Living with someone who has a mental health condition can be challenging. As a mental illness is unique insofar as it may affect a person’s thinking, motivation, emotions and behaviour, it may also affect the way that person relates to others. This can cause conflict or increase the risk of relapse – or be a source of stability and support in an otherwise chaotic life.

So says Dr Ajesh Janki, psychiatrist at Akeso Clinic in Umhlanga, who provides the following answers to frequently asked questions to help people with mentally ill family members cope with this often challenging situation.

Q: Where can I learn about mental illness?

A: Instead of reverting to “Dr Google”, stick to reputable websites like Medscape or the SADAG/SASOP websites. You may also wish to speak to your loved one’s treating psychologist or psychiatrist, but remember that they are bound by ethics and the law and that this can only happen if it is consented to.

Q: What do I do if my loved one is refusing help?

A: Try to understand their reasons and to reassure them about their concerns. Remind them that an assessment is not necessarily a commitment to taking treatment or being hospitalised. Remind them that treatment does not necessarily involve taking medication and that there are psychological therapies as well.

In severe cases where there is a lack of insight or the person poses a danger to themselves or others, involuntary admission might be necessary. This involves a legal process of compelling a person to be admitted to hospital despite their unwillingness to consent. This is usually done in the interests of someone’s health or safety or for the protection of others.

Q:  How do I deal with difficult behaviour?

A:  It is helpful to anticipate potential problems and devise plans to reduce the risk of commonly encountered behaviours such as drug or alcohol misuse, threats of acts of aggression or threats or acts of self-harm. Verbal or written agreements on what is appropriate can be helpful.

Harm minimisation strategies are sometimes preferable, for example, it might be better to agree on drinking small amounts of alcohol at home as opposed to someone going out and binge drinking.

Self-harming behaviour can be particularly problematic. Learn to identify triggers to this behaviour and strategies that might help reduce it. Likewise, dementia presents specific problems like shouting, wandering, and fire risks from leaving the stove on due to memory disorders and from the side effects of medication.  Try to monitor for these risks and make practical adjustments where possible, for example disconnecting the stove, monitoring exits by means of cameras. If appropriate, consider the services of a care agency or in extreme circumstances, an individual might best be placed in a home.

Q: What do I do if someone is suicidal?

A: Try to establish how the person is feeling and what is contributing to their feelings of desperation. Offer assistance within your means and remember that you are not a therapist or psychiatrist.  There are many support groups that might be of assistance. These are listed at the end of this article.

Seek an urgent appointment with a mental health professional and if this is not possible, take the person to the casualty department for an assessment and if necessary, an emergency admission to hospital.

Q: How do I deal with a distressed adolescent?

A: It is estimated that up to 20% of adolescents meet the diagnostic criteria for a mental illness. Commonly encountered problems include drug and alcohol misuse, depression, self -harm and suicidal thoughts. Try to support the adolescent as much as you can but remember that these situations often require specialist expertise.

Q: I have thoughts of leaving my partner or spouse.  Is this a sign of a lack of commitment?

A: Living with someone who has a mental illness can be extremely difficult. Some people find that it exhausts their emotional resources. Try seeking professional advice on practical strategies that may help your relationship but if this fails, many people decide to end their relationships.

Q: Which organisations might be useful to get more information or for support?

A: Akeso Psychiatric Clinic www.akeso.co.za

Akeso Clinics is a group of private in-patient psychiatric clinics. Akeso Clinics offer specialised in-patient treatment facilities. In the event of a psychological crisis, please call 0861 4357 87 for assistance.

South African Depression and Anxiety Group www.sadag.org

This website has information on mental illness, support groups and other practical information.

South African Society of Psychiatrists www.sasop.co.za

This website has information on psychiatry and psychiatrists.  There is a “Find a Psychiatrist” function, information on support groups and information on mental illnesses.

FACT BOX

• The World Health Organization (WHO) estimates that mental disorders account for 30 percent of non-fatal disease burden worldwide and 10 percent of overall disease burden, including death and disability. https://www.dana.org/Cerebrum/2016/Making_Mental_Health_a_Global_Priority/
• One third of all South Africans have mental illnesses – and 75% of them will not get any kind of help. https://www.timeslive.co.za/local/2014/07/07/one-in-three-south-africans-suffer-from-mental-illness—most-won-t-get-any-help
• More than 17 million people in South Africa are dealing with depression, substance abuse, anxiety, bipolar disorder and schizophrenia – illnesses that round out the top five mental health diagnoses, according to the Mental Health Federation of South Africa. https://www.timeslive.co.za/local/2014/07/07/one-in-three-south-africans-suffer-from-mental-illness—most-won-t-get-any-help
• “Nearly 20 percent of high school students a year think about fatally harming themselves. Roughly 25 percent of all general practitioners’ patients are ill due to psychiatric rather than medical conditions.” https://www.hst.org.za/news/mental-illnesses-rise-sa
• “It is important to understand that mental illnesses are treatable. Between 70 percent and 90 percent of individuals have a significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.” https://www.hst.org.za/news/mental-illnesses-rise-sa