I’ve spoken to patients, family members, police officers, students, nurses, providers – mostly the former two groups. Of the family members, the most frequently asked questions are:
How do I get my loved one to accept they have a mental illness?
How do I get my loved one to take their medication?
I call them the Golden Questions, because I never know what to say.
The two go hand-in-hand, but I’ll answer the first question as best I can, because I have helped people accept they have a mental illness in the program I work for. I’m not going to address the second question separately.
So, this is how I helped individuals with mental illness (we refer to them as “members” in this program) accept that they have a mental health condition – and that IT’S OKAY TO HAVE ONE. In the field, this is called “building insight (into one’s mental illness).”
I must note this is specific to my program – which is voluntary – that rehabilitates individuals with co-occurring mental health and substance abuse disorders coming from jail and prison. I use all of these at once.
In my program, all members MUST be housed, typically in a sober living home or board and care. This is to provide a stability that is required to advance in one’s recovery.
2. Injectable medications
Members are required to take medication if they want to participate in our program. They can decline medication, but then they can no longer be in our program.
Injectable medications are shots that are given typically 1-2 times per month. They take the place of daily pills, which has advantages in several ways. First, it reduces the issue of people forgetting to take their medication (or just plain not taking them). Second, it also reduces the stigma associated with taking medications every day – frequently a reminder of having a mental illness, which numerous people shun.
Third, it provides a more uniform dosage of medication into the body – thus, enhanced stability. (I can explain the difference between injectables and pills in another post.) This is frequently used for individuals experiencing psychosis. The medication will help reduce or eliminate their symptoms, which allows people to focus on other aspects of their recovery. A simplistic (but not unrealistic) example is that the injectable medication may eliminate voices saying, “Don’t take your medication.” Without that distraction, members can start to believe they have a mental illness or start working on things like therapy and coping skills.
I lead a Symptom Management group which focuses on teaching members about the various mental illnesses. If I have a member who has poor insight, I add them to this group.
In this group, members are educated on all the symptoms that members of that group experience, e.g. depression, anxiety, hypomania, mania, and psychosis. The power of education is that it shows that mental illness is separate from one’s identity. It is an illness that someone has and can successfully maintain, just like diabetes. It teaches members to identify the symptoms within themselves, empowering them to self-monitor.
The member must be given educational materials as well. You can easily get them from the NAMI (National Alliance on Mental Illness) website or DBSA (Depression and Bipolar Support Alliance). This further emphasizes that mental health is something physical, tangible, and real.
4. Peer Support, Support Groups, and Sharing Experiences
It is crucial for the member to be around other individuals with mental illness, preferably the same or related mental illness. They need to know that they are not alone. I know hundreds of people with mental illness, and one thing I see constantly is that people with mental illness think they are the only ones going through their symptoms…which is certainly not a shock, because our society does not talk about it!
Whether it is in a support group setting, or just among members hanging out, the member needs to hear similar experiences to reduce the stigma they feel because of having mental illness. The mental illness must be normalized.
In my groups, I specifically talk about stigma and self-stigma. Actually calling it out helps members to discuss it, see it within themselves – and learn how to counter it.
Members must have a professional to help them process how they are feeling about having a mental illness. They need someone to listen to them, to guide them to acceptance.
6. Someone by their Side
This is the role I always take on. I am there to help members vent, to remind them they are not alone, to help them separate their mental illness from their identities, and to share my experiences. Show them that their condition is not who they are. Inspire them.
7. Serious Stigma Smashing
Something that always reaches people are stories of recovery – especially from famous individuals with mental illness. People always flip when I say that Abraham Lincoln had depression (I like to say, “See, Abraham Lincoln freed slaves when he was depressed. You can still accomplish great things with a mental illness!”) and the countless other people who have mental illness.
Members need time alone, too, to process what’s happening to them. For many, having and accepting mental illness is a paradigm shift, full of conflicting emotions and confusion. It took me six years to accept that I have a mental health condition – and that it’s okay to have one.
Also, whereas I tend to do all of these things in close proximity to each other time-wise, it may benefit your loved one to take a more step-wise approach to this. That is up to your discretion, though.
9. Hope, Encouragement, and Praise
Hope. I’m not just talking about the loved one having hope – I’m talking about you having hope, too. Both of you need to believe that the future will be better, that what they are going through is temporary, that they have the potential to be someone with a more meaningful life. If you don’t believe that your loved one will get better, how can they?
Encouragement is also important, including praising your loved one for all accomplishments, no matter how little, and especially noting changes and differences. Things like, “You struggled to get out of bed before, but you did it all by yourself today, and that shows you’re getting stronger.” “I’m really proud of you for doing __.” “You’re doing a really good job and I know things are going to get better.” “I know things are rough right now, but they won’t always be this way.” (Etc.)
I know this is a lot. This is the full package that I know has worked for members in my program, specifically, though I believe this can help many others, too. I hope that if you have loved ones who do not understand or deny their mental illness, any of these components will help them find recovery.
Anything I’ve forgot? Leave a comment and let’s talk about it!