Mental Health Treatment and Recovery

Summary

• You’re not alone
• Can lead to infection or serious injury
• Tell a loved one
• Try distraction or substitution

Note: Reading this article could make you feel vulnerable if you self-injure. 

If you regularly injure yourself, you might often feel alone. You are not.

Therapist Andrew Levander is the director of a Los Angeles, CA, program dedicated to treating young people like you. He describes the typical person he treats as a girl between the ages of 14 and 17 who cuts herself with a razor blade or glass. Other people who self-injure may hit themselves, pull out their hair, burn themselves, or scratch themselves. Even if you feel like you need to self-injure, Levander and other experts say that it is possible to stop.

Reading this article will not solve your problems, and it is not meant to be a “cure.” It can’t substitute for counseling or help from a health care expert. But it might help you take a step toward recognizing and changing your behavior.

You are not alone

Levander estimates that up to 4 percent of the general population engages in some form of self-injury. To give you another perspective, another estimate puts the number of people who self-injure at 2 million in the United States alone. The majority of those people are females between the ages of 11 and 26.

People who hurt themselves often share common feelings. You may recognize some of them: feeling unable to think clearly; having feelings of rage and powerlessness; feeling like an outsider who can’t trust anyone; feeling afraid of punishment; and having anxiety, depression, or low self-esteem.   

Why people hurt themselves

“Why?” may be the hardest question for you and others who self-injure to answer.

Experts have offered some reasons for this behavior. Self-injury is not a non-fatal suicide attempt.  While some people may appreciate the attention it brings them, it is rarely used just to get attention. Often, experts say, it may be a way to feel control over the helplessness and anger felt from abuse, neglect, or other bad experiences. It becomes a coping method for deflecting your distress, turning it into pain that seems understandable and controllable.

Caring for yourself

Even if you don’t mean to seriously hurt yourself when you self-injure, you’re taking big risks. A cut or burn can become infected and cause life-threatening complications. Substances that you swallow or inject also can be deadly, even if you don’t think they’re poisonous. 

Keep your wounds clean and burns cared for properly. If you’re unsure about your medical situation, tell someone that you need emergency care.

How do you know if you’re ready to stop?

Deciding to stop self-injury is a personal decision. You might have to think about it for a long time before you decide whether you’re ready. Your parents and friends can’t make the decision for you. You need to be motivated.

If you want to stop, you may feel uncomfortable, scared, and frustrated at times. If you decide you’re not ready, don’t feel discouraged.

Making a change

If you are ready to make a change, take it slowly. 

Share your feelings

Dealing with the roots of your anger or fear can be painful and scary. But it can be hard to stop self-injury if you don’t address the real cause.

• Find loved ones you can talk to about your self-injury. If you can’t talk to your parents, approach a friend or family member.
• Get help from a counselor or doctor. If you don’t know where to turn, ask a trusted adult or look online for a crisis hotline or clinic to call for help.
• Look for a self-help group. You may find that talking to others in similar situations helps. Ask a trusted adult to help you find an online group, or one that meets in person in your area.

Look for patterns

Even though it may be hard, try to record your feelings before, during, and after times when you self-harm. That may help you learn your own patterns, avoid situations that trigger your behavior, and notice things that help you avert episodes of self-injury.

Try distraction or substitution

Some people find they can distract themselves long enough to avert an episode of self-injury. Keep a list of activities that you enjoy and that need focus.

You also may want to try substituting activities that produce intense sensations but that don’t involve injuring yourself, such as squeezing ice for a few seconds, drawing on yourself with a marker, or snapping your wrist with a rubber band.

Resource

The Healing House

By Kristen Knight

©2003-2019 Carelon Behavioral Health

Source: Andrew Levander, M.A., M.A.C.; American Self-Harm Information Clearinghouse; BBC News; CNN.com; Discovery Health Channel; Focus Adolescent Services; GuardianUnlimited; The Healing House; Self-injury: You are NOT the Only One; Vista Del Mar Child and Family Services; A Bright Red Scream: Self-mutilation and the Language of Pain by Marilee Strong. Viking, 1998; Bodily Harm: The Breakthrough Healing Program for Self-Injurers by Karen Conterio and Wendy Lader, Ph.D., Hyperion, 1998; Cutting: Understanding and Overcoming Self-Mutilation by Steven Levenkron. W.W. Norton, 1998; Women and Self-Harm: Understanding, Coping, and Healing from Self-Mutilation by Gerrilyn Smith, Dee Cox, and Jacqui Saradjian. Routledge, 1998.

Summary

Help your loved one by educating yourself. Be helpful, but don’t try to solve their problems.

It can be scary when someone you love gets sick. They may be acting differently and you don’t know why. You want to help them. But you don’t know what you can do to help them get better.

If your friend—or even your parent—is having problems, the best thing you can do is learn as much as you can about the illness. Read everything you can find. Ask questions if you have a mental health resource person at school or in the community. The more you learn, the better you’ll be able to help your loved one confront the challenges of their mental illness.

The more you know what they are going through, the less you’ll be afraid or turned off by their problems. And, you’ll have realistic expectations when they start to get better.

It’s not your fault

Young people often believe they are responsible for their friend’s condition. You might even believe you caused your friend’s problems. 

You might say: “If only I had been a better friend, they would be fine!” or “I should have known something was wrong. Maybe I could have prevented their depression.”

But, nothing could be farther from the truth.

You are not responsible for someone else’s problems. Mental illnesses do not come from something you or anyone else did to that person. They are caused by abnormal chemicals in the brain. You didn’t cause it and there was nothing you could do to prevent it.

You can’t solve the problem

You also might believe that you have the power to pull someone out of a depression simply by telling them to work harder, or change their attitude. That may not work for everyone. Once again, brain chemistry has to change and the best way for that to happen is through medication or psychotherapy directed by professionals.

If you try to push your friend to control the illness, you just put more pressure on them when they’re already very confused and unhappy.

Learn all you can

If your parent is ill, once again, learn all you can so you can understand what is going on. You might have to switch roles for a while and give up being taken care of, while your parent gets help. In fact, you might not have any other option. Having other support people you can turn to will be helpful.

Be flexible and supportive

You can help a lot by doing some things for yourself that you expected him to do for you. You can do the laundry. Shop for groceries. Make your own lunch. Wash the dishes. Sometimes just listening and encouraging a person to set their own goals can help greatly. It probably won’t be forever, and you’ll be taking a burden off someone who’s already struggling with a heavy load.

If your parent is going to need long-term help, another caretaker may step into the home to help take care of you and other children, or you might be moved temporarily into a foster or relative’s home. Try to be flexible and accept this temporary situation.

Take care of yourself

On the other hand, if that solution doesn’t work for you, don’t be afraid to speak up. Tell your caretaker if you need help getting to school or work, doing homework or dealing with your parent’s illness. 

Mental illnesses are treatable and most people get better with treatment. Give your parent as much support as you can to make it easier for recovery to move along as quickly as possible, but don’t give up your schoolwork, your job or your social life. It’s important that you stay strong and healthy. Counseling may be appropriate if you find it difficult to cope with the additional stress. Other options you could explore include support groups and recovery support services for family members.

Remember, the best way to help a loved one is to show your support through your words and actions. Keep the line of communication open. Don’t run away, but say something like, “I’m here and want to support you. If there’s anything you need from me, just let me know.”

By Paula Hartman Cohen

©2010-2021 Carelon Behavioral Health

Source: Scott Haltzman, MD, psychiatrist, author, and Medical Director of NRI Community Services, Woonsocket, RI; Joseph Wegman, PD, LCSW, specializing in depression, New Orleans, LA

Summary

• People with hearing loss report higher rates of depression.
• Treating hearing loss can improve quality of life.
• Know the signs of depression and ask your doctor for help if you have symptoms.

Hearing loss can be hard in many ways. More than just trouble hearing sounds, it can lead to feeling isolated, down, worried, frustrated and tired. What’s more, experts have found a strong link between hearing loss and depression among adults. This is especially true for women.

Older adults who do not treat their hearing loss are also more likely to feel depressed. Since it is harder to hear, they may avoid social situations, which can be lonely. Treating hearing loss can improve quality of life on many fronts. At the same time, it is helpful to know the signs of depression and how to ask for help.

Impact of hearing loss

Hearing loss is linked to a range of issues, and reactions vary:

• Some people feel stress and anger. This can increase conflicts both at home and at work.
• Some are too embarrassed to admit they can’t hear and resist help. Yet not treating hearing loss can put safety at risk. For instance, someone with limited hearing may not hear a car approaching as he walks across the street. Or he may not hear an approaching ambulance while behind the wheel of a car.
• Some people have an easier time accepting that they need help.

In fact, many factors impact how hearing loss affects someone. The toll it takes depends on:

• When the hearing loss began
• Whether or not the loss was gradual or sudden
• How severe the loss is
• What kind of daily communication needs the person has
• The person’s personality

Treatment itself also affects everyone differently. Some people have an easier time adjusting to hearing aids than others. But while they can be hard to get used to, hearing aids can improve hearing. As a result, relationships and mental well-being benefit from:

• Less conflict
• More engagement
• Greater awareness of surroundings
• More self-confidence

Hearing loss and cognitive skills

Hearing is also linked to other brain functions that can affect mood. Some research has connected hearing loss to a decline in cognitive skills. Experts from Johns Hopkins University found that older adults with hearing loss had a faster decline in thinking skills than those without loss. It may be the social isolation caused by hearing loss that is to blame. Yet no matter which changes come first, it is a tough cycle.

How to know if you need help

If you (or someone you love) have a hearing loss, it will help to know how to spot something more serious than stress. Think about how you are feeling. Be aware of these signs of depression:

• Sad, anxious or empty feelings that don’t ease up
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness or helplessness
• Irritability and restlessness
• Loss of interest in activities you enjoy (including sex)
• Fatigue and low energy
• Trouble focusing and making decisions
• Poor sleep
• Change in eating habits
• Thoughts of suicide
• Aches or pains that do not get better with treatment

If you have any of these symptoms, talk to your primary care doctor. Your doctor may suggest talk therapy or medicine. There are also steps you can take to help yourself, including:

• Stay active. Get exercise and take part in an activity you once enjoyed.
• Set realistic goals for yourself.
• Spend time with people you care about.

There is help for people with depression as well as hearing loss. Talk to your doctor about ways to both hear and feel better. There are things you can do to improve your quality of life.

By Sarah Stone

©2015-2019 Carelon Behavioral Health

Source: National Institute on Deafness and Other Communication Disorders, www.nidcd.nih.gov/news/releases/14/Pages/030714.aspx; American Academy of Audiology, www.audiology.org/publications-resources/document-library/untreated-hearing-loss-linked-depression-social-isolation; American Speech-Language-Hearing Association, www.asha.org/Aud/Articles/Untreated-Hearing-Loss-in-Adults/; Harvard Medical School, Harvard Health Publications, www.health.harvard.edu/blog/hearing-loss-may-be-linked-to-mental-decline-201301225824; National Institute of Mental Health, www.nimh.nih.gov/health/topics/depression/index.shtml; Better Hearing Institute, www.betterhearing.org/sites/default/files/quality_of_life.pdf

Summary

• Determine whether the injuries require medical care.
• Read about self-injury.
• Encourage your loved one to seek care and support.

If you suspect a loved one is injuring themself, brushing off the problem won’t make it go away. Though it might seem scary or uncomfortable, you can help.

Why do people hurt themselves?

“Why?” may be the hardest question for a person who self-injures to answer. Some people try to control difficult feelings with alcohol, drugs, binge-eating or purging. Other people may find relief in cutting themselves with razor blades or knives. Other people who self-injure may hit themselves, pull out their hair, burn themselves or scratch themselves.

Self-inury may become a way to feel mastery of the helplessness and anger often felt from abuse, neglect or invalidation. It can be a tension release. That’s one of the reasons why it becomes such a difficult behavior to end.

How you can help

Understanding why someone hurts themelf and can’t stop doing it may be hard for you, too. Be prepared to deal with feelings of disgust and fear. Comment on the behavior and convey concern, without criticizing.

People can’t be coerced into stopping the behavior. They have to be willing to try to change their behavior. Here is how you can help:

• Decide whether the injuries need medical care. Always take care of a medical emergency first.
• Read about self-injury. Do not try to be a mental health expert. It will likely overwhelm you and might harm the person.
• Make it clear that your loved one can talk to you about it, and that you aren’t repulsed. It is alright to say that you are overwhelmed by the injuries and the pain they must be causing.
• Encourage the person to seek care and support. Work with a health care professional to help the person.
• Help your loved one get help to explore the reasons behind their actions. 
• Place the responsibility for the behavior on your loved one. If they tell you about an episode of self-injury, ask, “How would you like me to react to that?”
• Be supportive without reinforcing the behavior. Project confidence, optimism and empathy. Say, for example, “You’ve been brave to deal with this issue.”
• Set reasonable limits to help keep the relationship intact. You might say, “I can’t talk to you while you’re cutting yourself because it hurts too much to watch.”
• Provide distractions if necessary.
• Be patient. It can take a long time for a person to give up self-injury.

What not to do

People who self-injure may expect to get angry, rejecting responses. Break that pattern.

• Don’t give ultimatums.
• Don’t expect the person to be able to “snap out of it.” Saying, “There, now it’s over,” is not helpful. Instead, say, “Let me help make it better.”
• Don’t ask, “Is there anything I can do?” Find ways you can help and ask, “Can I?”
• Don’t give pat responses. The feelings surrounding the issue are complicated. For example, if your loved one tells you they feel repulsive, don’t simply say, “You’re not repulsive.” Ask why, and explore those factors.
• Set limits for yourself. The person’s needs may overwhelm you. Refer them to professional care, when appropriate.

You also have to care for yourself. You may feel upset and stressed. Make sure you set limits — as much as you care for your loved one, you might have to take a break. Seek out support for yourself.

By Kristen Knight

©2003-2021 Carelon Behavioral Health

Source: Gabrielle Carlson, M.D.; Andrew Levander, M.A., M.A.C.; American Self-Harm Information Clearinghouse; BBC News; CNN.com; Discovery Health Channel; Focus Adolescent Services GuardianUnlimited; The Healing House; Vista Del Mar Child and Family Services; A Bright Red Scream: Self-mutilation and the Language of Pain by Marilee Strong; Bodily Harm: The Breakthrough Healing Program for Self-Injurers by Karen Conterio and Wendy Lader, Ph.D.; Cutting: Understanding and Overcoming Self-Mutilation by Steven Levenkron; Women and Self-Harm: Understanding, Coping, and Healing from Self-Mutilation by Gerrilyn Smith, Dee Cox and Jacqui Saradjian.

Summary

Reasonable job accommodations:

• Leave of absence without pay.
• Policy changes.
• Changing the work schedule.

A job accommodation is a change that is made to a job or the workplace. The change helps a worker with a disability do the basic duties of the job. This change does not alter the main job functions. The accommodation cannot cost too much. It also can’t make the employer change their location. Examples of accommodations for persons who have a mental illness may include:

• Leave of absence without pay (for example, counseling, hospitalizations, taking care of symptoms).
• Policy changes. These can include letting someone on medicine take breaks more often. These breaks may be to drink water or use the bathroom.
• Bringing a job coach to work to help learn the job.
• Changing the work schedule. This is helpful if a person’s medicine makes him groggy in the morning. 

These are examples of a few types of accommodations that might help a person with disabilities succeed on the job.

If you think a job accommodation will help you, talk to your boss. It’s not your employer’s duty to guess if you need one. He won’t be held liable if he doesn’t give you an accommodation if you didn’t ask. You don’t have to ask for it in writing. But, you should keep some kind of record of any talks or meetings you have.

Once you’ve asked for a job accommodation, your company must make a good effort to set it up. You also have to be willing to work with your company. If you don’t work with them in setting up the change, you may lose your rights under the Americans with Disabilities Act. Your company may ask you to show medical proof of your disability. If your company suggests a change, and you don’t think it will help, you should suggest something else. You may want to ask for an advocate to help you.

By Haline Grublak, CPHQ, Vice President of Member & Family Affairs, Beacon Health Options

©2010-2019 Carelon Behavioral Health

Like many physical conditions, it takes time to accept that you have a mental illness. At first, most people feel confused, angry, and afraid. This is a normal response. Don’t let it stop you from getting the help you need. Some people actually feel a sense of relief to find out why they feel the way they do.

The truth is that mental illnesses are real sicknesses. Just as real as diabetes or cancer. They have well-known causes and many treatment choices. With proper health care most people with mental illnesses get better. On the other hand, without proper care people can get worse.

Recovery tips

Here are tips to help you get on the road to recovery.

1. Learn about your illness. Ask your doctor to make it clear to you in plain language. Ask about books, websites, and other resources so you can learn about your illness. The more you know, the less scary it will be.
2. Never let your illness define who you are. Your mental illness can change how you think and feel. But you are still the worthwhile person you were born as. Having an illness does not change all the good things about you.
3. Get rid of shame. It just gets in the way. Nobody wants or deserves a mental illness any more than they would want or deserve to have the flu. Illness happens to everyone. Having a mental illness can be a journey in isolation unless you reach out to others. This is easier said than done. When we feel overwhelmed and unsure we tend to pull away from others.

There are two main reasons for this. First, many people don’t know how to talk about their illnesses. Second, many feel they would be burdening friends or family members with it. You can get rid of the shame and get on the road to recovery by telling those people who you are close to. When your family and close friends answer with love and support it’s easier to accept yourself and your illness.

4. Find support from others with the same illness. Your doctor may know of support groups in your area. There are support groups in almost every community in North America. The National Alliance on Mental Illness has good information about mental illnesses and area support groups. Talking with others with a similar illness can really help. Learning how others cope with their illnesses will remind you that you are not alone.

Professional support

There are times when having any illness becomes too much to bear. Even with good support. This is why professional counseling is so worthy. Talking with someone who is well trained can help you better learn how to take charge of your life and cope with your illness.

Another option to consider is talking with a recovery support specialist. These professionals may also be called peer support specialists. They are people who have also had mental illnesses, are now in recovery, and are professionally trained to support other people with mental illnesses. They can work with you to help you determine what you want to do to get well and stay well. Most mental health agencies now have recovery support specialists on staff.

Spiritual support

Life can be hard. Some of our questions just cannot be answered by doctors or counselors. But faith and religious groups offer a wide range of spiritual support and direction for people and families. Belonging to a church, synagogue, or mosque means belonging to a fellowship of people seeking a higher power while caring for each other. For some, just talking to a clergy person or lay minister gives peace and comfort.

Accepting your diagnosis is hard. It is the first step on the road to recovery.

By Drew Edwards, M.S., Ed.D.

©2022 Carelon Behavioral Health

It’s normal to need mental health support at times. Even people with good mental health can suffer setbacks and need emotional support at times. It’s human nature to have emotional ups and downs, and it’s healthy to respond to the downs by talking them through with someone who can listen, sympathize, and offer helpful support.

It’s unfortunate that some people consider admitting to and seeking help for mental health issues as signs of weakness. They’re not. They’re signs of strength and resilience. It’s perfectly normal to deal with mental health issues, and the best way to work through and get past them is with support.

It’s estimated that in any given year, one in every five adults will experience a diagnosable mental health issue. Those range from unhealthy levels of stress and anxiety to depression, grief, and problems with substance abuse or other addictions. Over the course of a lifetime, most people will experience one or more of those mental health challenges. Why suffer alone and risk getting worse when help is available?

Fortunately, attitudes toward mental health are changing. Prominent figures in sports, entertainment, politics and other public arenas are helping to normalize mental health challenges by being open about their own emotional issues and showing how appropriate help can make a difference.

If you’re concerned about a mental health issue, be strong and seek help. You’ll be glad you did.
 

What kinds of mental health support are available?

Social support

Social support—through your network of friends and family—is an important element in maintaining good mental health. When you’re feeling frustrated or down, talking through your emotions and the situations behind them can be tremendously helpful.

While your social support network can provide an emotional boost and a safety net for the normal twists and turns of life, it may not be all you need when you’re dealing with a more serious or complex mental health issue. Depression, anxiety disorders and addiction typically require professional support.

Counseling

Counseling is the process of talking with a trained mental health professional to collaboratively work through a problem. In this interactive process, called talk therapy, the counselor helps you identify goals and possible solutions, strengthen communication and coping skills, and work toward improved well-being in your mental health and relationships.

Professional counselors typically have at least a master’s degree in counseling, psychology, social work or a related field. To be licensed or registered to provide counseling services, they are typically required to meet certain standards and participate in ongoing education. Psychiatrists are medical doctors who provide mental health counseling and can also prescribe medications (which master’s-level counselors are not authorized to do).

There are many approaches to counseling, including three main models:

• Cognitive-behavioral therapy (CBT) focuses on changing negative or counterproductive thought patterns as a way to improve emotional well-being. In CBT, you learn skills to cope with problems and form new habits in the present, rather than delving into the sources of those problems and habits in the past.
• Psychodynamic therapy involves the examination and resolution of inner conflicts by exploring how behaviors have developed unconsciously from experiences early in life. Psychodynamic therapy is typically a longer-term approach to counseling.
• Humanistic or existential therapy emphasizes positive capabilities, creativity and personal growth rather than focusing on negative behaviors or the past. In humanistic therapy, the counselor helps you reconsider how you perceive yourself and works to build on your strengths and potential.

Depending on your needs and the counselor’s approach, different models may be combined to help you resolve your problem. The key is to find a counselor or therapist you trust and whose approach works for you.

Medication

For some mental health problems, including depression, anxiety and psychosis, medications can be a helpful supplement to counseling. A psychiatrist or another medical doctor can prescribe medication.

How to get mental health support

Your workplace may have a program that provides short-term counseling to help you resolve a mental health problem and can refer you to a qualified therapist for longer-term support. Your doctor can also refer you to a qualified therapist for counseling support and can discuss medication options with you.

©2021 Workplace Options

Summary

These approaches include:

• Animal-assisted therapy
• Creative art therapies
• Mind-body medicine

Medicine and therapy work well at treating many mental health problems. Yet some people want to try other ways to feel better. Here, you can read about some of those ways. Many people try these methods along with their standard plan of care. They may help support your efforts to get well.

• Animal-assisted therapy (AAT). This method is based on research suggesting that animals are good for people’s health. It is more than visiting with a pet. A therapist trained in AAT makes a treatment plan that involves animal interaction. Many studies suggest that animals are useful therapy tools. One study found that AAT reduced anxiety in people with mood disorders and psychotic disorders.
• Creative art (expressive) therapies. Art, music, writing, and dance are useful tools. They can help people work through feelings and events that are hard to talk about, or those that cannot be expressed using words alone. They are holistic. This means they work with the body, mind, and spirit. Studies suggest that these therapies can lower anxiety and depression. They may also boost self-esteem and self-awareness.
• Self-help groups. Social support can help you cope with or recover from a mental health problem. Self-help groups bring together people with problems like yours. Groups can give you helpful advice. Groups also allow you take steps to help yourself stay well.
• Pastoral counseling. Many people with mental health problems turn to a trusted pastor, priest, or rabbi for prayer and support. Some people seek help from a pastoral counselor. This is a person educated and trained in religion and providing mental health care.
• Food and supplements. Many special diets claim to help mental health. Studies looking at how diet affects mood and mental health are limited or have mixed results. We do know that a healthy and well-balanced diet gives your body all the nutrients needed for good health. We also know that taking large doses of vitamins is not needed and may even be harmful. Some people try herbal supplements to boost mood, reduce worry, or sleep better. For instance, good evidence suggests that St. John’s wort can ease mild depressive symptoms. But it is not a proven cure for depression. Many herbal supplements may not mix well with drugs you use. Some can even be harmful.
• Mind-body medicine. Meditation, yoga and similar techniques teach people how to use the mind to feel better. Evidence suggests that mind-body medicine might help with stress, worry, depression, and mood. It may also boost self-awareness and self-care.
• Massage therapy. This involves touching and rubbing the body to ease tension and stress. It may lower symptoms of anxiety too.

Do these work?

Many mental health providers think that these methods can play a role in treatment when used along with conventional methods. Yet, we don’t always have scientific proof that they work or are safe if used alone. In some cases, a therapy may seem to lessen symptoms in the short-term. But we don’t know if the benefits will last. Some have little to offer and may even be harmful. More research is needed to learn about the usefulness and limitations of many less-established ways. 

Before you try a new approach

Talk to your doctor to get all the facts. Your doctor can tell you if it may be useful and safe for you to try. Never stop or change your current plan without talking to your doctor first.

By Christine P. Martin

©2012-2021 Carelon Behavioral Health

Taking care of your mental health is as important as taking care of your physical health. As the World Health Organization puts it, “Mental health is an integral part of health; indeed, there is no health without mental health.”

Here are some key ways to take care of your mental health so you have the resilience to cope with life’s ups and downs, adapt to change and maintain healthy relationships.

Take care of your physical health

The human mind and body are connected. When you take care of your body, you also take care of your mental health. Consider these recommendations:

• Be physically active. Exercise can lift your mood and your energy level, reduce stress and help with the symptoms of depression and anxiety. When you engage in regular physical activity, you sleep better, think more clearly and regulate your emotions more effectively. Find ways to be active that you enjoy, and build them into your daily and weekly routine.
• Eat a variety of healthy foods. What you eat can have a direct effect on your mood and energy level. Eat plenty of fresh fruits and vegetables plus lean protein and whole grains. Avoid processed foods as well as foods with added sugar and salt, and limit your consumption of alcohol. Find a mix of foods you enjoy that sustain your energy while giving you the nutrients and vitamins you need to thrive.
• Sleep well. You need adequate sleep to think clearly, stay focused and regulate your emotions. Adopt healthy sleep habits by going to bed and getting up at the same time every day; winding down in the hour before bedtime in low light without electronic devices; and avoiding large meals, caffeine and alcohol late in the day.

Accept yourself

Every person is different, and no one is perfect. Accept yourself for who you are, and take pride in your unique strengths and quirks. When you find yourself being self-critical, pause and reflect on what’s good about you — why your friends love and appreciate you and all of the things you do well. If negative self-talk (the critical voice inside your head) is holding you back and making you unhappy, consider talking with a professional counselor to learn new skills for weakening that negative voice and strengthening your positive self-image.

Strengthen social connections

Social connections — your friends and family, the people you spend time with and talk to — are a key element in your mental health. Make time for the people you care about, especially the people with whom you’re able to discuss your emotions. Pay attention to who in your social network lifts your mood when you’re feeling down and who is open and honest with you when you’re seeing things in an unrealistic way. Cultivate these connections, and strengthen them by providing the same emotional support in return.

Calm yourself

When you’re dealing with a stressful situation or feel your body growing tense, take time out to calm yourself. Learn stress-reducing techniques like deep breathing, progressive muscle relaxation and mindfulness, and use the ones that work for you to relax your body and your mind. Physical activity, healthy sleep habits and time with friends can all help to reduce your stress.

Practice healthy thinking

Build your emotional resilience by adopting positive habits of thought. Practicing gratitude is one way to do this. Take time every day to think about what you are grateful for, and write it down. Positive reframing is another way. When you have a negative reaction to something, step back and reconsider things in a positive light, looking for the opportunity in the situation or the good in the other person and yourself. Work to solve problems one step at a time.

Talk about how you feel

When you’re sad, worried or upset, talk about what you’re going through with someone you trust. When you hold those feelings inside yourself, they can build, becoming more intense and uncomfortable. When you talk about them, you begin to process your emotions, understand what lies behind them and find ways to solve the problems you’re facing. A phone call or a cup of coffee with a friend may be all it takes. For deeper or longer-lasting emotional challenges, it may help to talk with a professional counselor.

Do something that absorbs your mind

If there’s an activity you enjoy or a skill you’d like to learn, make time for it. Focus on something that absorbs your full attention. That might be making something, playing music, singing, writing, cooking or gardening. It might be restoring an old car, making an improvement to your home or playing a sport. The best activity is one you can get lost in, that brings you into a state called flow, where you are fully engaged and forget about worries and negative thoughts.

Find purpose and meaning in life

Everyone finds purpose and meaning in life in different ways. It can be through spirituality or religious practice, caring relationships with others, helping people in need or doing work that in some way makes the world a better place. If you don’t find purpose and meaning in your job or your daily life, look for other ways to find this satisfaction. Consider volunteering, paying more attention to the relationships in your life, exploring your spirituality or simply looking for new ways to be kind.

Ask for help when you need it

When you’re suffering emotionally and nothing seems to help, reach out for support. Your doctor can direct you to a professional counselor who can help you cope with the challenges you’re facing. 

The earlier you get help, the better. Don’t put it off until you’re in crisis.

©2021 Workplace Options

Summary

Work can include a paid job, volunteering, or going to school.

Work can be a big part of recovery. Work doesn’t mean going to a 9:00 – 5:00 job every day. If working full time is scary, don’t let it stop you from working. Work can be any activity that a person does. It is something that is important to the community. Of course, work can be a paid job. But, it can also be volunteering, raising children, homemaking, or going to school. All of these activities have value, even if you don’t get paid.

Some members are anxious about going back to work because they think job stress might cause a relapse. Others think they can’t work because they still have symptoms, such as hearing voices, or being depressed. Still others have been out of work for so long that they don’t think they can handle a job.

In spite of the challenges, work can have a good effect on recovery. Recovery doesn’t mean that a person no longer has symptoms. Recovery has a much more complex definition than that. Members who are successful have described recovery as:

•  Having hope for the future
•  Having a reason to get up in the morning
•  Being able to make and keep friends
•  Doing something worthwhile
•  Being sure about their ability to handle stress
•  Believing that there is a link between personal effort and success
•  Being able to make choices

Work can help your recovery in all of these areas. It gives you a chance to make friends, helps you set goals, and if you get paid, gives you more choices in your life.

By Haline Grublak, CPHQ, Vice President of Member & Family Affairs, Beacon Health Options

©2010-2019 Carelon Behavioral Health

Most people you know likely have a loved one, family member or friend with a mental illness. In fact, there is a 20% chance you have a mental illness. It’s that common. Yet, there is still stigma around issues such as bipolar disorder, depression and anxiety. Studies show that about 75% of those with mental illnesses feel stigma.

Stigma is how people can be viewed negatively due to their culture, circumstances or illnesses. It’s felt through fear and shame by others. It can also come from within a person. Stigma can hurt relationships, work and family, and make a person with an issue more afraid to seek help.

The following questions and answers will help you learn more about the nature of mental illness.

What is a mental illness?

It is an umbrella term for disorders of the mind. These can include event-specific issues that cause post-traumatic stress disorder, depression that is passed down from a parent to a child, or an illness like obsessive-compulsive disorder. The feelings that start it can happen once, many times, or even be ongoing.

Some types of mental illnesses:

• Depression
• Anxiety disorders
• Bipolar disorders
• Psychotic disorders
• Mood disorders
• Personality disorders

Keep in mind that mental illnesses can be as broad and wide as physical illness.

How are mental illnesses diagnosed?

Just like with physical illness, there are some signs to watch for:

• Sudden social issues
• Problems at work or school
• Changes in sleeping, eating, or self-care
• Excessive drinking or drug misuse
• Mood changes
• Talk of taking one’s life

Going to a primary care doctor might be the first step. After talking to a primary care doctor, the person might be referred to an expert. From there, the mental health doctor will work with the person to make a treatment plan. This can include therapy, meds, non-drug care or a mix of them all. Lifestyle changes of eating habits, working out and quitting smoking might be helpful as well. 

Are people with mental illnesses more violent?

This is an idea that is furthered by headlines in the news. When a traumatic event, crime or manmade disaster occurs, the media is quick to bring up the possibility of mental illness. A person with a mental illness is just as likely to be violent as a person without. It depends on many factors like background, availability of weapons and motive. But a person with a mental illness is more likely to be a victim than a person without mental illness.

How do I refer to someone with a mental illness?

The mind and body are linked. People don’t want a mental illness any more than they want a physical one. A person doesn’t choose depression, just like they don’t choose heart disease. Don’t talk down to a person with a mental illness and assume she is not as smart or as able as you.

Think about labels. We often treat people with cancer or other physical health issues as heroes. Terms like brave and strong are used to describe their “battle” with the disease. People with mental illnesses are more likely to be referred to in harmful terms like paranoid and delusional, and that they are “suffering from” their disorder. This may make those with mental illnesses feel hopeless.

People are not their disorder but rather, have one. For example, a person is not schizophrenic—they have schizophrenia. Just like a person has the flu, but is not a flu. Calling people their disease takes the power away from them to see themselves as separate from it.

How can I help someone with a mental illness?

Treat the person as you would any family, friend or co-worker. Keep in mind that having a mental illness is the same as having a physical one. Offer to:

• Be a good listener and ask what the person needs.
• Lend a helping hand in seeking treatment or talking with family about their disorder.
• Learn as much as you can about the disorder and help find resources.

Don’t forget to help yourself. Being a caregiver or supporting friend can be hard.

How can I help myself?

If you think you have a mental illness, go to a doctor, friend, family member or anyone you trust. Getting to the bottom of your health problem will help get you on the path to treatment sooner. Try not to worry about stigma. There is no shame in taking care of yourself. Those that love you will want you to be well. The more you learn about your disorder, the more empowered you will feel.

People can—and do—recover from a mental illness, in the same way they recover from a physical illness.

By Andrea Rizzo, MFA

©2022 Carelon Behavioral Health

Summary

• Plan ahead for when symptoms of the illness occur.
• Set reasonable rules and limits and stick to them.
• Do not go along with delusional thinking.

Your family member should have a home that is safe and stable. A setting like this will help your loved one with his recovery. Your support and understanding is critical. Even when your loved one has support and a safe place to live, there may be times when your loved one is not doing well. He may act in a way that causes worry for you and other family members. These ideas may help you and your family:

• Plan for when your loved one gets bad symptoms. Talk to her doctor or therapist about how to plan. If possible, learn what can set off the symptoms. Agree on a course of action ahead of time.
• Learn to spot signs of relapse, such as changes in mood, sleeping, and eating habits. Your family member should also learn these signs. He may be able to tell you what has worked to rid him of stress and get control of symptoms. Seeing his doctor or therapist may help avoid a relapse. This is especially true if your loved one needs his meds evaluated.
• Learn what situations may cause trouble. Do not invite an insensitive friend to your home when your relative is there.
• Do not agree to stop the meds if your family member feels cured, or because the meds have side effects. Talk to the doctor who prescribed the meds. She may not know that your relative is having side effects. Be sure she understands the problems your loved one is having because of the meds. If your doctor refuses to listen or to act, a change in doctors may be in order.
• Set fair rules and limits and stick to them. It may help to ask the therapist for ideas. 
• Don’t tell your family member to “pull yourself together.” If he could, he would. Not being able to do this is part of the illness. Know that he is dealing with more than you are.
• Don’t expect that all bad habits be fixed at once. Focus on good things your relative is doing. Don’t focus on what is going wrong.
• At times people with mental illnesses have memory loss or can’t concentrate. Be patient with your relative. If your relative seems like she’s not listening, it may be because of the illness. Repeat the info in a kind and clear way.
• Do not go along with delusional thinking. The person with mental illness needs to be able to depend on someone who is in touch with reality.
• Your family member may see or hear things that aren’t there. Be honest. Accept his view of the world as his own. If asked, say that you are not having the hallucination. Learning how to respond in a respectful ways to these and to other symptoms is an important part of family support.  

By Haline Grublak, Vice President of Member and Family Affairs, Beacon Health Options

©2010-2019 Carelon Behavioral Health

Reviewed by Trenda Hedges, C.R.S.S., C.P.R.S., Wellness & Recovery Program Manager, Beacon Health Options

Summary

Signs of relapse:

• Difficulty in carrying out everyday activities
• Behaviors that are similar to previous relapses
• Extreme changes in emotions that are not caused by outside events

People with mental illnesses are stressed by the same kind of life events as everyone else. But the way they react to it can be different. Stress can bring on a relapse of their illness. Not eating right, lack of sleep, or worries about day-to-day problems can cause stress.

While you can’t make a person’s life stress free, you can lessen the effects of stress. Make sure your family member has lots of ways to live a healthy lifestyle. Help her eat healthy, balanced meals, exercise regularly, and get enough sleep. Encourage a regular routine and help her stay away from drugs and alcohol. Know what the early signs of a relapse look like. Acting early can help speed recovery.

Warning signs of a relapse:

• Changes in eating or sleeping patterns, personality changes
• Problems with doing everyday activities
• Changes in how your family member talks with others
• Acting in a way that is like other relapses your family member has had
• Extreme changes in feelings that are not caused by outside events

If you suspect your family member is having a relapse, you should:

• Tell his doctor or therapist right away. Ask for an evaluation of his meds.
• Try to lessen stress that may be coming from outside sources.
• Encourage her to stay involved in any therapy or peer programs.
• Try to keep the home environment as calm, secure, and stable as possible.
• Try to talk to your relative about your concerns. Talk with him about things he can do to keep the relapse from getting even worse.

Be prepared:

• Have a crisis plan ready for yourself.
• Keep emergency phone numbers (doctor, therapist, police, hospital, etc.) in a convenient place.  Load these numbers in your cell or smart phone.
• Know your limits and how you will react if those limits are broken. Make sure your relative knows your limits and what will happen if your limits are broken. 

By Haline Grublak, Vice President of Member and Family Affairs, Beacon Health Options

©2010-2019 Carelon Behavioral Health

People with serious health problems are at risk of having a crisis. This is the same for people with serious mental illnesses. A crisis can come about for many different reasons. Sometimes it can happen for no clear reason at all. Events like these can also set off a crisis: 

• Stopping or refusing to take meds
• Meds no longer work or the dose needs to be changed
• Overusing drugs or alcohol
• Losing a loved one, losing a job, holidays, or physical illness

People seldom lose control all of the sudden. There are often warning signs that the family will spot long before the crisis. There may be certain kinds of behaviors that predict a crisis. 

During these early stages, you can do things to avoid a full-blown crisis. Try to get your family member to visit her doctor or therapist. You may need to make the appointment yourself and drive her there.

If you haven’t been able to avoid the crisis, be calm and act rationally. Accept the fact that the person has a mental illness. You are not the cause of it. These guidelines can help:

• Don’t threaten your loved one. This may cause him to become more excited or afraid. People who are afraid may act out.
• Don’t shout. If she’s not listening, it isn’t because she is ignoring you on purpose. Other voices or intense feelings may be interfering.
• Don’t criticize. Criticizing will not make the voices go away or calm a person who is scared. It will only make the situation worse.
• Don’t argue. The person is not having the same reality that you are. 
• Don’t dare a person to act on what he is threatening to do. 
• Don’t stand over the person. If she is sitting down, sit down too.
• Avoid direct constant eye contact or touching the person.
• Follow requests the person makes if they are not risky or unreasonable. This lets the person feel somewhat in control.
• Don’t block the doorway, but don’t let the person get away.
• Be positive. Even if your loved one is out of touch with reality, he will respond to your love, care and concern.  

By Haline Grublak, Vice President of Member and Family Affairs, Beacon Health Options

©2022 Carelon Behavioral Health

Holistic methods are those used to take care of the whole person. This means more than treating the body. It includes a person’s mind and spirit as well. The methods can also be used to help one’s mental health.

A few of the methods are:

• Yoga
• Meditation
• Massage
• Hypnosis

Yoga is an eastern practice that joins poses, meditation and special breathing skills. Yoga can be used to help with overall movement and fitness. It also can help with a healthier mindset. Yoga is thought to help with stress, worry, mood, and depression.

Yoga began in India as a spiritual practice. Today many people in the U.S. use it to work out. Yoga classes are widely used to keep in shape and relax the mind.

Meditation is a mental technique that is often used with yoga. It can also be used by itself as a way of letting go of worry and stress. It is sometimes used to treat issues such as trouble with sleep and low moods.

Some research suggests that it improves the mind’s skill to focus. It is also thought to calm a person’s nervous system. All it calls for is a quiet setting and focused thinking. The Hindu practice of Transcendental Meditation includes chanting as a way to focus.

Massage involves touching a person’s body. This is done using special touching and rubbing techniques. It is widely used in sports to help with pain and rehab. Despite the hands-on technique, massage helps with mental well-being too. Massage is a simple and instant method of stress relief. In fact, some massage patients become so relaxed they fall asleep during the session.

Studies have shown massage may lower heart rate and blood pressure. It may help with worry and depression as well. It is believed that massage helps block a person’s pain signals. It also may help let loose chemicals that help mood. These include endorphins and serotonin.

Hypnosis is a mind-control method that is often not understood. It does not involve the control over a person. Instead, it is the control of a person over her own mind. A person is in an altered awareness. During this time, he is thought to be more open to ideas. It is often used to treat widely found fears. Some claim it can also help a person quit smoking or overusing alcohol. A person may be hypnotized by a trained person or taught how to do it for himself.

Keep in mind

Holistic treatments should never be used instead of standard health practices. You should always check with your doctor before starting any of these methods. More research is needed to prove how well these methods work for mental health.

Resource

“Terms Related to Complementary and Alternative Medicine”
http://nccam.nih.gov/health/providers/camterms.htm?nav=gsa

By Kevin Rizzo

©2022 Carelon Behavioral Health

It is easy for parents to identify their child’s physical needs: nutritious food, warm clothes when it’s cold, bedtime at a reasonable hour. However, a child’s mental and emotional needs may not be as obvious. Good mental health allows children to think clearly, develop socially and learn new skills. Additionally, good friends and encouraging words from adults are all important for helping children develop self confidence, high self-esteem and a healthy emotional outlook on life.

A child’s physical and mental health are both important.

Basics for a child’s good physical health:

• Nutritious food
• Adequate shelter and sleep
• Exercise
• Immunizations
• Healthy living environment

Basics for a child’s good mental health:

• Unconditional love from family
• Self-confidence and high self-esteem
• The opportunity to play with other children
• Encouraging teachers and supportive caretakers
• Safe and secure surroundings
• Appropriate guidance and discipline

Give children unconditional love.

Love, security and acceptance should be at the heart of family life. Children need to know that your love does not depend on their accomplishments.

Mistakes and/or defeats should be expected and accepted. Confidence grows in a home that is full of unconditional love and affection.

Nurture children’s confidence and self-esteem.

• Praise them: Encouraging children’s first steps or their ability to learn a new game helps them develop a desire to explore and learn about their surroundings. Allow children to explore and play in a safe area where they cannot get hurt. Assure them by smiling and talking to them often. Be an active participant in their activities. Your attention helps build their self-confidence and self-esteem.
• Set realistic goals: Young children need realistic goals that match their ambitions with their abilities. With your help, older children can choose activities that test their abilities and increase their self-confidence.
• Be honest: Do not hide your failures from your children. It is important for them to know that we all make mistakes. It can be very re-assuring to know that adults are not perfect.
• Avoid sarcastic remarks: If a child loses a game or fails a test, find out how they feel about the situation. Children may get discouraged and need a pep talk. Later, when they are ready, talk and offer assurance.
• Encourage children: To not only strive to do their best, but also to enjoy the process. Trying new activities teaches children about teamwork, self-esteem and new skills.

Make time for play

Encourage children to play: To children, play is just fun. However, playtime is as important to their development as food and good care. Playtime helps children be creative, learn problem-solving skills and learn self-control. Good, hardy play, which includes running and yelling, is not only fun, but helps children to be physically and mentally healthy.

Children need playmates: Sometimes it is important for children to have time with their peers. By playing with others, children discover their strengths and weaknesses, develop a sense of belonging, and learn how to get along with others. Consider finding a good children’s program through neighbors, local community centers, schools or your local park and recreation department.

Parents can be great playmates: Join the fun. Playing Monopoly or coloring with a child gives you a great opportunity to share ideas and spend time together in a relaxed setting.

Play for fun: Winning is not as important as being involved and enjoying the activity. One of the most important questions to ask children is “Did you have fun?’’ not “Did you win?”

In our goal-oriented society, we often acknowledge only success and winning. This attitude can be discouraging and frustrating to children who are learning and experimenting with new activities. It’s more important for children to participate and enjoy themselves.

TV use should be monitored

Try not to use TV as a “baby-sitter” on a regular basis. Be selective in choosing television shows for children. Some shows can be educational as well as entertaining.

School should be fun

Starting school is a big event for children. “Playing school” can be a positive way to give them a glimpse of school life.

Try to enroll them in a pre-school, Head Start or similar community program which provides an opportunity to be with other kids and make new friends. Children can also learn academic basics as well as how to make decisions and cope with problems.

Provide appropriate guidance and instructive discipline

Children need the opportunity to explore and develop new skills and independence. At the same time, children need to learn that certain behaviors are unacceptable and that they are responsible for the consequences of their actions.

As members of a family, children need to learn the rules of the family unit. Offer guidance and discipline that is fair and consistent. They will take these social skills and rules of conduct to school and eventually to the workplace.

Suggestions on guidance and discipline:

• Be firm, but kind and realistic with your expectations. Children’s development depends on your love and encouragement.
• Set a good example. You cannot expect self-control and self-discipline from a child if you do not practice this behavior.

Criticize the behavior, not the child. It is best to say, “That was a bad thing you did,” rather than “You are a bad boy.”

Avoid nagging, threats and bribery. Children will learn to ignore nagging, and threats and bribes are seldom effective.

Give children the reasons “why” you are disciplining them and what the potential consequences of their actions might be.

Talk about your feelings. We all lose our temper from time to time. If you do “blow your top,” it is important to talk about what happened and why you are angry. Apologize if you were wrong.

Remember, the goal is not to control the child, but for them or her to learn self-control.

Provide a safe and secure home.

It’s OK for children to feel afraid sometimes. Everyone is afraid of something at some point in their life. Fear and anxiety grow out of experiences that we do not understand.

If your children have fears that will not go away and affect his or her behavior, the first step is to find out what is frightening them. Be loving, patient and reassuring, not critical. Remember: the fear may be very real to the child.

Signs of fear

Nervous mannerisms, shyness, withdrawal and aggressive behavior may be signs of childhood fears. A change in normal eating and sleeping patterns may also signal an unhealthy fear. Children who “play sick” or feel anxious regularly may have some problems that need attention.

Fear of school can occur following a stressful event such as moving to a new neighborhood, changing schools, or after a bad incident at school.

Children may not want to go to school after a period of being at home because of an illness.

When to seek help

Parents and family members are usually the first to notice if a child has problems with emotions or behavior. Your observations with those of teachers and other caregivers may lead you to seek help for your child. If you suspect a problem or have questions, consult your pediatrician or contact a mental health professional.

Warning signs

The following signs may indicate the need for professional assistance or evaluation:

• Decline in school performance
• Poor grades despite strong efforts
• Regular worry or anxiety
• Repeated refusal to go to school or take part in normal children’s activities
• Hyperactivity or fidgeting
• Persistent nightmares
• Persistent disobedience or aggression
• Frequent temper tantrums
• Depression, sadness or irritability

Where to seek help

Information and referrals regarding the types of services that are available for children may be obtained from:

• Mental health organizations, hotlines and libraries
• Other professionals such as the child’s pediatrician or school counselor
• Other families in the community
• Family network organizations
• Community-based psychiatric care
• Crisis outreach teams
• Education or special education services
• Family resource centers and support groups
• Health services
• Protection and advocacy groups and organizations
• Self-help and support groups

©2022 Mental Health America and National Council for Community Behavioral Healthcare. Used with permission.

Source: www.mhanational.org/what-every-child-needs-good-mental-health

Good mental health, like good physical health, is important to human well-being. But what does it mean to be in a state of good mental health?

First, good mental health is more than just the absence of diagnosable mental illness. In fact, people with mental illness, just like people with physical illness, can cope with their disease or infirmity and have periods of relatively good health as they move toward recovery.

Second, good mental health goes beyond feelings of happiness and contentment. Positive emotions are wonderful to experience, but they are rarely a constant in life. People experience setbacks, challenges, and trauma over the course of their lives, and a realistic definition of good mental health needs to include the range of emotions people actually feel.

A better way to think about good mental health is as a form of emotional resilience. Just as a person in good physical health can be tired and have sore muscles after a period of intense physical exertion, so a person in good mental health is able to feel pain and sadness after a setback or loss, then return to emotional stability. Not right away, perhaps, but in time and with support.

People with good mental health are able to:

• Express and modulate their emotions appropriately
• Empathize with others and maintain good relationships
• Give and accept emotional support
• Cope with uncertainty, adverse events and the normal stresses of life

When you are in good mental health, you are able to appreciate the good aspects of life and feel the pain of life’s disappointments and losses. Except in the worst of times, you are able to work productively, contribute to your community and realize your potential.

©2021 Workplace Options

Summary

• Talk therapy treats emotional problems by increasing self-knowledge and teaching healthy mental habits.
• Whether short- or long-term, the focus should be on meeting a goal that you and the therapist have agreed upon.

What happens when you go into therapy? First, there’s the fact that it’s all about talk. As therapist and author Tamara L. Kaiser describes, it is “a conversation between therapists and their clients.” Along with this conversation, you may have some homework between sessions.

But how will this make you better? That’s your real concern. After all, people go into treatment because they have an emotional issue causing them real pain. In many cases, prescribed drugs such as antidepressants may ease the pain with little talk-therapy. How can therapy work as well, or even better, than these?

The answer is in your head, literally. Modern neuroscience found the circuitry of the human brain to be highly “plastic.” That is, the brain changes nerve connections and signal pathways as it takes in new experiences. All your life it is constantly learning and adapting. This means patterns of thought and emotion are not set in stone. They can be altered. Therapy targets the patterns that are harmful and essentially trains your brain to choose different ones.

In this way, therapy is simply another form of learning aimed to teach you about yourself as you replace bad mental habits with healthy ones.

A participant, not just a person seeking help

Therapy comes in many forms, and therapists have long-running debates about which methods work best. What’s clear, though, is the success of any method calls for effort and motivation by the person undergoing therapy. In cognitive-behavioral therapy (CBT), you can expect to get homework assignments. In all types of therapy, the goal is for the person to gain self-knowledge and to act on it. First you learn, with the therapist’s help, why you think and act the way you do. Then you do the work of changing. “The goal is to teach patients to become their own therapists,” says Judith S. Beck, Ph.D., President of the Beck Institute of Cognitive Behavior Therapy.

Research shows therapy works best with “extra-therapeutic” supports. These include motivation from family and friends, and from life events (such as changing jobs) which happen during therapy. Then there is the quality of the relationship between person and therapist, the choice of method, and the person’s own level of hopefulness. Therapy can involve just the therapist and you. Successful therapy often includes the support of family, friends, and community.

From intake to outcomes

Therapy often starts with an assessment followed by a diagnosis and treatment plan. Clients may fill out a health history questionnaire including questions about home, work, life, relationships, parents, partners, and other factors that affect their emotional life.

The therapist and client may decide on focused goals like: “Improve depressed mood by engaging in at least one pleasurable activity each day and sleeping no more than eight hours per day.” (Goals of this kind are typical of CBT.) Or they may be more wide-ranging, like learning how to have healthy relationships. In any case, both the therapist and person in therapy need to keep the goal visible and be able to reach it.

This “intake” process, as it’s sometimes called, is followed by scheduled sessions of 45 to 50 minutes.

What happens in and between those sessions will depend on the therapy method. The therapist may ask frequent questions to reveal issues and habits of thought the client had not noticed. This “Socratic questioning,” is important in CBT. In other forms of therapy, the therapist may mostly listen and let the person talk. This can include free association for which the therapist steps aside and lets the client say whatever comes into his mind.

Between sessions, especially in CBT, people can be given tasks which support the work they are doing with their therapist. An unhappy and anxious person who is out of work, for instance, might submit a job application as homework.

Time and progress

How long your therapy takes will depend greatly on the diagnosis. In CBT, says the Beck Institute, uncomplicated cases of anxiety or depression might need only six to 12 sessions. More deep-seated or long-term problems, such as bipolar disorders, can take many more. Some other methods take longer than CBT. Treatment for some complex problems, for instance, can go for many years. The major thing is to have realistic expectations from the start. And that comes when you and your therapist set the right goals in the right amount of time.

Resource

For a more in-depth look at a typical CBT course of therapy, see the U.S. Department of Veterans Affairs’ Cognitive Behavioral Therapy for Depression in Veterans and Military Service members: Therapist Manual by Amy Wenzel, Ph.D., Gregory K. Brown, Ph.D., and Bradley E. Karlin, Ph.D., at www.mirecc.va.gov/docs/CBT-D_Manual_Depression.pdf.

By Tom Gray

©2012-2019 Carelon Behavioral Health

Source: Beck Institute for Cognitive Behavior Therapy, Bala Cynwyd, PA, www.beckinstitute.org; U.S. Department of Veterans Affairs; Tamara L Kaiser, M.S.W., Ph.D., L.I.C.S.W.

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options

Chances are you work with someone who has a mental illness. By law, supervisors can’t disclose information about an employee’s mental illness. And you shouldn’t assume a co-worker has a mental illness even if that person seems to act strange or exhibits unusual behavior. But if you know a co-worker has a mental illness, you can help provide a supportive work environment by keeping some key communication “dos and don’ts” in mind.

Do suggest seeking professional help

If a co-worker confides in you about a mental illness, encourage them to seek professional help and use a support network of family and friends. Determine how far you can go to help them by following cues from your conversations. You can give the individual support and advice, but ultimately it’s up to the individual to seek that help.

Do listen

Although extremely rare, if a co-worker threatens harm to themself or others, you should know how to react. First, make sure that everyone involved is safe, Thompson explains. Ask that person how you can best help them, and listen to what they have to say. And if the situation occurs at work, notify a supervisor.

Do be understanding

By law, employers must make reasonable accommodations for people with mental illnesses, whether that entails a flexible schedule, a different supervision style or other accommodation. If you know a co-worker has a mental illness, make an effort to understand their needs. For example, try to keep all non-work related conversations out of work areas.

Don’t stigmatize

Most importantly, don’t stigmatize a co-worker with a mental illness. Providing support for a co-worker in need does not mean isolating that person. Take time to get to know that person as you would any co-worker.

By Kristen Knight

©2022 Carelon Behavioral Health

Summary

• Acknowledge the illness
• Get the right diagnosis
• Find the most suitable treatment
• Learn methods of interaction that avoid confrontation
• Get support for yourself

Who is this stranger? How can I reach him? Why can’t I make her better?

These are some of the questions that family members and close friends face when someone they love has a serious mental illness.

Conditions such as schizophrenia, major depression, and serious bipolar disorder not only cause anguish in those with these illnesses, but they can strain and sometimes break longstanding, close ties. The task of relating to a loved one in such cases can be difficult, draining and not always successful.

Close ties and understanding important

At the same time, those with the issue need the close ties and understanding more than ever. Mental illness can lead not only to private pain but also to public behavior that drives people away and leads to social isolation.

Eric Silver, a Penn State criminologist who published a study on how the mentally ill become victims of violence, has noted that people with serious mental disorders “tend to arouse negative responses from those around them, even among family members and friends.” He says this is particularly true of those with substance abuse disorders or delusional beliefs or hallucinations.” Persons with mental disorders often lack social graces while they engage in conduct that appears crude, bizarre, or even threatening to others,” Silver says.

Learn how to interact

Silver and other experts say friends and family members need to learn methods of interaction that enable them to cope with the person who has the illness while avoiding confrontation, which can sometimes lead to violence. Judy Benson, RN, a nurse practitioner in Omaha, NE, who specializes in psychiatric mental health nursing, says loved ones must learn to act like therapists. “You don’t argue with people about their illness,” she says, even if they’re delusional. And you don’t fight: “The less reactive family members are and the calmer they are, the less potential there is for violence.”

Get the right diagnosis and treatment

The task of maintaining a relationship is made easier (though still not simple) by getting the right treatment. First, acknowledge the illness, get the right diagnosis, and find the most suitable treatment. That’s hard enough in itself. In addition, the loved ones may have to come to terms with their own limits, including their limited power to make things better.

This can be especially painful for parents of teens or young adults who suddenly develop schizophrenia. Stephen Currier, a licensed social worker and vice president of behavioral health services with the May Institute in Norwood, MA, says it’s crucial, and not always easy, to “reach out to professionals who understand the serious mental-illness issues” and, in a sense, give up care of your child to someone else. “All of a sudden [parents] are finding, ‘I can’t make it better,’” says Currier. “They’ve got to let go; that’s got to be awfully hard when you’ve raised a kid for 18 years and you have to give him or her up to someone.”

Currier says the onset of other serious conditions, such as bipolar disorder and depression, raises different issues because it tends to come later in life, when the person typically has formed relationships such as marriage and a family. In this case, the deterioration in behavior—and the erosion of relationships—may be so gradual that family and close friends don’t notice it. For that reason, Currier says a sharp-eyed outsider, such as a primary care doctor who knows how to ask the right questions, can be very important.

Once a serious illness is confirmed, Currier says it’s important not to hold back on the level of treatment. He stresses “aggressiveness”—not being afraid to take advantage of medications, not being afraid to get the patient into an aggressive day program, and so forth. This also means taking a secondary role in the patient’s therapy, as a monitor and observer of care prescribed by professionals, not as the one who “makes it better.” Benson says medication “is basically the answer… people who don’t take medicines and have serious psychological illness just don’t get better.”

And sometimes, even medicine isn’t enough to keep the bonds with the person intact. It’s possible that the person, in spite of everything you and the professionals do, cannot safely live with you—or anywhere else in normal society. You need to be prepared for institutionalization. Also, parents of severely ill children need to plan carefully for their own old age, when they may need care and cannot expect it from the adult child.

Get support for yourself

And what about you? You may face a lifetime of dealing with the illness, though symptoms may become less intense with age. And dealing with any severe mental illness in a loved one, even if it is curable, can lead to anger, pain, embarrassment, and a sense of isolation. For these reasons, experts say, it is essential to get support and not to try going it alone.

The National Mental Health Association (NMHA) advises you to establish a support network and seek counseling, for yourself as well as for the patient and other family members. It’s also important to take time out periodically from caregiving to tend to your own mental health. “Schedule time away to prevent becoming frustrated or angry,” says the NMHA. “If you schedule time for yourself it will help you to keep things in perspective and you may have more patience and compassion for coping or helping your loved one.”

By Tom Gray

©2003-2019 Carelon Behavioral Health

Source: The National Mental Health Association; The National Alliance on Mental Illness; Eric Silver, criminologist, Penn State University; Judy Benson, RN, nurse practitioner, Omaha, NE; Stephen Currier, licensed social worker and vice president of behavioral health services, May Institute, Norwood, MA.