What do I do if I think a friend or family member has mental illness?

I’ve had many people ask me: What should I do if I think my friend or family member has mental illness?

Mental illness is a touchy subject. There is a lot of stigma surrounding mental health conditions, as well as a great deal of misunderstanding. I think we are all afraid of bringing up something, in case we might anger or offend the person. But if you really are concerned, here is my suggestion for how to proceed.

Step 1: Know and Recognize the Signs
Drawing from the American Psychiatric Association, Everyday Health, and Mental Health America, here are common warning signs of mental illness in adults as concisely as I can put it:

•    Thoughts of suicide and death, or attempts (IMMEDIATE RED FLAG)**
•    Delusions or hallucinations
•    Differences in usual behavior or decline in functioning
•    Prolonged sadness, irritability
•    Excessive fears, worries and anxiety
•    Rapid or dramatic shifts in feelings or “mood swings.”
•    Increase in risky behavior, which is unusual for the person, such as spending extravagant amounts of money or becoming hypersexual
•    Substance abuse
•    Dramatic changes in sleeping, eating, and self-maintenance

Additional signs are (quoting the above sources directly):
•    Confused thinking
•    Feelings of extreme highs and lows
•    Social withdrawal
•    Strong feelings of anger
•    Growing inability to cope with daily problems and activities
•    Denial of obvious problems
•    Numerous unexplained physical ailments
•    Recent social withdrawal and loss of interest in others.
•    An unusual drop in functioning, especially at school or work, such as quitting sports, failing in school, or difficulty  performing familiar tasks
•    Problems with concentration, memory, or logical thought and speech that are hard to explain
•    Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations
•    Loss of initiative or desire to participate in any activity; apathy
•    A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality.
•    Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult.
•    Fear or suspiciousness of others or a strong nervous feeling.
•    Uncharacteristic, peculiar behavior.
•    Dramatic sleep and appetite changes or deterioration in personal hygiene.

Step 2: Look at the circumstances
•    Does mental illness run in the person’s family?
•    Does/Did this person abuse substances?
•    Did this person undergo any major life changes, such as going to college, starting a new job, experiencing the death of a loved one, or divorce?
•    Did this person undergo any traumatic event recently or in the past?
(Partially drawn from WebMD)

Step 3: Decide whether to bring it up to the person directly, or tell someone close to that person
First, don’t throw in the mental health card right away. I also encourage you to avoid the word “illness” during the conversation because it is so stigmatized. Talk to the person and bring up the signs you’ve noticed gently and gradually. Try to understand why they are behaving, thinking, or feeling the way they are.

Express that you are concerned and you want to help. Listen to them empathetically.

For example:

“Hi Hufsa. Are you alright? … I just wanted to let you know that I’m concerned about you because of a few things I’ve noticed. Is it alright if I point them out to you? … Well, I noticed that you haven’t been going to class lately and just stay in your room. This worries me because you don’t normally do that. I’ve also heard you cry in your room at night. Have you noticed these things?”

Step 4: Address the stigma and bring up the mental health issue
It’s a fact that people don’t understand mental illness and that mental health is as real as physical health. Bring up that you care about the person, and also relate it to a physical illness like the diabetes. Again, I don’t recommend saying the word “illness” because that is charged and stigmatized (at this time).

“Hufsa, I care about you, and I’m only telling you this because I want you to be better. If I noticed that you were eating a lot of sugar, getting dizzy, and having blurry vision, I would let you know that I think you have diabetes and encourage you to seek help. I’m doing the same thing right now by telling you I think you’re not well mentally and physically.”

Step 5: Let the person know they’re not alone and offer your help
It is important that the person knows that they are not alone. I cannot stress this enough. Let them know that there is help available and that you will (or have someone else) go with them to their first appointment. Help them make a call to their local NAMI for information and resources and where to seek help.  Give them information from the NAMI website on mental illness to educate them and normalize what they are going through.

“I know this might be a lot to take in. But I want you to know that you are not alone. I will be there to help you through this process of getting help if that’s what you want to do…here is information I found about mental health and there’s an organization called NAMI that can help you too. I can call them with you…”

Step 6: Follow up and help the person build a support system
Be sure to check in with the person after. Taking in the concept of having a mental health condition can be frightening, confusing, and overwhelming. It is frequently a long process and the person needs people by their side.

Again, these are just suggestions for what to do. I have consulted with several individuals with mental illness about how they would like to be approached by someone else about their illness, and this is what I’ve come up. By all means, if you have something to add, please do so in the comments!

** IF SOMEONE HAS VOICED SUICIDAL THOUGHTS, call 1 (800) 273-8255 with the person, the Suicide Lifeline IMMEDIATELY.**

Michelle Obama’s Speech on Mental Health

“At the root of this dilemma is the way we view mental health in this country. Whether an illness affects your heart, your leg or your brain, it’s still an illness, and there should be no distinction.”

This video was SO SPOT ON. SO, ABSOLUTELY, SPOT ON. I couldn’t say some things better myself. Using the power of parallels to physical health, she has hit the issue of the stigma of mental health on its mark.

Obama is making strides in the realm of mental health. The Affordable Care Act includes mental health treatment in it, and does not allow turning down someone who has a mental illness. I’ll post more about this soon!

How To Fight the Stigma of Mental Health: Part I

How can we fight against the stigma of mental illness – a surmounting task? I hope to do a multi-part segment on ways that one can combat the stigma of mental health conditions. The first point I will bring up is the power of analogies to physical illness.

I was a private math and science tutor for two years. Hands down, the best way to teach a student something they didn’t know was to put it in terms of what they already understood.

The vast majority of the world does not understand mental illness – including people who have mental illness themselves. But if you put it in terms of what people already know – physical illness – you will make greater strides in conveying the message that mental disorders are real disorders that affect the brain the same way other illnesses affect the heart, or lungs, or kidneys, etc.

I use this technique when I speak to various audiences, including the people I serve in the community mental health system. I explain that mental illness is a lifelong illness, just like physical illnesses. Mental health requires healing and self-monitoring, which can consist of medication and therapy. Is taking pills for diabetes something to be ashamed of? Is going to the hospital after having a heart attack different than going to the hospital for a mental breakdown? Is knowing the symptoms of your mental illness as necessary as knowing the symptoms of a physical health condition, even a stroke or heart attack?

When I put mental health in terms of physical health terminology and principles, people start to nod their heads, with an occasional “ahh” or “mm-hmm.”

To make strides towards eliminating stigma – to work hard to combat the stigma of mental health – let’s work together with these suggestions.

We Must Believe in the People We Serve

Recently, I took a NAMI (National Alliance on Mental Illness) Provider Education Course. I discussed various topics in a room full of social workers, therapists, and directors.

There was one big point of contention, when I mentioned the importance of believing in our clients and being as encouraging as possible.

I talked about how I have told clients that their potential is limitless. I believe they are survivors, having gone through so much trauma, but are trying to turn their lives around.

Having said that, most of the room was in total disagreement. The Licensed Marriage and Family Therapist leading the class said that, “We must be realistic. I’ve found that it’s more often true that they cannot achieve many things.”

And to that I stood up and declared that to be wrong. I said, “We may be able to predict where someone can be in 6 months. Maybe one or two years. But we can never know where they will be in ten years.”
I highlighted my own example. “Several people have said I couldn’t graduate from an engineering college. My own parents and psychiatrist said I could never work, and that I should live on SSI. But I graduated, I now work full-time, I have accomplished great things, and I will accomplish even more great things in the future.

“People made predictions about me in the past, and they were dead wrong. There are too many success stories that have spat in the face of those who made pessimistic predictions.”

And by having a “realistic” point of view (which oftentimes is pessimistic), by telling someone their potential is limited and predicting a bleak outlook for the rest of their lives, you are hurting the people we are meant to help.

I hear psychiatrists and coworkers tell people, “You probably won’t be able to work again.” But that type of statement is damaging someone. It takes away their hopes and dreams. Perhaps it is true, but we ourselves can never know.

What I say instead is, “Right now it looks like you might not be able to work. I don’t know if you can in the future, but if you want to, I will support you and try to help you get to where you want to be.”

I think social workers fear being responsible for someone making mistakes. If we err on the side of discretion and “realism,” we are playing it safe. Perhaps if we believe in someone, they will try and fail – and then we will be responsible.

But I urge you to set that aside and be encouraging. Be hopeful. Have faith in the people we serve.

However, one thing I should note is that I never push. If I believe someone can work, but they don’t, I never, ever push them to do something they don’t want to do. I will encourage them, try to provide counseling and help them see the potential in themselves, but in the end, I never push.

I think if we encourage, and not push, that will help assuage our fears that we will be responsible for anything bad that happens, and still give hope to our clients.

So please. Have hope. Err on the side of encouragement, not discouragement. Recognize your own limitations in predicting where someone will be. Because in the end, we are frequently the only one who has hope in the client – which can dictate hope in the client as well.

In Light of Robin Williams’ Suicide (repost)

Robin Williams’ death is a tragedy. It breaks my heart every time I hear someone committing suicide, whether they be my friend or someone who I admired from afar. I remember watching Robin Williams on talk shows with my mom. I laughed so hard that I had trouble catching my breath.

And of course I’m not the only one. So many people have been posting about how much they loved this man – not only how funny he was, but how kind he was. He was someone who made everyone around him happy. This is so sad that it feels unfair. No – it is unfair.

News articles state that he had depression and substance abuse issues, though it is not yet known whether substances were involved in his suicide. I have previously heard that he had bipolar disorder.

But what specific mental illness he had is not the point of this post.

How did such a remarkable man, someone who was so admired by so many people, end up committing suicide? How could someone like that feel so depressed and so hopeless? He was loved by countless people all over the world. He had family who loved him. He had friends. How could he feel like everything was that hopeless, that he would end his life?

I cannot claim to know the reasons for Robin Williams’ death. I don’t know if anyone really knows right now, or if anyone ever will. And I cannot claim to know what could have been done to stop the suicide. I just don’t know enough information. I don’t know if anyone does.

But I aim to draw hope and a message from this tragic event, and stop events like it from happening.

I. THE NATURE OF SUICIDE – AND WAYS TO COMBAT IT

This suicide is counterintuitive and illogical. But that is the nature of suicide – when people are suicidal, they are not thinking clearly. They cannot see that there is hope; they can only see past failures and believe in the impending doom. The illness is what takes over. The illness strips the individual of reason. The illness skews their vision so they only see darkness, and no light.

But there are ways to combat it. There is always at least a glimmer of hope.

When in that dark place, you can call the National Suicide Prevention Hotline at: 1-800-273-8255 (TALK). You can reach out to family and friends. You can think about the people who you love, and those who depend on you. You don’t allow yourself to be isolated. There are many more ways.

However, it is equally as vital to PREVENT yourself from getting to that point. I cannot stress enough how crucial it is to take action BEFORE it reaches that point. Ask for help. Reach out. Let yourself be helped. Build and use a support system of loved ones, activities, organizations, etc.

Treatment should be considered. If someone reaches such a low point, there is something deeply wrong; it is a crime not to seek treatment or help a loved one seek treatment. Please note that there are a variety of treatments available – medication, therapy, holistic, and more.

There are also Warmlines – “warm,” not “hot”lines – for people who are not yet in crisis, but need support. They offer peer support and referrals. You can reach one at 1-877-910-WARM. (I happen to work for one.) Don’t wait until things are so bad you can barely see any hope.

II. WHAT NEEDS TO HAPPEN NOW

There is a direction we as a society need to move towards, spurred on by this terrible event.
What is imperative now is that society learns from what happened. Society cannot ignore how powerful mental illness is, and how life-threatening it is.

A paradigm shift must occur!

It is a fact that mental illnesses are as equally serious as physical illnesses. A FACT. I strongly argue that they are the same. To those that argue that they are “just feelings and thoughts” – how can you not take a “feeling” seriously, when it can spiral into something that compels someone to take their own life? How can one doubt the power of emotions when they reach a severity where they trump all reason?

Mental illness is a life threatening disorder. Just as someone can die from an aggressive cancer in the body, someone can commit suicide as a result of a progressive mental illness. In this sad case, it was Robin Williams.

There are too many people who don’t realize this, who are not receptive to cries for help and don’t understand that mental illness is not something you can just “get over.” Emotions, feelings, attitudes, behaviors, brain chemistry, physical effects, and more are all intertwined and should be taken equally seriously.

And this all starts with YOU.

The best way for society as a whole to reduce suicides is to realize the severity of mental illness. Break down the stigma towards mental illness which prevents people from seeking and getting help.

Support each other. Reach out for help if you need it. Accept people’s help when they offer it. Don’t ignore the problem or deny it — this goes to individuals suffering from mental illness as well as their loved ones.

This is something we all have to accomplish TOGETHER.

The world must realize that mental illness is real. If we accept its severity – if we believe that mental illness is a serious, biological disorder, and not a defect in character – I guarantee you more people will get the help they need. I guarantee you fewer suicides will happen. I guarantee you the world will be spared from so much pain.

Let there be one good thing from this sad event – let this be a way to pave a better future where mental illness is taken as seriously as a physical illness, so more people will receive the help they need.

Because we all need it.

And remember, I’m here for you, too.

What is Stigma?

Before I move forward with this blog, it would be worthwhile to define what exactly stigma is.

Stigma literally means a mark of shame or discredit. In a wider sense, it means prejudice and discrimination towards a certain action or characteristic. There is a stigma attached towards obtaining welfare benefits, and there is the stigma I will be focusing on in this blog: the stigma towards mental illness.

Stigma in the mental health world can be manifested as:

Shame or humiliation about carrying mental illness, or knowing someone with one
Disbelief in or denial of mental illness;
False stereotypes, harsh judgment, even fear of mentally ill individuals;
Discouragement towards seeking professional help;
Discrimination in the employment process;
Mislabeling as crazy, psycho, and unfit to be in society.

The list goes on. Congressman Patrick J. Kennedy explains that stigma is anything that prevents someone from getting care – “attitudinal barriers” towards seeking help [1]. Moreover, there is not only stigma in society towards mentally ill people, but also self-stigma. People with mental illness oftentimes look down upon themselves because of their illness. For instance, I stigmatized myself when I called myself a psycho and weak for not successfully living with my illness.

I am no social psychologist, so if you would like a more technical explanation of stigma, I recommend this article: http://webcast.und.edu/health-wellness/healthy-und/mental-health-stigma-fawn.pdf.

I believe that stigma towards mental illness is not talked about as frequently as it should be (admittedly, times are a-changin’, due to unfortunate tragedies such as in Newton, CT, but fortunate things like Silver Linings Playbook). It’s so important because as stigma is reduced, more people will be willing to get help for themselves or their loved ones. We won’t have to live in shame or fear. More of us can lead healthy, productive lives.

Beyond just the emotional argument, there are very, very practical reasons why stigma needs to be eliminated and mental illness must be treated in the U.S.:

It’s common. One in four adults in the U.S. are affected by mental illness in a given year, yet only 60% get the help they need [2].
It’s crippling. Four of the ten leading causes of disability are mental disorders [3].
It’s life-threatening. There are over 38,000 suicides every year, and 90% of the people who commit suicide have a diagnosable mental illness. And yes, I will add a nod to the couple of percentage points of increased violent behavior in untreated mentally ill people. 5-7% people with severe problems will harm others in a given year, compared to 2-3% general population [4, 5].
It’s an economic burden. Serious mental illness costs $193.2 billion in lost earnings per year due to loss of productivity [6].
It’s costly indirectly as well as directly. Mentally ill people suffer a higher rate of unemployment, alienation, and homelessness. There are also costs from social care, education, housing, criminal justice and social security systems [7].
It’s the right thing to do! We can’t let so many people suffer unnecessarily. (I refuse to believe this is an emotional argument.)

So that is what this blog is dedicated to: the elimination of stigma. I hope you’ll join me.

Best,

Hufsa

ENDNOTES
[1] http://www.huffingtonpost.com/bradley-cooper/silver-linings-playbook-mental-health_b_2595390.html
[2] http://www.usatoday.com/story/opinion/2013/02/04/kathleen-sebelius-on-mental-health-care/1890859/
[3] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248201/
[4] http://depts.washington.edu/mhreport/facts_suicide.php
[5] http://articles.baltimoresun.com/2013-01-07/health/bs-md-mental-health-services-20130107_1_mental-health-severe-mental-disorders-mentally-ill-people
[6] (http://www.time.com/time/health/article/0,8599,1738804,00.html)
[7] http://bjp.rcpsych.org/content/183/6/477.full