One of my friends sadly sufferers from schizophrenia. It developed during his late teens, and unfortunately he was in a household with parents who struggled with their alcoholism and so were not as supportive as they could have been. We all wonder whether it would have made a difference to how bad he got if there had been more of a support system for him in the early stages, whether from family, friends, or mental health professionals spotting the signs early on.
At one point before he had been diagnosed, while he was still working as a security guard (not a great job for someone on the verge of a diagnosis of schizophrenia – too much time alone is not great for people who are starting to doubt their own mind in terms of working out what's reality and what is not), he had plenty of access to finance for a car, and bank loans. After his diagnosis, and consequent loss of driving license, he found himself in financial difficulty as he lost his job also – and so took out a significant loan (£ 10,000 or so). He started needing to leave the house because of the stress of being with other people and not being sure of reality, and went on long walks, or trips to London and stayed out all night. One of these nights he buried the £ 10,000, in cash. To this day he does not know where he buried it.
Thankfully he met and fell in love with a girl who really takes care of him, chases up mental health teams for support, tells him when he's reacting to something which is only happening in his mind, and ensures he takes the correct drugs at the correct times, and assists him manage transfers from one drug to another (which at times requires hospitalization due to the side effects of new drugs). Although he still has good days and bad days, he's being looked after and protected from the symptoms getting any worse.
It does not help for him to now reflect back on what could have been, but it may be a significant and important lesson for others who are facing the realization that they or someone they know may be suffering from undiagnosed mental health issues.
So what can you do if you, or someone you care about, is struggling with their mental health?
Look Out for Early Signs
If they became withdrawn, or show increased drug and alcohol use, disinterest in activities, disinterest in looking after themselves, changes in appetite, or moodiness, be aware that these could be early signs. Even if they do not want help, and you may worry they'll better meet you for it, it's better to try and get professional help as early as possible, as early diagnosis and management could mean it's a one off experience rather than something which troubles them for life!
Talk About It!
There's a campaign in support of ending mental health discrimination, and their big focus is on just getting on and talking about it. So you do not have to be a doctor or mental health expert to talk to someone about their mental health. Think of it as if your friend is constantly going back to an abusive relationship – would we let them carry on going through the same cycles and just watch from the side-lines? Or would we try to talk to them about what they're doing, in case they have not seen the bigger picture of what's happening to them?
It's the same with mental health issues – if you really care about someone, try to talk to them about their situation. Not in a judgmental way, and do not do it when you're feeling frustrated, angry, or emotional about the situation. Make a note to try and ask them in a relaxed way if they are aware of some of their procedural behaviors, and also ask them if they need any help in working through some of their issues, or would like to be supported in seeking medical advice . They may need a lot of reassurance that help will be given, rather than that they will be locked up!
I know for my friend that even though he is aware of his illness and that some of what he thinks and worries about is not true, he still often thinks that the medicine he has to take will kill him (that someone is trying to poison him ). Being able to talk about this and being offered reassurance and encouragement to take medicine which, when he is well he knows the wants to take, makes the world of difference between him being able to maintain his current level of manageable symptoms, or going off the meds, starting an unwraveling of the current state into an unmanageable issue, and worst case, need for hospitalization (which he does not want want).
For someone who is on the periphery of the situation, not involved with day to day care or relationships, it's still good to really ask how your friend is! My friend is often nervous to come out with us for fear that people will notice 'how weird he behaves.' After I've asked him how he is feeling, or how he felt the other day when we all went out, he might say he's struggling with hiding his thoughts, or that he felt sick and that everyone was looking at him, in which point I can honestly reassure him that I really thought he'd done well and I had not noticed that he was struggling. Or during an evening if I notice he's looking a bit uncomfortable, it's great to just say 'hey, how are you feeling?' and let him know it's absolutely fine if he feels he needs to leave, or to tell him that he's doing well etc. Why would we avoid talking about this when he can really benefit from that extra support?
What's more, my girlfriend who is dating my friend who suffers, has said that caring for someone who has serious mental health issues can be very time consuming, and having a group of people who can offer support can be a huge help – from attaining appointments with him, to sitting at home with him so he is not alone when she needs to go out etc.
Her top tips are also:
– Be patient and consistent, someone struggling with something in their own head may not be able to respond to you as quickly as you like, or at all! It may be too much with what they're already trying to control
– Do not be scared of their diagnosis – many people will not become dangerous just because of a diagnosis, they're more likely to hurt themselves or commit suicide than hurt others – but their general personality is not likely to change (ie from someone non-aggressive in to a danger to public)
– Believe them that it is real to them – telling people they should be able to see things from your view will not help. Imagine you've been talking to someone for 10 years, and now you're told they're not real. You'd be likely to think your world is true and their world unreal!
– Do not worry about being frustrated, mad, or upset about your partner / friend's situation, and your own as a caregiver! Neither of you would have chosen this. But try to talk to external people for support, or helplines, rather than the sufferer, as they may withdraw from confiding in you. Do seek support – you do not want to end up resenting the sufferer!
– Do not neglect people's physical needs – mental health medications can often have negative side effects on physical health, as can symptoms of mental health, such as not remembering to eat, or affecting digestion / nervous system / memory loss. Try to encourage physical check-ups as well as mental health check-ups, as you do not want to come to a point where physical health is also negatively affecting the person's life.
Do not Talk About It!
However, having said how great it is to talk about mental health issues, it is also important to learn when to drop the subject! Whilst those suffering are in great need of specific support dealing with their symptoms or fears and issues, once these have been discussed or a plan of action has been put forward, you do not need to always talk about their mental health issues.
Sometimes all people need who have spent a long time dealing with their difficulties and is to be taken out of the situation for a change of scenery, a rest from dealing with it on their own, and cheering up and taking their mind off the situation. Nothing does as much for people struggling with mental health issues as honestly being able to forget that they even have them, even for just 20 minutes or a few hours.
To feel 'normal again' (whatever that really looks like), and part of the crowd, and to stop thinking about those things that are plaguing them, whether it be hearing voices, or obsessively worrying about having turned the oven off, or feeling despair due to depression – really having your mind taken off of these worries can do wonders.
Many psychotherapists or other mental health professionals recommend treatments such as Cognitive Behavioral Therapy (CBT) or Mindfulness Training or Courses – as these disciplines both focus on giving your mind the tools to think in a different way to its 'default setting'. So whilst distracting your friend / family member by good times is a great help, this will only help in the short instance (which is much better than nothing!). However, trying to encourage them to seek professional help which will gradually encourage them to renew their thinking patterns, giving them alternatives to focus their minds on, and different behaviors to practice to stop the harmful thought patterns, is also something great you can do for them.