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Home » Mental Illness » Mental Illness: Practical Tips

How the Caregiver Can Cope

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For Practical Advice on Care for the Caregiver that you can use for yourself in order to better be able to help your loved one.  Just as the airline insists that you grab the oxygen mask for yourself first, you must be in good condition to give care now and on into the future.  Our lives are entangled in a long term commitment.

Click here to view or print Self-Care for the Caregiver in Spanish, Chinese, Vietnamese, Farsi

 


 

 

Practical Advice for Family/Caregivers

Interacting with Their Loved Ones

 

Medication

  • Understand your family member’s medication(s) and its side effects
  • Help your family member to independently manage their medication(s)
  • Discuss with your family member the importance of the medication(s) in reducing their unpleasant symptoms
  • Make time to discuss everyone’s feelings about the medication(s)
  • Watch and learn the signs that your loved one may not be taking his/her medication(s)
  • Please refer to FERC’s Medication Information sheet and table included in our packet for further information on medication


Social Withdrawal and Isolation

 

  • Involve your family member in family social activities
  • Encourage your family member to become involved in a day program such as: social activities, daily living, and skill building
  • Facilitate social activities with your family member’s friends to include your family member
  • Acknowledge that your family member needs to be alone at times
  • Do not push too hard when your family member withdraws
  • Remember, he/she needs “down time” for sorting out and coping with his/her experiences

 

Hygiene and Appearance

  • Acknowledge and encourage their improvements and efforts, regardless of how minor they appear to be
  • Encourage your loved one to express their own style and creativity
  • Acknowledge the range of styles that are acceptable among your family member’s peers
  • If necessary, arrange for teaching or instructing in hair care, make-up, or personal style
  • Negotiate with your loved one if they are reluctant to bathe; try to implement incentives that you both are comfortable with
  • Remind your family member and assist if necessary, to “Please put on a clean shirt,” or “Please comb his/her hair”


Bizarre or Unusual Behavior (e.g., the need to pace back and forth, paranoia, or laughing to oneself)

  • Sit down and talk calmly with your family member about your concerns
  • Be firm, without relying on threats, about behaviors that are unacceptable
  • Be clear about what is unacceptable
  • Develop a happy medium; remember, you cannot change or control every behavior
  • Respond to a hallucination, delusion and/or paranoia by validating their feelings about it: “It must be so frightening”
  • Use reassurance to allay your family member’s fears: create a sense of safety, by using a phrase such as “You are safe here with me”
  • Try to tolerate behaviors that may appear a little different but that are not dangerous or harmful
  • Join a support group that will help/educate you on coping strategies
  • Distract your family member from his/her behavior by involving him/her in other activities such as one of their hobbies
  • Use humor (when appropriate)
  • Solicit information and support from treatment provider(s)
  • Become educated about  holistic (e.g., meditation, acupuncture, massages) approaches to symptom management
  • Be open to new treatment methods
  • Coordinate strategies and become involved with a treatment provider
  • In public or close quarters, distract your family member by starting a conversation or redirecting their attention


Violent or Aggressive Behavior

 

  • Aim to prevent escalation and police involvement
  • Talk directly with your family member about his/her behavior
  • Remain composed and speak in a calm tone
  • Firmly and clearly state what you do not like and what you would like your family member to do
  • Set clear boundaries and sign a contract with your family member
  • Do not make idle threats; follow through with the consequences that you both agreed to
  • Tell your family member how they make you and others feel as a result of their actions
  • Learn to identify early signs of relapse
  • If necessary, remove, hide, or lock away any item(s) that can be used as a weapon
  • Request outside assistance if necessary (Police Department, Crisis clinic, etc.)
  • Remember safety first


Self-Destructive and Suicidal Behavior

 

  • Create a supportive space for your family member to disclose feelings that they may have of hopelessness and despair; assist them with identifying these triggers
  • Take any disclosure of wanting to commit suicide seriously; ask if they have a plan
  • If at all possible, call crisis support services as an alternative to calling the police
  • If a family member discloses that they feel suicidal, do a safety assessment and removal of all items that could be perceived as weapons (e.g., sharp items, kitchen utensils, prescriptions or over the counter medication, household cleaners)
  • Look for warning signs such as: giving away personal items, mood changes, or a sudden calmness and  peacefulness - this  may be due to their plan to self harm
  • If cutting is a concern, address this issue, and look for visible marks in areas that are normally  unexposed (e.g., upper thighs, abdomen, pelvis, arms)
  • Remind your family member that they have options to resolve their issue(s) and explore them
  • Have your family member commit to working through this difficult time, develop a plan with them and have him/her agree to talk with you or a professional before they hurt themselves (obtain their signature if possible)
  • Be aware and look for behaviors that may indicate that your family member is going to have a relapse (e.g., different sleeping or eating patterns, bizarre behaviors)
  • Gently approach your family member and remind him/her that they are loved
  • If your family member still insists on self-destructive or suicidal behavior, talk to him/her about seeking help right away
  • If your family member carries out a threat, or you think they will imminently hurt themselves, seek help immediately and contact the police to initiate a 5150 process
  • Contact a therapist or psychiatrist regarding their current state


Interacting with Law Enforcement

 

  • Meet the police outside before they interact with your family member
  • As a safety precaution for everyone involved, do your best not to tell your loved one that the police have been called
  • To ensure safety, request that there are at least two police officers present
  • during a 5150 process; ask for CIT (Crisis Intervention Trained officers)
  • Clearly explain the condition of your family member and the reason for your call
  • Have a brief and concise (1 page) information sheet that includes a photograph, medical/psychiatric history, and family/caregiver contact information
  • Make copies of social security card, photo I.D. and keep copies for your records
  • Turn on all the lights in your home to improve visibility
  • Turn off audio appliances such as televisions and stereos to reduce distractions during your conversation
  • Remove any items that could be used as a weapon
  • Ask where they are transporting your family member

 

 

Interacting with Healthcare Providers

  • Come with a game plan/strategy for treatment (e.g., labs, appointment schedules, list of questions, suggestions & recommendations for an acceptable next step)
  • Encourage your family member to sign a release of information when they are doing well so that his/her treatment providers will be able to share information with you on his/her treatment: keep copies on hand
  • Be aware that if your family member refuses to sign a release of information, confidentiality statues DO NOT prevent providers from receiving information from family/caregivers (AB-1424: see enclosed information and form)
  • Have a brief and concise (1 page) information sheet that  includes medical/psychiatric history, and family/caregiver contact information
  • Select one  person to be the “point person” to communicate on behalf of your family member
  • When you talk to the provider, ask specific questions
  • Try to stick to one topic at a time
  • If you don’t understand a word or a phrase the provider uses, or something they say, do not hesitate to ask them to explain it
  • You may also find it useful to take some notes of what the provider is saying to you, or ask for some written information that you can take away with you



FAQs



 

Q: What is Lack of Insight?

A: Anosognosia is the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications. The term used by neurologist is “anosognosia,” which comes from the Greek word for disease (nosos) and knowledge (gnosis).  It literally means “to not know a disease.” This impaired awareness of illness is caused by damage to specific parts of the brain, and affects approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder; this is especially true if the person also has delusions and/or hallucinations.  Medications can improve awareness in some patients, consumers, and clients.

 

Q: What is Impaired Awareness of Illness?

A: People with impaired awareness of illness may not recognize that they are ill.  Instead, they believe their delusions are real (e.g., the woman across the street is being paid by the CIA to spy on him) and that their hallucinations are real (e.g., the voices are instructions being sent by the President).

 

Q: Is Impaired Awareness of Illness the Same Thing as Denial of Illness?

A: No. Denial is a psychological coping mechanism that we all use, more or less.  Impaired awareness of illness, on the other hand, has a biological basis and is caused by damage to the brain, especially the right brain hemisphere.  The specific brain areas that appear to be most involved are the frontal lobe and part of the parietal lobe.

 

Q: Can a Person be Partially Aware of Their Illness?

A: Yes. Impaired awareness of illness is a relative, not an absolute problem.  Some individuals may also fluctuate over time in their awareness, being more aware when they are in remission but losing the awareness when they relapse.

 

 

 

 

 

Q: Are There Ways to Improve a Person’s Awareness of Their Illness?

A: Studies suggest that approximately one-third of individuals with schizophrenia improve in awareness of their illness when they take antipsychotic medication.  Studies also suggest that a larger percentage of individuals with bipolar disorder improve on medication.  Safe and effective treatments are available and may include talk therapy, medication or a combination of the two.  Rigorous, published, peer-reviewed research clearly demonstrates that treatment works.  The best treatments are highly effective; between 70 and 90% of individuals have significant reduction of symptoms and improves quality of life.


Q: Why is Impaired Awareness of Illness Important?

A: Impaired awareness of illness is the single biggest reason why individuals with schizophrenia and bipolar disorder do not take medication

    • They do not believe they are sick, so why should they?
    • Without medication, the person’s symptoms become worse.
    • This often makes them more vulnerable to being victimized and committing suicide.
    • It also often leads to re-hospitalization, homelessness, being incarcerated in jail or prison, and commit violent acts against others because of the untreated symptoms.


It is difficult to understand how a person who is sick would not know it.

  • Impaired awareness of illness is very difficult for other people to comprehend.  A person’s psychiatric symptoms seem so obvious that it’s hard to believe the person is not aware he or she is ill.  Oliver Sacks, in his book The Man Who Mistook His Wife for a Hat, noted this problem. “It is not only difficult, it is impossible for patients with certain right-hemisphere syndromes to know their own problems… And it is singularly difficult, for even the most sensitive observer, to picture the inner state, the “situation” of such patients, for this is almost unimaginably remote for anything he himself has ever known.



 

 

 

How do I deal with Lack of Insight?

 

  • Remember that lack of insight (anosognosia) is NOT something that your loved one is choosing; they have no control over the fact that they cannot grasp what is happening to them
  • Meet your loved one where they are when it comes to understanding their mental health issues; they may need time to completely understand and grasp what is happening
  • Your loved one may be more aware of their mental health issues when they are in treatment and less aware when they relapse
  • Educate yourself and your loved one on the treatments available that can alleviate their symptoms (counseling or medication or both)
  • Do not focus on trying to convince the person to change, rather focus on achieving realistic goals in their life.
  • If the person resists treatment, and is of imminent threat to themselves or others, or is so disconnected from reality that they are unable to provide for their basic human needs or protection, they may need to be hospitalized against their will
  • Utilize the L.E.A.P, Treatment Strategy (Amador, 2000)

 

 

General Treatment Strategies (Amador 2000)

 

  • Listen, Empathize, Agree, Partnership (L.E.A.P.)

 

  • Listen to what your loved one is saying without jumping to conclusions about what they want; try to get a clear understanding of what exactly it is they are trying to convey.
  • Empathize with your loved one.  This will allow them to feel that they can open up to you and that you are not working against them.
  • Agree on things you observe with your loved one about what works or does not work for their treatment.
  • Partnership Create a partnership with your loved one in order to work towards their recovery.  This means allowing your loved one to be empowered by a partnership based on acceptance, non- judgment or stipulation.  It means breaking down all misconceptions and biases, and working from a “strength based approach”, (e.g., looking at the strengths of your loved one and building upon them.) to come to a common ground that will facilitate a path to recovery.



 

Signs/Symptoms to Watch For:

The following are signs that your loved one may need to speak to a medical or mental health professional. You may see any of these symptoms at any time, but are more likely to see them at certain ages.

 

General

  • Confused thinking
  • Prolonged depression (sadness or irritability) lasting more than two weeks.
  • Feelings of extreme highs and lows (e.g., grandiose or suicidal ideation)
  • Excessive fears, worries and anxieties
  • Social withdrawal
  • Dramatic changes in eating or sleeping habits
  • Strong feelings of anger
  • Delusions or hallucinations (hearing or seeing things)
  • Growing inability to cope with daily problems and activities
  • Suicidal thoughts
  • Denial or lack of insight of obvious problems
  • Numerous unexplained physical ailments
  • Substance abuse
  • Intense fear of weight gain
  • Cutting
  • Persistent nightmares
  • Persistent disobedience or aggression
  • Increased risk taking behavior (e.g., excessive spending, sexual promiscuity)
  • Hyperactivity


Transitional Age Youth (TAY):

  • Substance abuse
  • Confused thinking
  • Social withdrawal
  • Delusions or hallucinations (hearing or seeing things)
  • Growing inability to cope with daily problems and activities
  • Denial or lack of insight of obvious problems
  • Cutting
  • Inability to cope with problems and daily activities
  • Changes in sleeping and/or eating habits
  • Excessive complaints of physical ailments
  • Defiance of authority, truancy, theft, and/or vandalism
  • Intense fear of weight gain
  • Prolonged negative mood
  • Frequent outbursts of anger
  • Increased risk taking behavior (e.g., excessive spending, sexual promiscuity)
    Hyperactivity
  • Numerous unexplained physical ailments
  • Suicidal thoughts
  • Dramatic changes in eating or sleeping habits


In younger children:

  • Changes in school performance
  • Cutting
  • Social withdrawal
  • Poor grades/lack of motivation
  • Delusions or hallucinations (hearing or seeing things)
  • Excessive worry or anxiety (i.e. refusing to go to bed or school)
  • Hyperactivity
  • Persistent nightmares
  • Persistent disobedience or aggression
  • Growing inability to cope with daily problems and activities
  • Frequent temper tantrums
  • Delay in cognitive development
  • Numerous unexplained physical ailments
  • Suicidal thoughts
  • Defiance of authority, truancy, theft, and/or vandalism
  • Dramatic changes in eating or sleeping habits

 

Click here to view or print Practical Advice in English, Spanish, Chinese, Vietnamese, Farsi

 



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