Research has shown that mental illness tends to disrupt people’s lives even more than physical conditions, said Dr. Mark S. Komrad, MD, a psychiatrist and author of the excellent book You Need Help! A Step-by-Step Plan to Convince a Loved One to Get Counseling.
“On average, a person with depression is at least 50 percent more disabled than someone with angina, arthritis, asthma or diabetes,” according to this report by The Centre for Economic Performance’s Mental Health Policy Group.
The good news is that treatments for mental illness are highly effective. The bad news is that only one out of three people might actually seek help. And some research suggests that the people who need help the most are typically the least likely to get it.
People understand that you can’t treat a lump in your breast on your own, Dr. Komrad said. But that same understanding doesn’t extend to mental illness.
Self-reliance is deeply imbedded in our society’s psyche, he said. That becomes problematic when anything that’s the opposite of self-reliance — such as dependency — is viewed as weakness and something to be ashamed of.
People might worry about appearing weak if they seek counseling — and they might turn that stigma inward and see themselves as weak, Komrad said.
Another big deterrent is lack of insight. Many people with mental illness simply don’t think they’re sick.
That’s why it’s critical for families and friends to step in and help their loved one realize they need to seek counseling. Don’t worry about “meddling” in their lives, Komrad said. Rather, you have the opportunity and power to improve – and in some cases, save — their lives.
In You Need Help! Komrad lists the specific signs — along with real-life examples — that signal an individual needs help. These are some of the signs:
- Behavior that scares you, such as a significant temper.
- Problems taking care of themselves or regulating their behavior, such as ignoring basic hygiene, engaging in reckless acts or drinking and acting aggressively.
- Problems with thinking, such as becoming disoriented, seeing or hearing things that no one else does or forgetting important facts.
- Intense feelings, such as profound anxiety about leaving the house.
- Problems interacting with others, such as withdrawing from the people they love.
- Inability to work, such as not holding down a job or diminishing grades or effort in school.
- Experiencing trauma, such as abuse or the death of a child.
Ultimately, the key is to look for what Komrad calls “a change in baseline.” In other words, is your loved one acting differently in any area of their life, including work or home? Komrad said that it’s not unusual to see a person unraveling at home first.
Approaching Your Loved One in the Early Stages
Komrad suggested the following ways to approach your loved one about seeking help in the early stages of mental illness.
- Let your loved one know that you need to have an important conversation with them. According to Komrad, this helps to focus their attention and implies they should take it seriously.
- Pick a good time and place. For instance, avoid talking during family gatherings or when you’re fighting.
- Approach them with empathy. You might say something like “I know this is really hard for you, but I’m talking to you because I love you. If I didn’t care, we wouldn’t be having this talk.”
- Be prepared for the person to be upset – and try not to get defensive.
- Use “I” statements, such as “I’m concerned about you.”
- Ask for a gift – literally. Ask your loved one to give you the gift of seeking help, whether it’s for your anniversary, a holiday or your kids’ birthdays. Here’s an example from Komrad’s book:
“Getting a consultation with a psychiatrist about your mood swings would be the best thing you could do for our little girl’s birthday. It’s better than anything else that you could possibly give her. Please, do it for her. She, more than anyone, needs you to get some direction and proper help, more help than I know how to give you.”
- Facilitate the process by finding a professional and scheduling an appointment. Even if they refuse to go, see the practitioner anyway. Talk to them about helping your loved one. Komrad said that 15 percent of his practice is meeting with clients about their loved ones.
- Offer to pay for the appointment, if possible. A common excuse is that therapy is too pricey.
- Don’t use words like “crazy” or “abnormal.”
Taking Stronger Measures
When your loved one has little insight into their illness – their “rationality is diminished” – or refuses to get help, you’ll need to take stronger measures. Komrad calls these strategies “therapeutic coercion,” which is akin to tough love.
An especially powerful tool, he said, is to explain to your loved one that families come with certain privileges – and responsibilities. For instance, if you’re a parent who’s financially supporting your adult child, leverage these privileges to get them to seek a professional evaluation.
If that doesn’t work and your loved one is a danger to themselves or someone else or is very ill, contact the authorities, Komrad said. Research your city’s laws on involuntary evaluation. And show up at every step of the process, he said.
“Don’t just call the authorities and wait.” Show up to the ER and the court hearing. “When you do show up, tell the story.” In fact, tell the ugliest parts, he said. Talk about the facts that substantiate the seriousness of the situation.
If you’re feeling unsafe for any reason, articulate that to the authorities. If you’re uneasy about bringing your loved one home, communicate that as well. As Komrad said, you don’t want to give the system an easy way out. You want to make sure they grasp the gravity.
Supporting Your Loved One Long-Term
Supporting your loved one through treatment is “a long-term project,” Komrad said. Check in with them regularly about their treatment and how you can help.
Also, realize that “a change in them is a change in you,” he said. In other words, as they’re making changes in their life, you might want to seek professional help as well. You might even realize that your relationship is part of the problem. As Komrad said, “Sometimes relationships can be sick, too.”
As a family member or close friend, you have a lot of power in helping your loved one. Use it.