Understanding their experience of the illness can help you care for them better
If you’re a caregiver to a person with a mental health issue, chances are that your life has been impacted in several areas. In the beginning, you may have had to come to terms with the diagnosis, and deal with caring for a loved one who may have suddenly become dependent on you; you may have also had to begin rearranging your responsibilities and priorities based on their needs.
Gradually, you may have started to face practical challenges: having to do more chores around the house because of the family member’s illness; having to (in some cases) attend to them through the day and monitor their health. Because of the changes in your lifestyle and the health of your loved one, you may also have to plan your finances differently. Through these changes, the illness of one person can impact the entire family.
Coming to terms with the situation
Caregivers may find it difficult to accept that a person who was functioning well earlier, was able to contribute at home, at work or study, is now no longer able to do so. The person begins to show neglect with activities of daily living – eating, bathing, sleeping or taking care of their own hygiene. A person who used to help with household chores earlier, or was an earning member of the family, may not be able to keep up with the same chores if they have a mental health issue. They may also have frequent mood swings, or may exhibit impulsive behavior.
This can be distressing for the caregiver, particularly when the lack of contribution is felt financially, or practically (when the person is unable to help with their share of household tasks, for instance). The person may be dysfunctional in social settings – preferring to withdraw from socializing, or display certain behavior (staring, speaking to themselves or not responding to others) that are considered socially inappropriate.
Understanding the underlying message
As a caregiver, it may be frustrating for you when your loved one repeatedly gets angry, irritated or sulky. Experts say that before you respond to your loved one, stop for a moment and think: why is the person behaving in that manner? What are they trying to communicate?
Experts say that most behavior that is challenging to handle is the patient’s expression of an unmet need. If the caregiver tries to understand the need that the person is trying to convey, then they are able to connect with their loved one and figure out how to fix the problem.
For example, a person who is hungry may display anger if they are disturbed and/or unable to effectively communicate that they are hungry.
There are some common events that can trigger the person’s frustration over their unmet needs and such behavior among people with mental health disorders:
The illness itself or the medication could trigger some types of behavior that may otherwise be considered inappropriate.
Caregivers’ expectations, whether expressed or unexpressed, as well as comparisons with other people around them, or with children (eg., “You behave like a child,” or “Look at him, he doesn’t behave like this...”): the caregiver may expect the person to function at par with other people of their age who do not have the challenges posed by a serious mental health issue. This becomes frustrating for the person, who may feel limited or inadequate.
Excess caregiving: many caregivers tend to give the person more attention than necessary, and prevent them from doing daily tasks, household chores or other activities.
Lack of stimulation, or excess of stimulation; this could also include the fact that the patient may not have anyone to interact with.
Managing challenging situations
A mental illness is like any other illness and can be treated. Remember that the person may be displaying some behavior due to the mental illness. It is not the person’s weakness or choice that is making them behave in a way you find difficult to cope with. At the same time, it’s also important to not succumb to the trap of attributing all of a person’s actions to their mental health issue. The person is just like any other and may be expressing their joy, frustration, anger or annoyance like other people around them – this does not necessarily have to be caused by the illness or its symptoms.
Expressed emotion plays a huge role in the patient’s recovery. The person is able to sense negative emotions, and this may hamper their wellbeing. Avoid passing critical or negative comments. Instead, be warm, affectionate and loving when you interact with the person.
Sometimes, the person has trouble conforming to the expectations that their caregivers have of them. Very often, caregivers want to protect their loved ones, and so expect them to be in bed all day, or do not allow them to assist with household tasks, even if they express an interest in doing so. Rehabilitation for mental illness is different from that of a physical illness. People with certain types of disorders may need to undergo treatment, and still be functional enough to go to work or assist in household chores. They require some support when they begin doing certain tasks. If you are not sure whether your loved one will be able to manage a certain task, you can have a conversation with the treating psychiatrist or counselor.
Empathize with your loved one when they are upset. Try to look at them just as you would at others around you. Listen to them – having a mental health issue does not mean that they have no emotions. They are likely to feel very emotional, and less likely to have someone listen to them. Ask how they are feeling, and what activities they would like to pursue. Involve them in household activities and discussions – this makes them feel welcome, accepted, and an integral part of the family.
Experts say that maintaining a log of the person’s behavior in ABC format can help the caregiver seek the most effective support.
ABC stands for:
Antecedent: what happened before your loved one displayed that behavior?
What was the nature of the Behavior exhibited (anger, withdrawal, etc)? How long did it last?
What were the Consequences? How did the caregivers or other family members react to this behavior?
You can also watch out for cues that hint at the re-occurrence of the particular behavior: a person who is getting angry may clench their fists, raise their voice, or start getting restless. These cues can vary from person to person, and being able to identify them can help you be prepared to manage the behavior when it occurs.
All of this information can be offered to the psychiatrist or counselor, who can analyze it to understand what changes in the person’s environment can create a change in behavior. The caregiver can also seek the professional’s advice on how to handle the situation if the behavior occurs again.