Displaying items by tag: family

Quick Facts

• Mental health issues affect around 20% of Australians every year (ABS, 2008), but it is possible to live a full and meaningful life even if you experience mental health issues.
• This factsheet answers commonly-asked questions about the effects of mental health issues on the families of people affected, and how they can be supported to help the person and themselves.
• The term ‘family’ is used in this factsheet to describe any relative or friend who cares about a person living with mental health issues. 

• How are families affected?

  • Many mental health issues first appear when the person is in their late teens or early twenties. Whether it’s depression, an anxiety disorder, or a less common condition such as bipolar disorder or schizophrenia, symptoms are likely to occur when the person is still living with their family. Even if they have moved out of home or are older, the symptoms may not only be distressing for them, but may affect others too. 
  • Mental health issues often have a ‘ripple effect’ on families, creating tension, uncertainty, troubled emotions and big changes in how people live their lives. Different family members are likely to be affected in different ways. These effects on the family are sometimes not acknowledged by health professionals.
  • Families may also take on the role of day-to-day care. This often happens with little training or support, or acknowledgment of their own needs and mental health. When families are accepted as partners in care and do receive training and support, there is strong evidence that this leads to better outcomes for everyone involved.
  • Sometimes families are not listened to by health professionals. ‘Patient confidentiality’ may be given as a reason for this, but sometimes families aren't invited into treatment even if it would be consensual and helpful. Yet families are often the main support for people living with mental health issues, and have a right to be treated as ‘partners in care’. They need information about mental health issues and treatment provided, and about training or support that can help them support others and themselves. 

• Where do we start?

  It is important to maintain a sense of hope, and to develop practical skills. This can mean:
  
  Coming to terms with the fact that someone you care for experiences mental health issues and that this is likely to have a serious emotional impact on you as well as them. There may be anger at this happening in your family, confusion or a sense of loss and grief at how the person has been changed by their mental ill-health. It’s important to acknowledge and talk about these feelings.
  
  Developing a sense of balance between different types of support approaches. It can take time to figure out what this looks like, but it might involve:

  • acknowledging the effects of mental health issues on the person and hopes for recovery
  • wanting to do things to help the person while them to be independent
  • showing you care while not being over-involved
  • giving the person your time while having time for yourself and other family members too
  • encouraging the person to do things while not being unrealistic and demanding.

  Preparing yourself by learning as much as you can about the relevant mental health issue, and considering what you can reasonably do to support the person. Discuss this with other family members and the treating health professionals. If there is a type of care you cannot provide, then discuss with the health professional what arrangements can be made to provide it in some other way.

• What skills do we need?

  Living with mental health issues isn't easy. Caring for someone affected often isn't easy either, and sometimes first instincts are not helpful. Here are some information and tips that others have found useful:

  • Talk things over with the person affected and other family members. Talk about how you feel and encourage others to do the same. Try to ensure everyone has the same understanding and position.
  • Find out about any training for family carers of people with mental health issues you can attend, and consider joining a support group to meet others in your position.
  • Encourage the person living with mental health issues to be involved as much as possible in looking after themselves, and to get out socially and do things in their local community as much as is practical.
  • Consider the person as a whole – remember that they have the same range of personal, emotional and social needs as anyone else. Is their physical health being looked after by a GP? Are alcohol or drugs a problem which needs attention?
  • If there are suicidal thoughts, self-harm or aggression towards others, take these seriously and discuss with a health professional. Prepare a plan together for what to do if someone becomes unwell again. Always have crisis numbers handy.
  • Plan ahead for when you are unable to provide care. Talk about this with the person and health professionals, and consider what legal and financial steps may be needed to ensure care continues.

• What do we do in a crisis?

  When someone becomes extremely unwell, it can be distressing and confusing for others, as well as the person concerned. If you are concerned someone is at immediate risk to themselves or others, contact 000 or make contact with your local hospital.

  If you are concerned, but there is not an immediate risk, contact Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467. For more detail, see how to help in a crisis for guidance.

• How can we look after ourselves?

  When caring for someone else, it’s important to remember to look after yourself and other family members too.
  
  

  • Allow for regular ‘time out’. Make sure to make time to regularly do things you enjoy and to socialise. Ask about respite care to give everyone a break.
  • Talk about how you feel. Don’t ‘bottle up’ feelings if you are sometimes frustrated or need support. Let the treating health professionals and others know how you feel, and ask for support if you need it.
  • Be sensible about what you reasonably can – and cannot – do. Try to prioritise and organise what you need to do, by making a weekly list for example. Ensure that this is realistic and fair, and that it includes time for yourself and others as well as the person you are caring for.
  • Don’t try to do too much. Pace yourself and look out for signs that you are becoming stressed. Have a plan for what to do if this happens.

• Where can we find support?

  • Ask a health professional or call the SANE's free counselling service on 1800 18 SANE (7263) for details of support groups and other services for family carers in your local area. There may also be groups for young people whose families are affected.
  • Visit the SANE Forums online to share experiences, information, and support with other family and carers.
  • Centrelink provide details of benefits and services for family carers as well as for people with a mental illness. See www.centrelink.gov.au or call 132 717.
  • Call Carer Gateway on 1800 422 737 for details of services for people with a disability and their carers.

• How do I get more information?

  Contact SANE's free counselling support online or on 1800 187 263 for information, guidance, and referral.

Quick Facts

If something is not quite right about the way a loved one is behaving, it can be helpful to think about any significant recent changes in behaviour or mood. It may not be a serious problem. But if there is a developing mental illness, then getting help early is very important.

If mental illness is identified early, then treatment can work early too. It’s more likely that the person will keep up good relationships with family and friends, and there will be less disruption of school, work, and everyday activities.

Related: Supporting someone having thoughts of suicide

‘I’d never lived out of home before. I felt isolated and alone, and I just couldn’t handle the stress alongside everything else going on in my head. That’s when things really took a turn for the worst, and I experienced my first episode of psychosis.’

 

Hannah

• Regular behaviour vs concerning behaviour

  Some behaviour is considered normal, but may be difficult to handle. People may be rude, argumentative, unmotivated or withdrawn. Often this is a normal reaction to stressful events such as a family crisis, relationship breakdown or physical illness.
  
  In these cases, the person probably doesn’t need to see a doctor for assessment. Try to be as supportive as possible while waiting for the bad patch to pass. If the behaviour is disruptive or distressing for other people, or if the difficult behaviour persists, seek help from a counsellor, a GP or other health worker.

  When to seek help

  Some behaviour may be considered out of character or abnormal for that person. This may include:
  
  

  • withdrawing completely from family, friends and others.
  • sleeping poorly – for example, sleeping during the day and staying awake all night.
  • becoming very preoccupied with a particular topic – for example, death, politics or religion.
  • uncharacteristically neglecting responsibilities, personal hygiene or appearance; eating poorly.
  • deteriorating performance at school or work.
  • having difficulty concentrating, following conversation or remembering things.
  • panicking, becoming anxious, depressed, or talking about suicide.
  • having extreme changes in mood for no real reason.
  • hearing voices that no-one else can hear.
  • believing, without reason, that others are plotting against or spying on them, and feeling fearful or angry about this.
  • believing they are being harmed, or influenced to do things against their will.
  • believing they have special powers or influence.
  • believing their thoughts are being interfered with, or that they can influence the thoughts of others.
  • spending extravagant and unrealistic sums of money.

  These behaviours are a strong sign that something needs to be checked out by a doctor, particularly if they have been present for some weeks. There may only be a minor disturbance but a mental illness may be developing.

  Related: The first steps

• What about illicit substances?

  
  Some people who are developing a mental illness may use alcohol or street drugs to help feel better. These drugs will make symptoms worse, and can make treatment more difficult.
  
  Drugs such as cannabis can also produce psychotic symptoms like those listed above. This may be short-term (a drug-induced psychosis) or can lead to a long-term psychotic illness such as schizophrenia. If someone’s behaviour worries you – or drug use causes problems at home, school or work – then try to get help for the person. A doctor can make a medical assessment to see if there is a mental illness which needs treatment, or decide if referral to a drug and alcohol agency for treatment would help.
  
  Related: Cannabis and psychosis

• Encouraging a visit to the doctor

  Sometimes people don’t want to see a doctor because they feel they are being criticised, that others are against them, or because they feel frightened, anxious or angry. Some may have trouble putting their thoughts together to explain their problems.
  
  It can help to talk things over when you are both calm and when you feel the person is likely to be cooperative. For example: I’d like to talk something over with you that’s been worrying me – is this a good time or shall we talk later?

  The doctor is ready to help

  Focus on how the person is feeling and try to stand in their shoes. Ask someone else to talk to the person if you do not feel sympathetic or are not trusted by them.
  
  At first, try to focus on problems the person feels comfortable talking about. For example: I know you’ve been having trouble sleeping and concentrating lately – would you like to talk to someone about it?
  
  You’ve been feeling very down in the dumps lately – shall we talk to the doctor and see if she can help?
  
  Encourage everyone involved to think of the doctor as someone who can help, and who will not judge them. Suggest that you, another relative or a friend go along to the appointment.

  Talk to the doctor beforehand

  If possible, discuss the situation beforehand with the doctor, especially if the person is reluctant to talk about how they feel. Write down some notes about your concerns beforehand.
  
  If there is outright resistance to the idea of getting medical help, talk to the doctor yourself to work out a plan.
  
  The doctor may be able to visit the person at home to make an assessment. If this is not possible, they should still be able to tell you where to get help and support – for the person and for the family and others who are worried.
  
  Related: Guide for families, friends and carers • What I wish I knew when I became a carer • 

• How to talk to the doctor

  Book a longer appointment and take this pamphlet with you as a discussion-starter. When explaining your concerns, give specific examples rather than vague expressions.
  
  Instead of: Jack gets very frustrated, try Jack was so angry last night that he kicked his bedroom door down.
  
  Instead of: Mia looks awful, try Mia wears dirty clothes to school and doesn’t wash or comb her hair any more – she used to be fussy about her appearance.
  
  Instead of: Paul is very shy these days, try For the past week Paul has only come out of his room to get food.
  
  Instead of: Donna thinks we hate her, try Last night Donna would not come out of her room or eat with us. She said we are all plotting against her.

Sometimes a person may be showing signs of mental health issues, but chooses not to seek treatment. 

There are a variety of reasons why this happens. The symptoms of psychotic illnesses such as Schizophrenia, for example, may involve delusions, hallucinations, and disturbance to thinking processes – these can make it difficult for the person to realise or acknowledge that they have a mental illness and need help. The person may have stigmatising attitudes towards mental illness, which make it difficult to acknowledge the need for help. Or they may accept they have an illness, but not want to take medication, with the possible side-effects involved.

Whatever the reason, it may be that you are feeling concerned about their mental health, distress, or abiilty to manage their daily life. 

Encourage the person to access treatment on their own volition and with your support. Here are some strategies to make communicating your concerns easier and hopefully more effective:

• Dedicate a conversation to your concerns. Choose a time and a place that is suitable for both of you. A time when you are both calm and when you feel the person is most likely to be receptive and cooperative.
• Plan what you are going to say but prepare to be flexible.
• To set this up you might open with ‘I’d like to talk something over with you that’s been worrying me. Is this a good time or shall we talk later?’
• Do your best to speak in a calm, quiet voice. Try to avoid expressing any frustration that will interfere with the person’s ability to hear what you are saying. Do not get drawn into an argument about the content of delusions, but focus on practical help that is available.
• Emphasise talking about changes and symptoms rather than a disorder. Talking about a disorder can often feel stigmatising and prevent a person from engaging.
• It can be helpful to focus on aspects that the person feels the most comfortable talking about. For example ‘I know you’ve been having trouble sleeping and concentrating lately, can we talk about that?’
• Be patient, it may take a while for the person to process what you are saying and respond to your concerns.
• Do not underestimate the power of listening. Giving the person space to talk and letting them know that they have been heard is a valuable and supportive contribution.
• Remember that you do not have to offer immediate solutions.
• Remaining calm and supportive during this conversation will make it more likely that the person will be willing to talk again.
• Offer to make an appointment for them and suggest that you or another relative or a friend accompanies them.

What if they still won’t accept help?

If the person is still reluctant to acknowledge a problem or to see a mental health professional, ask what is stopping them. Once you know what they are worried about, work together to find solutions to overcome these barriers. For example:

• Sometimes people don’t want to see a doctor because they feel frightened, anxious or angry, that others are against them, or that they are being criticised. You can help by encouraging everyone involved to think of the doctor as someone who can help and who will not judge them.
• Sometimes people may have trouble putting their thoughts together to explain their problems, they might be reluctant to talk about how they feel, or not realise they are ill. In this case, you could discuss the situation with the doctor beforehand, writing down some notes about your concerns as clearly as possible in advance.

Remember that if at all possible it is best for the person involved to voluntarily seek help.

Don’t worry if your first attempt to talk isn’t successful. An initial conversation may plant the seed of seeking help in the person’s mind. By showing that you care and are not going to judge them, they will be more likely to come to you when they do decide to seek help.

If there is outright resistance to the idea of getting medical help, talk to the doctor yourself to work out a plan. The doctor may be able to visit the person at home to make an assessment. If this is not possible, they should still be able to tell you where to get help and support – for the person as well as others who are worried.

Someone refusing to acknowledge a problem or accept treatment can place family members and friends under significant strain, especially if the person is experiencing active symptoms. Don't think you have to deal with this situation alone, contact local mental health services, a helpline or carer organisation for advice and support.

Like all of us, young people can feel a bit down sometimes. Everyday frustrations, disappointments, problems at school, troubles in the family or any stressful event can cause this feeling. However, if these feelings go on for more than two weeks and start to affect their daily life, it may be a symptom of Depression or another condition. Anxiety may also affect young people as they feel pressure to do well at school and negotiate changing peer and family relationships. For those who are genetically vulnerable to developing these conditions, the stressors may seem insignificant to other people, but are enough to trigger symptoms.

It can be difficult for parents, friends, and young people themselves to tell the difference between signs of a mental health problem and the changes in mood and behaviour that are a normal part of growing up. As well as the family GP, specialist treatment and support services for young people are also available.

Young people and children also need support when they have a parent, sibling, or other family member affected by mental illness. Many young people in this situation take on a caring role themselves. Most States and Territories have specialist services to help young people in this situation. See below for details.

Support services for young people affected by mental illness

ReachOut
www.reachout.com 
A web-based support service for young people going through tough times, with practical tools and support, including online forums.

Headspace
1800 650 890
http://headspace.org.au/

Headspace is the National Youth Mental Health Foundation providing early intervention mental health services to 12-25 year olds. 

Kids Helpline
1800 55 1800
http://www.kidshelp.com.au/

A 7-day, 24-hour counselling service for children and young people aged 5-25 years. Available by telephone and online.

Kids Matter
www.kidsmatter.edu.au

A mental health and wellbeing framework for primary schools and early childhood education and care services.

Out and On-line
www.outandonline.org.au

An online program to improve wellbeing and reduce mental health symptoms in same-gender attracted youth aged 18-25 years, providing early intervention for of Anxiety and Depression.

Parentline

Parentline QLD & NT
Phone: 1300 30 1300 (cost of a local call)
8am to 8pm, seven days a week
www.parentline.com.au

Parentline VIC
Phone: 13 22 89 (cost of a local call)
8am to Midnight, 7 days a week
www.education.vic.gov.au/about/contact/Pages/parentline.aspx

Parent Helpline SA
Phone: 1300 364 100 (cost of a local call)
24 hours a day, seven days a week
www.parenting.sa.gov.au

Parentline NSW
Phone: 1300 1300 52 (cost of a local call)
9am to 9pm Monday-Friday
4pm to 9pm Saturday and Sunday
www.parentline.org.au

Parenting WA Line
Phone: (08) 6279 1200 or 1800 654 432 (free for STD callers)
24 hours a day, 7 days a week
http://www.communities.wa.gov.au/communities-in-focus/parenting_and_children/parentingwa/Pages/Parenting-WA-Line.aspx

Parentline ACT
Phone: (02) 6287 3833 (cost of a local call)

Parenting Line TAS
Phone: 1300 808 178 (cost of a local call)

Support for young people in families affected by mental illness

COPMI (Children Of Parents with a Mental Illness)
www.copmi.net.au 

National resource centre for health professionals and others working to support children in families affected by mental illness, including information about local services available in each State and Territory.

Itsallright
www.itsallright.org

A story-based online resource with information and tips for young people who have a family member with mental illness.

The experience of mental illness not only affects the individual but also those who care about them. Families and friends can play a vital role in supporting a person with mental illness. Many in this role do not even think of themselves as a ‘carer’. They have found themselves in this role because they see it as part of their relationship with the person who is affected. They may be a parent of someone with a mental illness, or an adult caring for a partner, parent or friend. A child who looks after a family member with a mental illness, such as a parent, can also be a carer. Carers also may not necessarily live with the person they care for.

Whatever the personal relationship, caring for someone living with a mental illness can be stressful. It is essential therefore to look after yourself as well as the person you are caring for. Self-care includes looking after your own physical, mental and emotional health. Doing this can be sometimes be down to a matter of changing habits and attitudes. It need not take up a lot of time, or cost a lot of money.

Tips for looking after yourself as a carer

• Remember to nurture your own mental and physical health.
• Remain physically active in ways that you enjoy (for example – walking, stretching, jogging or playing a team sport).
• Get enough sleep each night (for example – go to bed and rise at regular times).
• Stay in touch with friends and family who can encourage and support you.
• Establish a regular night out for fun (for example – seeing a movie once a week).
• Take up a new hobby or reconnect with an activity you used to enjoy (for example – cooking, reading, gardening, photography, listening to music).
• Find a local carers support group and join SANE’s online Carers Forum where you can share experiences, tips, and support with others in your situation.

A range of services exist to support family members, friends, and carers of people with a mental illness. These can provide practical, financial, and emotional support through services such as respite care, training, and peer support.

Support services for carers

Carers Australia

1800 242 636

Carers Australia is the national peak body representing Australia’s carers for all health conditions. It advocates on behalf of carers to influence policies and services at a national level. Services are provided by a network of State and Territory Carers Associations, including counselling, advice, and information.

Carers online support

An online eight-session course from Carers Australia, providing mental health foundations for carers new to their role.

Mental Health Carers Australia (formerly ARAFMI National)

1300 554 660

Mental Health Carers (formerly ARAFMI) Australia is a collective of organisations whose members have a relative or friend affected by mental illness. These organisations may have different names depending on the State and Territory where you live. Mental Health Carers Australia present the views and perspectives of carers and advocate for changes and services to improve the lives and wellbeing of people affected by mental illness, including carers and family members.

Mental Illness Fellowship of Australia (MIFA)

1800 985 944

The Mental Illness Fellowship of Australia is a membership organisation, representing at the national level, the interests of its member organisations and people affected by mental illness. MIFA has member organisations operating in most States and Territories.

There are lots of simple, everyday ways you can support someone who has a mental illness. Small things can make a big difference: being there to listen, keeping in touch and reminding the person that you care. Another powerful way to help is to learn as much as possible about the illness and its treatment. This will help you communicate more knowledgably and effectively with the person you care for and any treating health professionals. You can also share this information with family and friends to help them to better understand and provide support.

Being a carer can make demands upon your own physical and mental health too. Make sure you speak out to other family members and health professionals, for example, and ensure you get the support you need.

Tips for being a carer

• Ask how you can help. People will want support in different ways at different times so asking is the best way to know how you can help. Sometimes people struggle to express what they need so making suggestions can also be useful.
• Give them time. Some people might prefer a text message or email rather than talking on the phone or face-to-face. This means they can get back to you when they feel ready. What’s important is that they know you’ll be there when they’re ready to get in touch. Others may prefer to hear a human voice, with a regular phone call instead.
• Try to be open-minded and non-judgemental. This can be hard with some of the behavioural changes associated with symptoms. For example, if someone starts staying in bed rather than meeting their responsibilities it can be tempting to attribute this to the individual rather than the condition. It is best to focus on how to deal with the symptoms rather than judge the behaviour alone.
• Encourage sticking to a treatment plan and make a crisis plan so that you know what to do if symptoms escalate.
• Remember you are not to blame if things get difficult and try not to take hurtful comments personally. Some mental health conditions may involve increased anger and irritability that can be difficult for the person to control. At the same time, aggression and violence are always unacceptable. Do not hesitate to call on help in these circumstances, even if this involves the police.
• Try to be patient. Getting better can take time.
• If you live together, setting out house rules can help. However, be sensitive to the fact that there may be times when keeping to those rules feels beyond the person’s ability.
• If you know someone has been unwell, don’t be afraid to ask how they are. They might want to talk about it or they might not. Letting them know they don’t have to avoid the issue can be helpful.
• Try to avoid clichés. Phrases like ‘Cheer up’, ‘I’m sure it’ll pass’ and ‘It could be worse’ won’t help and can make the person feel more isolated. 
• Don’t just talk about mental health. Keep in mind that having a mental illness is just one part of a person's experience. People aren't defined solely by their health problems.
• Encouraging the person to do things without being unrealistic or demanding. For example, social contact is very important to our wellbeing and so encouraging outings and meetings with others can be helpful. Bear in mind this can sometimes feel daunting for someone affected by mental illness.
• Consider the person as a whole. Remember that they have the same range of personal, emotional and sexual needs as anyone else. Is their physical health being looked after by a GP? Are there alcohol or drug problems that needs attention?
• Many carers neglect their own needs because of their caring role. This doesn’t help you or anyone else in the long run. Look after your own physical and mental health, and talk to a health professional about what support is available. See What support is available for carers? 

If you are concerned about your caring role or its impact on you, contact the SANE Help Centre on 1800 18 SANE (7263) for information, guidance, and referral for support.

When you’re affected by mental health problems, other people can often be the best medicine. Making the effort to stay in touch with others makes you feel better, and can be a critical, even life-saving support.

Connect 

With friends, family, and others

When affected by mental health problems, we often don't feel like mixing with other people. We avoid seeing friends and family as usual. We may even avoid going to work or attending appointments. Interacting with others can just seem too overwhelming and difficult. It feels easier to be on your own.

Isolating yourself from others will only make you feel worse, however, and can mean delay in being diagnosed and receiving treatment and support. Make an effort to see people as usual, even if only for shorter periods or in ways with which you feel comfortable (for example, going to a movie together).

Most importantly, do tell a trusted person how you are feeling, especially if you are not yet receiving treatment or have thoughts of harming yourself. Talking to someone in this way is often the first step to recognising it’s time to make an appointment to see a GP or other health professional, to get the treatment and support you need to feel better again.

With your treatment and support team

The more that doctors, psychologists, and others understand how you are feeling and thinking, the better they will be able to help. Be as frank and open as possible with them, so that treatment and support can be  suited as best possible to your situation. Be clear about symptoms, how the treatments help and also any side-effects that need to be discussed. Tell them, too, about any support needs you have – such as accommodation, for example – so that they can provide referral to relevant support services in the community.

Working on a positive relationship with health professionals will encourage them to provide a more engaged service – helping them to help you.

Online and offline

Being connected with others is an important part of everyone’s mental health.

Make staying in touch with friends and family a regular part of your life, whether it’s meeting up or simply catching up by phone once a week. It’s surprising how much difference it makes to have a chat with someone at the local newsagent or market stall too. We humans are truly social animals, and really do feel better and more connected after even a brief encounter.

Thanks to the Internet, we can be sociable even when alone at home too. It is especially valuable to join an online community such as the SANE Forums which provide a safe, anonymous online space to discuss shared concerns, exchange information and tips, and provide peer support. The Forums are available 24/7 and are a safe, anonymous, and moderated service provided by SANE in partnership with community mental health support services all around Australia.