning in life, and constructing a way of living that protects them from becoming ill again.

• Empathy must also extend to family members who struggle to understand and encourage those we love who have mental illness. Brain disorders go through hard, intractable periods where helping those who suffer them is often very difficult to do.

• In the process of caring for people with mental illness, one learns tolerance, charity, endurance, and self-restraint. Don’t criticize yourself if you can’t muster up these graces. Coming to terms with changed life circumstances in serious illness is a huge adjustment. Empathic understanding will deepen and enrich our relationship with our relative suffering from mental illness

Written by the NAMI Venture County Journal, published in the NAMI SGV Journal, May/June 2003.

• The mental illness your spouse suffers is something that is happening to your entire family. All are affected, it is nobody's fault. It is not your spouse's fault, it is not your fault, it is not your children's fault. IT IS NOBODY'S FAULT. It is a misfortunate illness. It is NOT automatic grounds for divorce, any more than other disabilities.

• YOU CANNOT FIX YOUR SPOUSE. There is NOTHING you can do to make him well, so don't feel compelled to try. You don't have the answers. All you can do is be supportive and loving (in a profound sense), and handle the every-day details and practical issues of life for him that he cannot cope with.

• All members of the family have a responsibility to cope with the illness. Escape is not a helpful way of dealing with the crisis. You all need each other.

• The ill spouse must recognize and accept the illness, be willing to receive treatment, and if possible, learn to manage the illness. He must cooperate with his medical team. He must take his medications. He must learn to recognize relapse symptoms. If the ill spouse is not willing to do these things, it may become impossible for the family to continue to support him. The family is not required to throw away their own lives for someone who refuses to cooperate. There are limits, and they must be enforced without feelings of guilt.

• Educate yourself concerning every aspect of the illness. EDUCATION BRINGS COMPASSION. Ignorance encourages anger and fear.

• Grieve your loss. It is a great loss. The grief process for this illness is similar to the grief process for the death of a spouse, except it doesn’t end. You need to allow yourself to experience the entire process of grieving.

• Get help for yourself to cope with this incredible challenge, either from your own counseling sessions, or a NAMI support group. You can't do it alone. With help, you can live life with gusto. Don't refuse to recognize your own need for help, just because the ill spouse is getting most of the attention. This illness is happening to your whole family. You should not try to do it alone.

• Help your children UNDERSTAND the illness as much as their ages allow. NO FAMILY SECRETS! Don't deny them the opportunity of learning about the illness, the unfair stigma attached to it, and developing their skills in coping. It can be an incredible learning opportunity for them. If they need professional help to understand it and their own feelings, get it for them.

• Try to create a safe environment for the spouse to express himself without feeling threatened, constrained or condemned. He desperately needs a nurturing, safe place to express the incredible frustration he is feeling about this illness.

• You and your children need to SHARE YOUR FEELINGS honestly and openly. They are suffering a loss also. It's OK to feel angry and cheated. At times, you may feel embarrassed by the ill spouse's behavior. Avoid trying to protect your spouse by not discussing the problem with family members or friends. Don't require your children to conspire with you in a code of "Family Secrecy". Family secrets will isolate you from others. Humor and openness will help the entire family, including your spouse, accept the illness for exactly what it is and reduce guilt for all family members. Remember that small children, by their very nature, assume that they are responsible for anything in their environment that goes wrong.

• Never put yourself or your children in physical danger. If you sense your spouse is becoming dangerous, you should leave and call professional help. You should never tolerate abuse of you or your children! SAY NO WAY, and mean it. Trust your instincts & intuition on this one.

• Become your spouse's advocate with the medical professionals, and be assertively involved in his treatment and medication. Don't be afraid to go with him to appointments, to call his psychiatrist if you suspect something isn't right, or to inform the psychiatrist of the effects of the medication being prescribed. If the psychiatrist won't cooperate with you, demand a different one! Stand your ground assertively, but try not to be a pain in the neck. Treatment should involve the entire family, so find professionals who will work with the whole family. You know more about your spouse's illness than anyone else. TRUST YOUR INSTINCTS.

• Coldly assess what your spouse can and cannot handle, and then compensate assertively. Most people with severe mental illness cannot handle money, some household chores, time commitments relatives, too much stress. It is not uncommon for them to want to move all the time, searching for peace. YOU MUST NOT DO THINGS FOR YOUR SPOUSE THAT HE CAN DO FOR HIMSELF. Don't rob him of his dignity, but recognize the imperative need to create some stability for your family, financially and otherwise. You will probably need to get a job and develop a career, if you are not now working.

• Maintain your own identity. Resist becoming consumed with this illness. Life goes on and you have an obligation to yourself and your children to take care of yourself and to meet your own needs. We all must continue to develop our interests and talents. You are a valuable human being, so don't play the martyr role and sacrifice yourself. That's just self-pity. "GET A LIFE".

• Always hope for healing. The medicines do work, and new ones are constantly being developed. You may get your spouse back whole someday. If nothing else, the experience will broaden and deepen you in ways you never imagined. You CAN be a better person for it. Or you can choose to let it destroy you and your family. It IS your choice.

• Keep in mind that bad things happen to almost everyone, and you're no exception. You have not been singled out for special persecution. Trying to make good choices in life won't protect you from misfortune. You haven't been dumb to "get yourself in this situation". IT IS NOT YOUR FAULT. Life is not easy. We have to take what we get and make the best of it. "Bloom where you are planted".

(Kathy Bayes & Spouse Support Group)

In a marriage where one partner is mentally ill ("MIS"), the well spouse ("WS") must aggressively set and enforce boundaries if the family is to survive. Setting boundaries must not be confused with setting limits. Limits are daily struggles to control undesirable behavior, some won, some lost.

Boundaries are much more fundamental and are absolutely vital to the survival of the family. The MIS does not have an option to conform to boundaries. They are not negotiable. These boundaries are particularly necessary when the mental illness is chronic, but they are also important in managing an episodic illness like manic depression. We have found that if the WS communicates exactly what his or her expectations are without emotion, the MIS will hear even through the static of illness AND the chaos of psychosis. The WS must believe in these boundaries absolutely and without a shred of doubt. The WS must also communicate undebatable harsh consequences if the boundaries are violated.

Setting and maintaining boundaries actually improves the MIS's sense of security, stability, predictability and order, even though the MIS may not like some of them. Setting boundaries will encourage a more relaxed, nonjudgmental family atmosphere. The need to set boundaries must not be confused with the need for an understanding atmosphere. The Mental Illness must not be allowed to dominate or grossly disrupt the household, spinning it into chaos. If the following boundaries cannot be enforced, then the well spouse must consider alternative care, and consider carefully if the marriage will survive.

THE BOUNDARY OF SAFETY

First, the well spouse must ensure safety for the family. The WS's first responsibility must be to any young children in the family. If the MIS refuses to cooperate with doctors, participate in the treatment program, take medication, and is abusive, the WS will not be able to stay with the MIS. Even though well spouses believe strongly in the sanctity of marriage and in eternal commitment [or they would have been "out of there" a long time ago], the WS's first responsibility must be the children. If the WS doesn't look out for the welfare of the children, then who will?

The WS should not tolerate physical abuse. Whether this behavior is a function of the illness or the person, it must be stopped immediately, Sometimes medication must be adjusted to control anger and violent behavior. This adjustment should be made immediately, or the WS should leave until the danger has passed.

The WS should not tolerate verbal abuse. This behavior is more likely to be a function of the illness, not the person. Regardless, it should be stopped or controlled. The WS certainly must learn not to internalize abuse. The WS must protect young children from verbal abuse.

THE TRUTH BOUNDARY

The Well Spouse must categorically refuse to hide the illness from children, extended family and friends. Only if the MIS is working is there justification for hiding the illness, and then only from work colleagues. Not telling creates enormous isolation. Not telling and talking creates enormous confusion for children. Not telling and talking prevents education. Not telling and talking prevents development of good coping skills. No Family Secrets! No Stigma! This is a biological brain disorder. It is an Illness, like any other.

IDENTITY BOUNDARIES

In the initial experience of mental illness, the WS often is so consumed by trying to fight a battle he or she has little knowledge of that the WS loses his or her identity in the battle. It is like shooting darts in the dark, with no direction, no logic, and little success, but a tremendous gut feeling that something is seriously wrong. Often we hear spouses say, "And I knew if I left him, he would die". They are probably right! When the series of events and experiences is finally given a name, efforts to control its effects can begin to take on direction and become much more successful. After the initial diagnosis, it often seems that everything and everyone revolves around the MIS. The WS must find his or her identity once again, apart from the battle. The WS cannot fix the MIS, and should quit trying. Of course, the WS can help, but he or she must learn to let go and to find himself. Hobbies long abandoned must be rediscovered. Interests must be cultivated, children enjoyed, talents explored and expanded, knowledge exercised. Do nice things for yourself. Find freedom. Demand space. GET A LIFE.

MORAL BOUNDARIES

Mental illness does -- or does not make a person a nice person, worthy of your respect and love. The mentally ill can respect your moral boundaries even in the midst of psychosis if you make them very clear. If the MIS is not willing to respect the WS's value structure, then the marriage may not survive.

We do not tolerate violence, dishonesty, street drug use, sexual unfaithfulness, and criminal behavior. The WS must communicate grave consequences for these behaviors. The WS is deeply committed to the sanctity of marriage, and for the MIS to violate this value is profoundly discordant and intolerable to the WS. Often the WS's report that "the MIS never gave me a good excuse to leave" is because the WS's moral boundaries were never violated. That "non-occurrence" was not an accident. Rather, it illustrates commitment by the MIS to the marriage.

MEDICAL SYSTEM BOUNDARIES

The MIS may not want the WS to participate in treatment decisions, but the WS must know what is going on and communicate assertively with the doctors and therapists. The WS is the best person to communicate what is really happening with the MIS to the doctors. The WS must know what the treatment plan and prescribed medications are. The WS must help watch for unwanted side effects and give feedback on the effectiveness of medication. We have found that the WS often must push doctors into trying new medications. The WS simply must be an expert in the treatment of the illness and participate assertively. To not participate leaves the WS too much in the dark. Education obtained through the Journey of Hope is invaluable here.

PRACTICAL BOUNDARIES

The Well Spouse will probably need to take over the practical, day to day responsibilities of the family. These responsibilities may include the following, depending upon the severity of the illness:

• Making sure the family has a permanent place to live. Often Mentally ill persons will want to move and/or change jobs often, running from the illness and failures to cope. The WS must affirmatively and unequivocally put a stop to this constant moving. If the WS has the finances, he/she should buy a house, put down roots, and deal with reality.

• Handling the finances. Most mentally ill persons do not handle money well. This may mean withdrawing credit cards from the MIS. This usually means setting up a separate checking account. This means paying all or nearly all of the bills. We have found that even when the WS has tried to share some bill paying responsibility with the MIS, it usually fails. If the WS is a woman who is not working, she MUST get a job.

• Handling the discipline of the children. The MIS often is very inconsistent and unpredictable in disciplining the children, which creates stress and confusion. The MIS may interpret misbehavior merely because normal childhood behavior is disturbing to him/her. The WS must establish firm guidelines, and aggressively intervene if the MIS is totally out of line. He/she will not like it, but the damage that can be inflicted upon young children can be irreparable. The WS will feel confused about the best way to raise children, and may be susceptible to pressure from the MIS, but the WS must trust his or her instincts. None of us have all the answers, but the WS is more likely to be right. At the same time, children should not be allowed to use Mental Illness in the family as an excuse for disrespect and bad behavior.

• Taking charge of home maintenance. Many mentally ill persons simply don't see the tasks that need to be done. They also may lack the organizational skills to make a plan to get them done. The MIS may also lack judgment in hiring work done. Of course, the MIS should participate in household chores, but the WS will probably have to organize it.

• Maintaining the automobiles. The MIS may be oblivious to mechanical difficulties and lack judgment in getting repairs done.

• Obtaining and maintaining insurance. Often the necessity of insurance is lost on a MIS.

• Handling family paperwork. The MIS will lose mail, and is probably not capable of doing income tax returns. In our household, my husband refused to even open the mail, even though he is a licensed attorney. He doesn't have a clue as to how I do the income tax.

• Long range planning. The MIS is barely able to handle today, let alone worry about tomorrow.

• Maintaining Family Traditions. Often a MIS is stressed by family celebrations. These events are important to the family and the WS should not let the MIS steal them from the family, even if the stress is uncomfortable. The MIS just has to deal with it.

HOW TO SET BOUNDARIES

• Know yourself and what you can live with. Have confidence in your right to demand conformance to these boundaries. Communicate them unequivocally and unemotionally. Believe in them without reservation.

• Be prepared to enforce consequences. Often the mere threat of leaving scares the MIS into compliance. The MIS really knows how dependent he or she is and how much he or she needs the WS. That is a powerful tool for gaining compliance, to be used very selectively. Don't feel guilty, these boundaries must be observed if the marriage and the family is to survive. Establishing boundaries is in the best interest of the MIS.

• Get family support. Don't allow the MIS to "divide and conquer". Discuss your needs with influential family members. Get them to help. Discuss your needs with the psychiatrist and therapist, enlisting their help. Get reinforcement and courage from your NAMI support group.

Why am I struggling with my loved one’s mental illness?

If you find it difficult to come to terms with the challenges presented by your sibling’s or parent’s mental illness, you are not alone. Most people find that mental illness in a brother, sister or parent is a tragic event that changes everyone’s life in many fundamental ways.Strange, unpredictable behaviors in a loved one can be devastating, and your own personal anxiety may increase as you struggle with each illness episode and worry about the future. It seems impossible at first, but most siblings and adult children find that over time they do gain the knowledge and skills to cope with the challenges effectively.

What can I do to better understand and cope with the situation? 

The best starting place for learning to cope is to educate yourself; find out as much information as possible about mental illness by reading and by talking with others experiencing similar difficulties. NAMI has a variety of resources available for you: books, pamphlets, fact sheets and tapes available about different illnesses, treatments and issues you may have to deal with. The NAMI Family-to-Family Education Program is a 12-session course that teaches families about the illnesses, skills needed to navigate challenges and how to find support for the future. NAMI also provides support groups for family members of individuals living with mental illness. For information on support groups and classes contact your NAMI State Organization or NAMI Affiliate or call the NAMI HelpLine at (800) 950-6264.

Do you have any coping tips?

The following are some things to consider as you learn to live with mental illness:

Basic Principles:

• You cannot cure a mental disorder for someone you love.

• No one is to blame for the one you love developing the disorder.

• Mental disorders affect more than the person who is ill; they affect everyone.

• Despite your best efforts, your loved one's symptoms will change for the better or sometimes for the worse; it is out of your control.

• It is important to learn to separate the disorder from the person you love.

• If you feel anger and resentment, direct that negative energy toward the illness, not the person that you love.

• Remember that it is quite often difficult for the person you love to accept their disorder. This is a process you too may contend with. Acceptance of the disorder by all concerned may be helpful, but it is not necessary.

Strategies and Realities:

• Hallucinations and delusions have little or nothing to do with reality. It is not helpful to discuss them with your family member or attempt “talk them out of” such a belief.

• It is not realistic to think that it is possible to “fix” a biological disorder such as diabetes or depression with talk. However, addressing social complications is helpful.

• People you encounter will have a varying ability to discuss this with you. Unlike medical conditions which typically bring out sympathy, the community will likely be mixed in how they provide support for you and your loved one.

• Acknowledge the remarkable courage and strengths your loved one may show when dealing with a mental disorder.

• Grief issues for siblings are often common and powerful. Dealing with family responsibilities is another challenge to get support and advice on.

• After denial, sadness and anger over learning about your loved one’s mental disorder comes acceptance. Acceptance and understanding of the disorder itself yields compassion for the person you love.

• The symptoms presented by the disorder may change over time and circumstance. This can make expectations of your loved one a challenge – stay flexible.

• With your loved one’s permission, you may request information from their mental health treatment team to deepen your understanding of their condition.

• If your loved one isn’t getting what they need, assess your ability to engage their mental health provider to see how a case manager or other professional can help.

• It’s not personal, unusual or uncharacteristic behavior is a symptom of the disorder.

• Don’t be afraid to ask your sibling or parent if he or she is thinking about hurting him or herself. The possibility of suicide is a real concern, and asking about it will not give them the idea. See if they have a safety plan to address these concerns.

Self-Care and Balancing Your Needs with Those of Your Loved One:

• Prioritize your own self-care. Good nutrition, rest, support groups, relationships, spiritual or religious support, exercise and hobbies are avenues to support self-care.

• You are not a paid professional. You are a sibling or child, not a parent or caseworker.

• The needs of the ill person do not have to come first; it’s not always possible.

• It is important to establish boundaries and to set clear limits for you.

• It is natural for you to experience a variety of emotions. You, not the person with the disorder, are responsible for your own feelings. Getting psychotherapy support can often be quite helpful for these experiences.

• You are not alone. Sharing your thoughts and feelings in a support group has been helpful and enlightening for many. NAMI has thousands of support groups across the nation. The shared experience found in support groups reduces isolation and stress.

Reviewed by Ken Duckworth, M.D., Darcy Gruttadaro and Teri Brister, May 2013

What you can do to manage violent or disruptive behavior:

• When you and your relative are BOTH calm, explain to him/her what kinds of behaviors you will not tolerate, as well as the specific consequences upon which you (and other family members) have decided (and agreed) for specific violent or disruptive behaviors.

Example: “Next time you threaten to harm any of us, the police will be called.”

• Get to know and recognize cues that your relative is becoming violent or disruptive. (Your own uneasiness or fear is usually a good cue.)

• Tell your relative that his/her behavior is scaring you or upsetting you. This feedback can defuse the situation, but proceed with the next suggestion if it does not. Saying you are scared does NOT mean you act scared.

• If you (and other family members) have made a limit-setting plan, now is the time to carry out the consequences. If you have not already warned your relative of the consequences when he was calm, use your judgment and past experience to decide whether to warn him/her or to just go ahead with the plan without saying anything.

• Give your relative plenty of space, both physical and emotional. Never corner a person who is agitated unless you have the ability to restrain him/her. Verbal threats or hostile remarks constitute emotional cornering and should, therefore, be avoided.

• Give yourself an easy exit, and leave the scene immediately if he/she is scaring you or becoming violent.

• Get help! Just bringing in other people, including the police if necessary, can quickly defuse the situation.

• If you or someone else has witnessed your relative recently committing or planning a violent or dangerous act, that is grounds for involuntary commitment.

What you should NOT do:

• Do NOT try to ignore violent or disruptive behavior. Ignoring only leads your relative to believe that this kind of behavior is acceptable and “repeatable.”

• Do NOT give your relative what s/he wants if the way s/he is trying to get it is through bullying you. Giving in reinforces this bullying behavior and makes it likely that s/he will use it again. Only give in if it is the ONLY way out of a dangerous situation.

• Do NOT try to lecture or reason with your relative when s/he is agitated or losing control.

• NEVER be alone with someone you fear.

Example: Do not drive him/her to the hospital by yourself.

Source: The Training and Education Center Network, Mental Health Association of Southeastern Pennsylvania, Philadelphia, Pennsylvania