“Unawareness of a mental illness is a symptom brought on by the disease. It is not a choice that an ill person makes.” Dr Xavier Amador, an internationally renowned clinical psychologist and leader in his field, made this statement in his book “I’m not sick. I don’t need help”.
If someone you love lives with a mental illness, and you’re trying to help them get the treatment they need, here are some valuable insights and an introduction to LEAP. It’s a useful communication tool that’ll help you help a loved one with a mental illness accept treatment.
What is a mental illness?
The American Psychiatric Association defines mental illnesses as “health conditions that involve changes in emotion, thinking or behaviour, or a combination of these”. Mental illnesses are associated with distress and problems functioning in social, work or family activities.
How to speak to someone about their mental health
Talking to a loved one showing symptoms of a mental illness can be difficult. You need to know what to do to gain their trust and get them the help they need. Here are a few valuable tips on talking to someone about their mental health without worsening the situation.
- Choose the right time with no distractions
- Keep the conversation open and calm
- Don’t judge, remember a mental illness is not their choice
- Listen carefully to what they have to say
- Let them lead the discussion at their own pace
- Don’t put pressure on them to tell you anything if they’re not ready to talk
- Don’t try to diagnose the mental disorder
- Find out more about their general wellbeing, both emotional and physical symptoms
- Offer them options for treatment but don’t tell them what to do
- Find a doctor, therapist or support group they can speak to if they can’t talk to you openly
- Hand it over to the professionals if you feel out of your depth
- Get help yourself, speak to a professional health care specialist for advice on how to help
Why people with mental illnesses often refuse help
It can be exasperating for a parent, spouse or friend when a loved one refuses to accept help for a mental illness. It’s equally frustrating when they don’t take the medication prescribed for their mental health condition and “relapse”.
As mentioned, denial is a function of the disease. You must understand that refusal to accept help or stay on medication is caused by brain dysfunction that your loved one has no control over.
You may have heard the term anosognosia. It’s a lack of ability to perceive the realities of one’s condition. Someone with anosognosia is not able – due to brain dysfunction – to accept they have an illness or disease, even though their symptoms match a formal diagnosis. This distortion of reality is often mistaken for denial.
Classic signs of anosognosia include:
- Persistent lack of insight into their symptoms, lasting for months or years
- Believe they are “not sick”, even when there is overwhelming evidence they have a mental illness
- Illogical explanations are given to rationalise symptoms
Use LEAP to help someone with a mental illness
If you despair that you will never be able to help your loved one get proper treatment for a mental illness, there is hope. It comes in the form of a simple tool called LEAP.
LEAP is a communication process developed by Dr Xavier Amador, a world-renowned psychologist. Dr Amador assists families and mental health providers with helping individuals with mental illnesses recognise their condition and seek treatment.
LEAP is the acronym for Listen-Empathize-Agree-Partner.
Source: I’m not sick. I don’t need help
The cornerstone of LEAP is reflective listening. It’s also the one feature of the method that immediately turns down the volume on everyone’s anger, builds trust and mends fences. The aim is to listen with only one goal: to understand the other person’s point of view and reflect your understanding.
You don’t comment on what the person said, defend yourself, judge, or point out ways you think they’re wrong.
Reflective listening is a skill that needs to be cultivated. It doesn’t come naturally to many people. To succeed, you need to learn to listen and not react to what your loved one feels, wants or believes. Then, after you’ve listened carefully to what they’ve said to you, you need to relay to them, in your own words, your understanding of what you just heard.
Empathy is the second tool in your toolbox. It would help if you learned when and how to express empathy (understanding and sharing feelings).
If you want your loved ones to consider your point of view, they need to know you have seriously considered theirs. Even if you feel frustrated or exasperated, you need to empathise with their fears or concerns regarding treatment. In particular, you need to show compassion if they feel fearful, angry, sad or hopeless.
Remember, empathy is not the same as agreeing with someone. You’re merely showing you’ve listened, and you understand how the person is feeling.
It can be extremely frustrating and heartbreaking knowing that what you want for your child or partner is not what they necessarily want for themselves. This conflict may be due to anosognosia.
You may want to admit your loved one to a hospital or an inpatient treatment centre, or you want them to keep taking their medication. Your loved one disagrees because they don’t think they’re sick or don’t accept they need to keep taking their medication.
As hard as it might be, the best approach is to find common ground. Point out both positive and negative consequences of what you want for them and acknowledge that they have personal choice and responsibility for their decisions.
The wrong way to talk
“You didn’t take your medication, and now you’ve been fired from your job.”
“You stopped taking your medication, and now you’re back in the hospital.”
“Do you think you would have been fired from your job if you had kept taking your medication?”
“Did you feel better when you stopped taking your medication, or did you start feeling scared and anxious again?”
“Did the voices quieten down after you stopped taking your medication?”
“After you stopped taking your medication, how long was it before you were back in the hospital?”
Result based on common ground
Instead of focusing on your agenda, try to meet your loved one halfway.
You How did you feel after you stopped taking the medication?
Him I had more energy but I also couldn’t sleep, got scared, and could hear voices again
You When you took the medication, were you able to sleep better, didn’t get scared, or hear voices
You Do you want to take your medication again so those feelings don’t upset you
Him Yes or I’ll think about it
Forming a partnership with a loved one who has a mental illness can be challenging, particularly if you’re feeling frustrated and discouraged. Partnering with your loved one requires trust and understanding. It’s satisfying to get to the point where you can collaborate on accomplishing mutual goals.
Partnering involves working together as a team to get what you both want. Together, work on a plan to get a formal diagnosis, treatment options and developing a support team.
What causes mental illness?
Mental health disorders are caused by a combination of genetics, environmental factors and brain chemistry. Although a mental disorder is a complex disease, research shows these four risk factors are key contributors to what may cause a mental illness.
Research shows that mental illness is twice more common in people whose blood relatives also have a mental disorder. Particular biological makeup may increase your risk of developing a mental illness, or else your life situation may trigger it. There is no such thing as an addiction gene, but people with mental illness in the family have a predisposition to inheriting it.
Environmental factors before birth
Exposure to environmental stressors, inflammatory conditions, toxins, alcohol or drugs while in the womb can be linked to mental illness.
Environmental factors after birth
The world you live in plays a significant role in your mental health. Research shows that environmental factors have the power to affect a person’s neurochemistry and biology and increase one’s chance of developing a mental illness.
Environmental factors include:
extreme weather conditions
unhealthy conditions at work
work or home stress
chronic medical conditions such as cancer, diabetes, heart disease
physical or emotional abuse and neglect
Neurotransmitters occur naturally in your brain and act as chemical messengers to send signals to parts of your brain and body. When the neural pathways are impaired or damaged, the nerve receptors’ function changes, leading to depression, anxiety, addiction, and other mental disorders.
What are the signs and symptoms of mental illness?
Every individual with a mental illness has a unique condition, and their symptoms vary greatly depending on the type and severity of the disorder. However, specific symptoms are common to mental health conditions.
If you know the person well, you may notice changes in their behaviour or mood which raises red flags that there is an underlying mental health issue. Look out for changes in mood, personality, personal habits and social withdrawal.
There are more than 200 classified forms of mental illness. The more common disorders are depression, bipolar disorder, dementia, schizophrenia and anxiety disorder.
Major depressive disorder
Major depressive disorder is a type of mood disorder. It is also called clinical depression. Symptoms include sadness, tearfulness, emptiness, irritability, angry outbursts, insomnia or sleeping too much, weight gain or loss, low energy and unexplained physical symptoms such as backache, headaches, and stomach ache.
Anxiety disorder is characterised by extreme worrying. Anxiety makes it difficult to function normally and maintain relationships. Symptoms include feelings of nervousness, panic and fear, as well as sweating and a rapid heartbeat.
Schizophrenia changes how you think, feel and act. Symptoms come and go, and no one has all of them all of the time. When the disease is in full swing and symptoms are severe, a person with schizophrenia can’t tell if specific ideas and perceptions are real. Symptoms include highly exaggerated thoughts, illusions of grandeur, and perceptions or actions that show the person can’t tell what’s real from what isn’t.
Bipolar disorder is a mental illness marked by extreme changes in mood that last a few days or weeks at a time. Someone with bipolar disorder has alternating periods of mania and depression.
Obsessive-compulsive disorder (OCD)
OCD is triggered by changes in brain chemistry, a personal crisis, abuse or something negative that profoundly affects the person, such as the death of a loved one. OCD symptoms include obsessions, compulsions or both.
Dementia is not a disease itself. It’s a collection of symptoms that result from damage to the brain caused by different conditions. Symptoms of dementia vary according to the part of the brain that is damaged. Early signs often appear long before the disease is diagnosed, including behavioural changes, memory loss, poor concentration, struggle to follow a conversation or find the right word, and confusion about time and places.
Attention deficit hyperactivity disorder (ADHD)
Attention deficit hyperactivity disorder (ADHD) is categorised by two behavioural problems: inattentiveness and hyperactivity. Most people with ADHD have problems that fall into these categories, but this is not always the case.
Someone with autism spectrum disorder (ASD) has a developmental disability that affects how they communicate, behave, or interact with others. Symptoms of autism are varied and can be mild or severe, depending on where they are on the spectrum.
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) occurs when someone has experienced a shocking, scary, or dangerous event. PTSD symptoms include flashbacks (reliving the trauma repeatedly), bad dreams and frightening thoughts, and physical symptoms like a racing heart, tremors, and sweating.
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