When you're unfamiliar with mental illness, it can be hard to understand how to help someone going through a difficult time or their ongoing challenges. I've known Jessica since we were in high school and I can't think of anyone more suited to her career. She is one of the kindest, most compassionate people I know and I think this post is a must-read for everyone and perfectly aligned with Life is Sweet month
In my work as a Mental Health Counsellor at a post-secondary institution students share with me the impact of their unique mental health challenges every day. I am honoured to do this work and inspired every day by the resilience, honesty and integrity I see in the clients I work with. By far the most common refrain I hear stems from the reality that a mental health diagnosis is stigmatizing. While there is a great deal of funding, attention and sensitivity being directed to this essential issue (like the work of the brave and determined Ashley Gibson) mental illness continues to be a site of embarrassment, shame, judgement and often denial. In my experience, many people simply do not know how to respond, relate to, or support someone living with mental illness. And truly, how could they? Mental illness is a subject we either sweep under the carpet or that we sensationalize, a school shooting for example. At the same time, one of the most powerful protective factors for someone living with MI is the support of family and friends. In this way, we face a double bind. MI is scary and difficult to talk about, and yet, talking about it may help alleviate stigma, encourage individuals to get the help they need and promote education. In reflecting on the incredible courage that Ashley and her guest bloggers show in sharing their experiences, I decided to focus on a few tools, strategies and insights I hope may help some readers to respond in supportive ways to the needs of a friend or family member managing the roller coaster that is mental illness. This, of course, is a large and complicated topic. I have made an effort to speak to some general strategies and perspectives. I do not position myself in this discussion, or my practice, as an expert. Instead, I view my perspective as one that is informed by the opportunities I have had to witness and share the stories of many individuals living with mental illness.
#1- Know what Mental Illness means - Information is Power
Very often I hear clients question the meaning of their diagnosis. “Does this diagnosis change who I am? How will others see me? Should I tell people?” MI is characterized by alterations in thinking, mood or behaviour or some combination thereof [Canada Public Health, 2013]. It is associated with impaired functioning and inhibits the way one lives day to day over a period of time. Symptoms range from mild to severe. Very often, an individual who lives with one MI illness may also experience a second MI. The Centre for Mental Health and Addiction notes that depending on the population being considered, the percentage of people who experience a second MI ranges from 20% to as high as 80% (CAMH, 1998).
Please understand that MI can be a reflection of environmental life circumstances, or biological in nature. It can be episodic, or a life-long reality. It is NEVER the individual’s fault. While it is important for an individual to take responsibility for living with mental illness one should never have to wear it. That is, a person is not their diagnosis. The diagnosis may be an important part of a new way of living; it does not need to define life or the individual. Learning that someone you care for is struggling with mental health is troubling. It should not become the main lens through which you understand or interact with that person. We are each made up of many identities that intersect in ways that define us: gender, religion, age, sexuality, gender, education and so on. For many people, MI is one of those identities. It does not need to be the dominant point of identity however.
#2 Listen! Listen! Listen!
In school we learn to write essays, we learn to research, think logically, share, give presentations; we do not learn to listen. Because MI is so stigmatizing, it is incredibly powerful to share, even a piece of one’s experience with someone else and to have that person listen without judgement. I try to follow the 80/20 rule. If my voice is taking up more than 20% of the discussion, I tone it down. Active listening requires the listener not only to hear the words that are being expressed, but also, the meaning behind them. Showing you are attuned to and engaged in a person’s story can be as simple as a nod of the head, leaning toward the person speaking, making eye contact and reflecting back important words or phrases. Simple questions that are phrased in a gentle way such as: “What was that like for you?” or reflections like “That must be really hard” “I’m sorry you are going through this” are effective means of communicating your understanding and your empathy. This means leaving space for the individual to share however much or little feels comfortable. To support empathetically, imagine what it would be like for you to have the story be your own; place yourself in the story teller’s shoes. This kind of active listening is incredibly powerful for the person sharing their story. You do not need to be a counsellor to support someone who is suffering or struggling. Staying with the person in their feelings and experiences, trying to understand and reflecting what you hear lead the speaker to feel valued, understood and cared for.
#3 Thank the person for trusting you to share with you
I make a point of trying to thank individuals I work with for trusting me with their story. In my experience, this simple thank you does a lot to validate the importance of the individual’s story, the difficulty they may have in sharing and begins the process of creating safety in the relationship. No one is perfect, and sometimes we do not respond in ways that fit or may even offend the speaker. Saying thank you can help to alleviate any negative feelings around pieces of the conversation that did not feel so great. A simple thank you also emphasizes that the expert of the story is the storyteller and highlights the shared experience of listener and speaker in sharing that story.
#4 Focus on Needs - Avoid Problem Solving
Hearing someone you care for is hurting is painful. Like any kind human, when most of us hear this we want to fix the problem and to stop the pain. This is a natural reaction. At the same time, a person in crisis and pain is rarely in the mind set for problem solving. While listening and empathizing helps the individual to feel supported and heard, jumping into ways to manage the problem does not meet the person where he or she is at. We are all experts on our own experience. Instead of telling someone what they need, ask them! Asking the person what he or she needs in the moment, in the next few days and beyond empowers the individual. I am consistently struck by how self-aware people are even in crisis. Inquiring “What do you need for today…the weekend… the week in order to manage” is a constructive question which asserts that the individual sharing their story knows best. It also begins the process of self-reflection and self-care. People living with MI often feel they have lost control. Asking this question reminds the individual they can have some control in moving forward. Asking what you can do to help meet the needs that are identified is a constructive means to begin looking at coping and solutions without problem solving. Very often, MI brings up many questions about the future. Focusing on day to day needs can help to reduce the panic that can be brought on by mental health concerns and empower the individual that he or she has the capacity to respond to the present challenges.
#5 Understand that Recovery is a process
Recovery is both a process and a goal. Recovery is about learning to cope effectively with symptoms related to mental illness and finding quality in life. I sometimes hear clients refer to this as “the new normal”. For many people, recovery is a life-long journey. We all experience ups and downs, and challenges; mental health is no different. Very often, families and friends express hope that their loved one will “go back to normal” as the symptoms reside. The challenge is that healing from MI is not the same as healing from the flu, or even a broken limb. The pressure to be “cured” puts a great deal of pressure on the individual and promotes the perspective that living with MI is not normal. In fact, with 20% of the population experiencing the reality of MI; it is normal. The perspective that recovery is a process not an end point can help to challenge some of this stigma, set realistic expectations and allow you to better support someone you care for in managing mental health concerns. In this way, recovery should be defined by the person doing it.
#6 Get the support YOU need
When someone you care for is behaving uncharacteristically, being hurtful or suffering it is natural to have your own reaction and feelings. When a person first experiences symptoms of mental illness and seeks the support of medical health professionals, a care plan is often created. This plan outlines how the individual and their supports can respond to manage the symptoms of mental illness and what the individual needs for support. I try to encourage friends and family to connect with the supports they need as part of this plan. To think “we”, you sometimes need to think “me”. It is okay to prioritize your own needs in the healing process. Having the tools you need to process, understand and respond to mental illness as well as the new behaviours or emotions that may come with it will enable you to better meet the needs of someone you care for. For some this may mean sharing with close family or friends. For others, it could mean getting support from a professional in the field or connecting with a support group.
#7 Set Limits and Boundaries
Setting boundaries and limits is a difficult task in any relationship. I think it is one of the most common challenges that clients share with me and definitely one I struggle with myself! This is especially true if the relationship is compounded by mental illness. Boundaries and limits in relationships help each person to assert their needs, to take responsibility for their feelings and actions and to expect the same of others. Boundaries assert the difference between “my stuff” and “your stuff”. Asserting boundaries helps you to explore and determine: what is my experience? What is in my ability to control? How much am I willing/able to do for someone else in the situation? What do I expect from others and are these fair expectations. To begin the process of setting boundaries, take time to individually reflect upon concerns you have and previous challenges or conflicts you have experienced. Common points of reflection include how much (if anything) are you willing to offer your loved one in terms of: financial support, practical help, living arrangements, emotional processing, time commitments and what your expectations are around behaviour, medication and treatment.
When you have processed how you feel and have a sense of what you need moving forward, engage in a larger conversation that includes the person with MI as a participant. Express your perspective and hear others as well. Decide together how to respond to inappropriate behaviours or broken expectations. This creates a transparent understanding for everyone involved around what is considered to be acceptable behaviour and the outcomes for unacceptable behaviour. I am often struck at how readily people with MI are identified as “The Problem.” In fact, communication, family roles, values or behaviours inherent in the relationship may significantly contribute to “the problem”. A discussion of boundaries in which all individuals concerned are present and heard encourages a reflective process about each person’s role in creating stress or distress, establishes expectations, and allows for an opportunity to consider how all individuals participate in conflict in the family unit or relationship that may exacerbate tension or conflict. Try to be consistent in maintaining boundaries. Doing so can help to avoid burn out and feelings of resentment.
A Final Note:
Just as people do, mental illness comes in many shapes, sizes, colours and with unique personalities. Anorexia. Depression. Bi-polar. Schizophrenia. Complicated Grief. Seasonal Affective Disorder. Narcissism. Post Traumatic Stress Disorder. Borderline Personality Disorder. Anxiety Disorders. Obsessive Compulsive Disorder. And so on. For each person, relationship and family mental health is a very individual and personal process. In no way has this post intended to speak in an absolute way about the nature of these experiences we categorize as Mental Illness. Instead, the aim has been to identify particular strategies, perspectives and insights that might aid individuals in responding to their own MI or that of a loved one. Despite the commonality of these experiences, many people are more likely to cry quietly in bed than to seek support. I often express to clients that emotions and thoughts can be a bit like unruly children: the more you aim to ignore or silence them, the louder they become. My lived experience has been that people do heal, grow and change in ways that help them to manage MI and its impacts. I believe the starting point is exploring and sharing our experiences. My wish for you, reader, is to consider, if you are comfortable, how you might begin to engage in that process.
- Centre for Addiction and Mental Health, “Answers to Common Questions on Concurrent Disorders,” Journal of Addiction and Mental Health, September-October 1998, 16.
- Public Health Agency of Canada, “The Human Face of Mental Health and Mental Illness in Canada”. Ottawa, Canada: 2006.
Jessica Warnock works as a Mental Health Counsellor at a post secondary institution. She has her Masters in Counselling and Psychotherapy from the University of Toronto. Jessica works from a strengths-based and solution-focused perspective that draws upon a variety theoretical models and strategies in order to meet the unique needs of the client while prioritizing empathy and the counselling relationship. In her personal commitment to wellness, Jessica strives for balance and self-compassion. For comments or questions, please contact Jess via email.