Mental Health Stigma

How to Talk to a Loved One with Mental Illness

Jim Sugel on October 3, 2024

Supporting a loved one with mental illness can be challenging, especially when you don’t know how to approach sensitive conversations. Mental illness can distort a person’s thinking, affect their mood, and make communication difficult. However, approaching these situations with care, patience, and understanding can make a significant difference.

At Redeemed Mental Health, we know how essential it is for families and friends to be part of the healing journey, and one of the most important ways you can support someone is by learning how to talk to them in a compassionate and effective way.

This article will guide you through some key strategies for speaking with a loved one who is struggling with mental illness, emphasizing empathy, active listening, and support.

Understanding Mental Illness

Before diving into strategies for communication, it’s important to understand mental illness. Mental illnesses are health conditions that affect a person’s thinking, mood, and behavior. These conditions can range from depression and anxiety to bipolar disorder, schizophrenia, and more. Each illness comes with its own set of challenges, but one common thread is that they can deeply affect the way a person interacts with the world around them.

People with mental illness may:

Struggle to communicate their emotions clearly
Withdraw from social interaction or become overly dependent on others
Experience mood swings or emotional instability
Have difficulty managing day-to-day responsibilities
Feel misunderstood or stigmatized by society

These challenges often make it harder for them to reach out for help or talk about what they are going through. That’s why having open, honest, and supportive conversations is essential for both their healing and your relationship.

1. Approach with Empathy

The foundation of any conversation with a loved one who has a mental illness is empathy. Empathy involves not just understanding their situation but also actively imagining how they might feel and responding with care. When speaking with someone about their mental health, avoid coming from a place of judgment or frustration. Instead, approach them with kindness, compassion, and a willingness to listen.

How to Show Empathy:

Validate Their Feelings: Even if you don’t fully understand what they’re going through, it’s important to acknowledge their emotions. Phrases like, “I can see that you’re really hurting” or “It sounds like you’re feeling overwhelmed” can help your loved one feel heard and understood.
Avoid Minimizing Their Struggles: Mental illness can sometimes cause frustration for both the individual and those around them. However, it’s important not to say things like, “It’s not that bad” or “You just need to snap out of it.” These statements can feel dismissive and may cause your loved one to shut down.
Be Patient: Recovery from mental illness takes time, and progress can be slow. Remain patient and avoid rushing them to feel better or demanding quick changes. Your patience will show that you are there for the long haul.

2. Choose the Right Time and Place

Conversations about mental health can be intense, emotional, and deeply personal. It’s essential to choose the right time and setting to approach the topic.

Consider the following:

Private and Comfortable Environment: Choose a quiet, private location where your loved one feels safe and at ease. Avoid bringing up sensitive topics in public or when other people are around.
Timing: Make sure you’re both in a relatively calm and stable state before initiating the conversation. If your loved one is in the midst of a mental health crisis or feeling particularly agitated, it might not be the best time to engage in deep discussions.
Be Ready for Silence: Mental illness can make it hard for someone to express their feelings or even find the right words. There may be moments of silence during your conversation, and that’s okay. Give them space to think and speak when they’re ready.

3. Practice Active Listening

One of the most powerful things you can do for a loved one with mental illness is to listen—really listen. Often, people struggling with mental health issues feel isolated and misunderstood. By practicing active listening, you demonstrate that you care about their experiences and are willing to hear them out.

Tips for Active Listening:

Give Them Your Full Attention: Put away distractions, including your phone or TV. Make eye contact and focus entirely on the conversation.
Reflect What You Hear: Use phrases like, “What I’m hearing you say is…” or “It sounds like you’re feeling…” to ensure you’re interpreting their feelings correctly. Reflecting back what they’ve said shows that you’re paying attention and trying to understand.
Ask Open-Ended Questions: Instead of asking questions that can be answered with “yes” or “no,” try to ask open-ended questions that encourage deeper conversation. For example, “Can you tell me more about how you’ve been feeling?” or “What has been the hardest part for you lately?”
Avoid Interrupting: Resist the urge to offer solutions right away or interrupt with your thoughts. Allow them to express themselves fully before responding.

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4. Offer Support, Not Solutions

It can be tempting to try and fix things for a loved one who is struggling. However, mental illness is complex, and there are no quick fixes. Offering unsolicited advice or trying to “solve” their problems can come off as dismissive or controlling.

Instead, focus on offering support:

Ask How You Can Help: Rather than assuming what your loved one needs, ask them directly: “How can I support you right now?” This gives them the opportunity to express their needs and feel empowered in their recovery.
Be Supportive Without Being Overbearing: Offer your support in a way that respects their autonomy. Avoid pushing them to make decisions or take steps they’re not ready for, and instead be a steady source of encouragement.
Respect Their Boundaries: While it’s important to offer support, it’s equally important to respect their boundaries. If they’re not ready to talk about certain things or need space, give them the time and room they need.

5. Be Mindful of Language

The language you use when talking to someone with mental illness can have a significant impact on how the conversation unfolds. Words are powerful, and using the wrong language can unintentionally cause harm or perpetuate stigma.

What to Avoid:

Avoid Blame or Shame: Refrain from using language that suggests your loved one is at fault for their mental illness. Phrases like “Why can’t you just get over it?” or “You’re being so difficult” can make them feel guilty or ashamed.
Don’t Label Them by Their Illness: Your loved one is more than their diagnosis. Avoid using terms like “crazy” or “insane,” even in casual conversation, as these words can feel stigmatizing and hurtful.

What to Say Instead:

Use person-first language: Instead of saying, “She’s schizophrenic,” say, “She has schizophrenia.” This reinforces the idea that their illness is just one part of who they are and not the entirety of their identity.

6. Encourage Professional Help

While emotional support from friends and family is crucial, professional help is often necessary for managing and treating mental illness. If your loved one is not currently receiving treatment, it can be helpful to gently encourage them to seek professional help.

How to Approach the Topic:

Frame it as a Positive Step: Instead of implying that they need help because something is “wrong” with them, frame professional treatment as a positive, empowering choice. You can say things like, “Talking to a therapist could give you some extra tools to manage what you’re going through,” or “There’s no shame in asking for help.”
Offer Assistance: Navigating the mental health system can be overwhelming. Offer to help them research therapists, make an appointment, or accompany them to their first session if they’re nervous.
Respect Their Autonomy: If your loved one isn’t ready to seek professional help, respect their decision. Continue offering support and gently revisiting the topic when appropriate.

7. Take Care of Yourself, Too

Supporting a loved one with mental illness can be emotionally draining. It’s important to remember that you can’t pour from an empty cup. Make sure you’re also taking care of your own mental health during this process. Consider seeking support from a therapist, counselor, or support group for family members of individuals with mental illness. Taking time for self-care allows you to show up as your best self for your loved one.

Conclusion

Talking to a loved one with mental illness can be difficult, but it’s also one of the most important ways to show your support. At Redeemed Mental Health, we believe that open, empathetic conversations can play a crucial role in the healing process. By approaching your loved one with patience, empathy, and a willingness to listen, you can create a safe space where they feel heard and supported.

Remember, you don’t have to have all the answers. Just being there, offering your support, and encouraging them to seek help when they’re ready can make a world of difference.

What is Anosognosia in Mental Illness?

Jim Sugel on July 10, 2024

Today, millions of Americans struggle with mental health problems ranging from substance abuse to anxiety or depression to bipolar disorder or schizophrenia. With almost 1 in 4 Americans qualifying for a mental health diagnosis of some kind, it’s incredibly normal to have a mental illness or mental health problem. But, for some of us, realizing that we have those problems is part of the mental illness. Instead, a percentage of people suffer from a condition known as Anosognosia, in which they are unable to realize or recognize that they have a mental health problem.

While this can be linked to denial, anosognosia is an illness of its own and is characterized by damage to the brain, which can result from bipolar disorder, schizophrenia, Alzheimer’s, dementia, some kinds of trauma, and traumatic brain injury.

What is Anosognosia?

Anosognosia is a condition in which you cannot recognize another or other health conditions that you have. For most people, it means you simply are not aware of a deficit or illness that you have and instead see yourself as normally functioning and not in need of medication or help. In mental illness, it most often crops up in bipolar disorder and schizophrenia, where affected individuals may think they are normally functioning and not in need of any help at all. However, the illness is from a family of agnosia’s, all of which relate to inability to recognize sensory input. For example, the inability to see visual motion, inability to recognize body parts, inability to recognize partial paralysis, inability to differentiate visual objects, etc.

In mental illness, anosognosia is most-often linked to bipolar disorder and schizophrenia. Here, individuals can suffer significant trauma to the brain, resulting in their inability to see that they are functioning any differently than the people around them. They may also not notice or not realize that episodes happen and may therefore feel that any attempts to get them help are trying to harm them or asking them to do something for no reason.

What’s the Difference Between Anosognosia and Denial?

There are significant overlaps between anosognosia and denial. People who are in denial of having a mental health condition can delude themselves to the point of very significantly believing that they don’t have a problem.

Denial can also be a significant mental health problem in which a person can delude themselves into a condition that can be diagnosed as anosognosia. If you are incapable of acknowledging that you have a deficit, whether because of brain injury or because of a mental health problem, it likely qualifies as anosognosia.

Anosognosia is normally linked to the mechanism by which people make a mental image of themselves. Here, you have to change that mental image as you move through your life. You get a haircut, now you have to think of yourself with short hair. You learn a new skill, your mental image of yourself updates to include being able to achieve tasks with that skill. But when you lose skills, it can be difficult for your brain to adapt. You see this with people who lose limbs who very often react and try to use those limbs for decades after losing them. For example, patients with amputated limbs show brain activity for those amputated limbs decades after amputation, because the brain never gets rid of the portion of the brain dedicated to moving that limb.

Mental illness is thought to have a similar mechanism, where persons who lose functionality, such as by going into a bipolar manic episode, are unable to recognize the episode because their brain isn’t updating their mental image. The brain is inflexible. Whether that’s caused by brain chemistry, denial, or traumatic injury to the brain is less relevant than the fact that the problem exists.

Anosognosia can be a form of denial. It might also be something forced on the individual by a brain injury. You can’t just talk someone with anosognosia out of it. If that were the case, they would just have denial and not anosognosia.

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Who Develops Anosognosia?

Anosognosia is extremely rare on a population level but extremely common when you start to look at the specific groups that it affects. For example, one study shows that it impacts an estimated 40% of people with bipolar disorder, 40-98% of persons with schizophrenia, and 20-80% of persons with Alzheimer’s.

Often, anosognosia follows significant trauma to the brain, which can occur as a result of a mental health disorder like schizophrenia.

Signs & Symptoms of Anosognosia

Anosognosia is characterized by an inability to recognize that something is wrong. That can mean:

The individual stops taking their meds
The individual goes from understanding they have a diagnosis to claiming they are completely healthy and potentially back again (Anosognosia can come and go)
The individual is paranoid about why people want them to get treatment or take medications
The individual deteriorates and starts having worse symptoms of mental health problems becuase they stop taking care of themselves and going to treatment (after all, nothing is wrong).

Diagnosing anosognosia normally starts with a questionnaire to assess whether someone is aware of having problems. The Scale to Assess Unawareness of Mental Disorder (SUMD) is the standard used here. After this, you may receive a CT, EEG, or MRI scan to check for physical damage to the brain. Often, there are no physical signs, especially in patients with schizophrenia and bipolar disorder.

How Do You Treat Anosognosia?

Anosognosia can be extremely difficult to treat because people receiving treatment are often resistant to treatment. For this reason, it’s best to take a mixed approach of switching away from getting someone to acknowledge illness and towards getting someone to acknowledge goals.

For example, in patients with schizophrenia, getting them to take medication is often the primary goal. About a third of persons with schizophrenia-related anosognosia are able to recognize that they have mental health problems when they take their medication long enough for it to have an effect.

Motivational enhancement therapy is also often used to help people meet goals like going to treatment and taking medication. Again, the goal is not to convince the person that they are ill or that they have a diagnosis. Instead, it’s to convince them that there are benefits to fixing a specific behavior or making a change and then getting them to do it – to improve their overall wellbeing. In patients with “denial” MET is used to convince people that they have a mental illness and need treatment, but this approach does not work with anosognosia.

Getting Help

People with anosognosia are unable to acknowledge that they have a mental health problem. This may be total (they never realize they have a mental health problem) or it may come and go (they take meds for months and then suddenly believe they are well and are taking medication for no reason). In every case, the best approach is to get that person to a doctor where they can be diagnosed and given treatment. Often, the challenge is keeping that person in treatment because they won’t normally see anything wrong with themselves. That means talking to them about goals like work, living alone, taking care of themselves, etc., and then working out reasons that mental health professionals can help with that. You won’t get anywhere trying to talk someone with anosognosia into believing they are sick. However, you can talk them into getting help for other reasons by normalizing mental healthcare for normal life. Good luck getting treatment.

How Can I Rebound After Psychosis and Jail?

Andrea Wagner on November 10, 2023

Psychosis is a largely unacknowledged but extremely prevalent factor behind people committing violent crimes and going to jail. In fact, an estimated 3.6% of male and 3.9% of female prisoners have a psychosis diagnosis in prisons worldwide. Psychotic episodes from personality disorders, schizophrenia, or other psychotic disorders can wreak havoc on your life – not just because they make it harder to maintain routines and relationships but also because they can get you into very real trouble with the law.

How do you bounce back from that after having hit rock bottom? If you’re getting out of jail or prison after a psychotic episode, you probably want to take steps to protect yourself and your future. Ensuring you have the tools to stay healthy and in control is important. Of course, your treatment will typically depend on your diagnosis and what you’re facing. However, these tips will help you rebound after psychosis.

Talk to Your Doctor

Your first step should always be to talk to your doctor. That’s true whether or not you have a diagnosis. Here, you should:

Verify your diagnosis or attempt to get one
Get a prescription for anti-psychotics
Get a referral into a mental health treatment program so that your health insurance covers it

Nearly everyone with a psychosis diagnosis will require medication either permanently or intermittently throughout their lives. Most schizophrenia patients require medication for their entire lives. Data shows that about 30% of schizophrenia patients can manage without medication – after 10 years of treatment and learning to cope with symptoms.

This means that talking to your doctor and working out your prescription, if your prescription is still right for you, and how to combine it with therapy is an important first step. You likely need antipsychotics to benefit from mental health treatment. That will mean getting a prescription if you don’t already have one, waiting for it to take effect, and then moving into treatment that can work with you based on those symptoms.

Seek Out Mental Health Treatment

Attending psychosocial rehabilitation programs is one of the most important steps you can take in ensuring your recovery and rebound. In fact, primary treatment for psychosis is a personally tailored mix of talking therapy and medication. This means that you’ll need treatment to ensure that you have the tools to manage psychosis symptoms. Mental health treatment typically includes 30-90 days programs of in-house or outpatient treatment, where you’ll attend a clinic with group therapy, individual therapy, and counseling. There, you’ll learn how to manage symptoms, how to change behaviors to reduce symptoms, and how to build skills and coping mechanisms that improve your quality of life around your symptoms.

Depending on you, that can mean learning to accept symptoms and your psychosis and working to manage it. You might also need help building stress management, routines, and self-care skills. Many people also need help building social networks, managing relationships, and learning to ask others for help. Your treatment will typically depend on where you are and what you need. However, you can expect it to involve behavioral therapy such as cognitive behavioral therapy or dialectal behavioral therapy. You’ll also get counseling and group therapy to help you deal with the problems that psychosis cause in your life, to deal with psychosis itself, and to recognize the symptoms of psychosis and react to them with enough time to get help.

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Look for Assisted Living

Assisted living and supported living solutions are an ideal way to rebound from psychosis and jail. Here, you’ll stay in a shared home for several months, sometimes longer. There, you’ll have a routine, set meal times, people to check up on you, and accountability. If you stop going to treatment or stop taking care of yourself, people notice. If you stop spending time with the group or sharing meals, people notice. That forced accountability can be an important part of recovery because it forces you to adopt the routines and schedule of self-care that can help you to stay in recovery.

Of course, assisted living centers aren’t right for everyone and some people get the same out of an inpatient treatment program. However, it can be a valuable way to bridge the gap between no autonomy in prison and total autonomy out of prison by giving yourself accountability and someone to help you with schedules and routines.

Long-term Support and Aftercare

If you’re living with psychosis, it’s a permanent part of your life (although you may have drug-induced psychosis like marijuana psychosis, in which case it may be temporary). However, that normally means you’ll have to look for long-term aftercare and support. That means having people who will notice if you start to slip, having people to check up on you, and ensuring that you maintain your routines. For many, a simple self-help group with weekly meetings will be more than enough for therapy maintenance. However, you’ll want to discuss your options with your therapist based on your progress.

In addition, it’s generally a good idea to have more rather than less support. If you have a probation officer checking up on you, that’s good. If you have a social worker doing so, even better. If you have recurring visits with your therapist to check in on your mental health, even after your treatment is over, even better. Ensuring you have long-term support, options to go back into treatment, and people to help you stay on top of your mental health is important for your long-term recovery.

Tracking Signs of Relapse

For many people, preventing relapse and recidivism is about tracking early warning signs of relapse. For most people with psychosis those symptoms include:

Irritability or nervousness
Reduced concentration and focus
Requiring time alone or more than usual
Sensitivity to stimulus (noise, light, touch)
Reduced quality of sleep
Nightmares
Unusual thought experiences

Depending on your specific diagnosis, that can vary a great deal. Therefore, you should sit down with your therapist to build a list and to learn how to recognize them in yourself.

Long-Term Care

Long-term care means investing your health for the long-term that means investing in self-care and ongoing support. This means:

Taking care of yourself with good sleep, eating, and exercise habits
Having a good routine
Learning communication and problem-solving skills
Having social support
Having meaningful things to do with your time
Getting ongoing treatment

Many people do prefer to get help with this, especially in the first few years after diagnosis. However, that should often be in the form of professional support and not simply relying on family to help you. This means assisted living, visiting social workers, social care, and even at-home nursing and care. What works for you will vary depending on your situation, but it is an important thing to consider.

Getting Help

If you’re moving back into your life after a psychosis breakdown and incarceration, it’s important to reach out and get help. That almost always starts with your doctor, where you can talk about what your options are, review your diagnosis and prescription, and get a referral into mental health treatment. From there, you can get mental health treatment to ensure you have the tools to manage your disorder long-term, so you can recover, and so you can learn to recognize and act when your mental health starts to go downhill. Good luck rebounding!

Redeemed Mental Health is a mental health & dual diagnosis treatment center offering PHP, IOP, and individual levels of care. Contact us today to begin your journey of recovery!