Mental illness affects millions of people across the globe. It can touch one’s education, health, employment, relationships.

So what do you do if someone you love is experiencing mental illness?

“No one took a high school health class to know what to do if your child, spouse, good friend is showing signs of mental illness,” said Sue Abderholden, executive director for NAMI Minnesota.

The National Alliance on Mental Illness is a nonprofit that offers support and education for people of all ages with mental illness and their families. They take more than 4,000 calls a year from people trying to find help for themselves or loved ones.

Anxiety, depression, bipolar disorder, schizophrenia, post-traumatic stress disorder, eating disorders and borderline personality disorder are examples of mental health issues. Some people may have co-current disorders, and symptoms occur on a spectrum.

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Mental health impacts mood, thinking, behavior and an ability to relate to others.

Emotionally, it can affect memory, attendance, patience, interpersonal skills and stress management. People can be overly emotional and angry.

If someone is manic, they’re prone to more risky behavior, such as riding motorcycles, driving too fast or overspending.

And symptoms can manifest physically — fatigue for a person experiencing depression or nausea while experiencing anxiety. It can affect sleep and appetite and lead to headaches, stomachaches, racing heart, back pain.

This can lead to issues at home, school and work.

“It feels personal if someone is aggressive or withdrawing or rude or caustic. If we can understand theoretically that it's part of a mental illness, then to some degree, it can help.”

It can be really hard to watch a loved one struggle, avoid the illness or not take steps toward life goals in the way you’d want for them, said Petra Woehrle, licensed psychologist at St. Luke’s.

A helpful first step is education, which is also key to navigating reasonable expectations.

“It feels real personal if someone is aggressive or withdrawing or rude or caustic. If we can understand theoretically that it’s part of a mental illness, then to some degree, it can help,” Woehrle said.

Avoid confrontation when discussing symptoms or concerns, Woehrle said. Focus on solutions and the current problem versus pulling in past experiences. Use supportive language, and frame it with feeling.

“‘I can’t take your behavior anymore’ isn’t particularly helpful,” Woehrle said. “But communication like, ‘I’m worried about you, and I’d like you to get help.’ This is a better way to communicate.”

Abderholden suggested: “Here’s what I’m seeing. Can we get this checked out?”

Be willing to be vulnerable, and be prepared that your loved one might not be able to match that in the moment. If they begin to shut down, allow space to return to the conversation.

Be direct and clear, take time to listen and reflect back what you hear.

LINK: Recommended lifestyle changes for anxiety, depression

It can be difficult if a long-standing mental illness such as schizophrenia is not being managed. In that space, approach the conversation with curiosity about the other person’s emotional experience and how they understand their situation, Abderholden said.

Don’t argue if they're having a delusional thought. You don’t need to agree, but what they’re thinking and perhaps seeing is absolutely real to them, so bring some empathy for the illness. And connect with the feelings.

“If someone believes they're being followed by police or if someone believes someone put a camera in their apartment, what’s the feeling underneath?” Abderholden said.

Refer to primary care providers, share resources, offer to assist in ways that are comfortable and within your means. Use resources and time to connect them with treatment providers or sources that will promote health rather than using time and money to bail them out of trouble.

There are online depression screenings. Also nutrition, exercise and sleep are critical. Therapy and sometimes medication may be part of the solution, Abderholden said. Try to focus on what you can control.

“You can’t make that stress go away, but you can make living with it easier, and you can increase your confidence and competence in providing effective support. Those are all very within your control,” Woehrle said.

If a loved one isn’t open to receiving help, continue to encourage them, and do what you can to help yourself. Some symptoms of mental illness can be draining at times, so building support is crucial, Abderholden said.

People feel ashamed, embarrassed or uncomfortable talking about challenges with mental health conditions because they fear judgment or penalties. The same goes for family. Parents can blame themselves, and it can lead to isolation. Hearing nonjudgmental people share how they got through what you are going through in a support group is invaluable, Abderholden said.

NAMI offers multiple family support groups online, meetings tailored specifically for partners and spouses, groups for young adults, LGBTQ+ and more. Brian Marsolek has been helping facilitate a NAMI support group for 10 years, and he most recently led one tailored for families of people experiencing mental illness. It’s a safe space to share difficulties, triumphs, resources — and to just listen. They’re about support in a nonjudgmental space with people who have been there.

“If you don’t live with it, you can’t understand it,” Marsolek said.

Group attendees varied from people at the start of a diagnosis to those who have been walking through it with loved ones for some time. Common topics are how to navigate health systems, confidentiality and how to help loved ones who live out of state.

It’s rewarding to see a sense of relief grow in people who come in stressed and emotionally exhausted. “Sometimes, when you’re in it, especially when you’re in crisis, you feel alone. But there’s a number of other people experiencing it,” Marsolek said.

Gary Meader / gmeader@duluthnews.com
Gary Meader / gmeader@duluthnews.com

“Recovery is often not a straightforward process,” said Mary Jo Kreitzer, director of the Earl E. Bakken Center for Spirituality & Healing at the University of Minnesota.

There can be improvement and setbacks, you can advise people to seek treatment, but it’s a choice they have to make in most instances. For your own self-care, focus on all aspects of your health, physical, social, emotional, spiritual, meaningful relationships, she said. If you’re acting as a caregiver, it’s important to acknowledge your needs, and it’s OK to set limits.

Woehrle recommended using resources and time to connect your loved one with treatment providers or sources that will promote health rather than using time and money to bail them out of trouble.

Also, ask for help. Reach out to someone to bring a meal or watch the kids for an evening, so you can sleep or take a break with a movie. Find some way to get centered with a mindfulness app or with music — it’s all so important. Contact others when you no longer have the skills to handle what’s happening. If you’re worried about suicide, take that very seriously, Abderholden said.

Start with a primary care provider if your loved one is a minor, and share your concerns and possible contributing factors. When the loved one is an adult, share your concern in a frank conversation and ask: “Are you at risk for injuring yourself?”

If a person is immediately in danger of self-harm or suicide, remove any weapons and over-the-counter medications. You may reach a point where you need to call emergency services, Kreitzer said.

If you’re worried about your safety or your loved one’s safety, create a crisis plan and communicate it to the family member by saying, “If you tell me you’re going to hurt yourself, I’m going to call additional support.”

We could benefit from normalizing mental illness, experts said.

“You go into the doctor to get your physical health taken care of. What are your support groups to get your mental health taken care of?” said Roni Horak, clinical director at RSI Behavioral Health and Counseling and president of the Duluth NAMI affiliate.

“When we talk about someone with other health conditions, we talk about their courage and determination. Do we use those words with someone with a serious mental illness?” Abderholden said.

It’s less about stigma, and actually about discrimination.

“Someone who is very, very depressed and struggling to get out of bed, getting in to work or taking a shower — if they were having trouble getting out of bed because of chemo, we would be very empathetic,” she added.

Opening the understanding that mental illness is an illness, not a choice or willful behavior, is the most helpful approach.

For your loved ones, Horak suggested setting attainable goals together, looking into wellness, accepting and walking through it — that promotes hopefulness.

It can take time, different medications and treatment, but generally, people get better, so have faith, Abderholden said. “When you’re in the midst of experiencing a mental illness, you’re not going to reach out, so we need to reach in. Stay connected to that person, don’t give up on them.”

Tips for loved ones

  • Be nonjudgmental.

  • Be willing to be there.

  • Have patience. This can be an ongoing situation.

  • Be available.

  • Avoid self-judgment.

  • Give yourself permission to self-care. Encourage other loved ones to do the same.

  • Reach out to understanding resources.

Support during a pandemic

The COVID-19 pandemic has changed the face of mental health support in Duluth.

Mental illness affects family and loved ones, and coping with mental health can be difficult in itself.

“During this time, everyone’s mental health is impacted,” said Sue Abderholden, executive director for NAMI Minnesota.

NAMI Minnesota has moved to online support groups, now offering about 16 — and counting — through Zoom per week. They’re aware of Zoom bombers — people who hack in to disrupt meetings with distracting or abusive language.

“We’re learning their tricks daily,” she said.

There’s a daily class on dealing with depression during the pandemic. Soon, they’ll offer 15-minute options for parents of children with mental illness, she said. Text line, warm line, They’re updating their website daily and introducing support for those who have loved ones in prison.

Overall, there’s concern about the mental health system.

Another barrier can Navigating insurance and costs and reimbursements can be tricky now.

Large providers aren’t able to bill public or private insurance.

It can be challenging in rural communities to access mental health services. There are people who don’t have internet access, and there are calls from those who don’t have a smartphone or tablet for telehealth. “It really shows us the divide in terms of economics,” she said.

This is hard on everyone, and we’ve never been through this.

Just take one day at a time, she said. There’s so much that we can’t control right now that we need to control what we can.”

“So what if you didn’t make beautiful muffins with the children. So what if you sat in your sweatpants and at a pint of ice cream. You just need to give yourself grace.”

Resources

  • 24-hour crisis phone line at Birch Tree Center is 218-623-1800

  • Crisis Text Line: bit.ly/2xqqkhp

  • Minnesota Department of Human Services: bit.ly/3ccDX2x

  • NAMI Minnesota online support groups: bit.ly/2yW0DpA

  • Call the warm line at 651-288-0400 or text “Support” to 85511 or call 844-739-6369.

  • Call the National Suicide Prevention Lifeline at 800-273-TALK (8255).

  • Use the Crisis Lifeline by texting MN to 741741.