How to Support Your Loved One Through Mental Health Challenges: A Guide for Family Members (Episode #21)

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But smile when you smile and laugh.

When you laugh something around. Welcome to the Human intimacy podcast. I'm Dr. Kevin Skinner with my friend and colleague, Dr. Dave Robinson. Dave, how are you doing today?

Doing great. Happy to be here.

You know, one of the things that Dave and I, we go back 30 years. One of the things that I, I really appreciate about Dave is he is really focused on helping family members deal with loved ones dealing with a variety of issues. So today we're going to be talking about how to help a family member who's dealing with some kind of a mental health challenge. And often as I talk with individuals, they find that their family members dealing with mental health issues and they don't know how to respond. So, Dave, first question to you today is I've got a family member dealing with a mental health issue. What do you suggest I do?

I mean, I think the, the first thing most people do is they panic and they just don't know what to do. And so then oftentimes then we just go to what our gut tells us. And so I think I kind of have a, a model that I've thought about. It's called the, the CARES model that really talks about options that we can be thinking of when we're dealing with somebody who's struggling with a mental health concern in their, in their family because it gives us some practical things to look at. And so, so I think, you know, that would be the thing I'd have us look at is these five different aspects of our relationship with our loved one who's struggling.

All right, so you're saying there's a model. You call it the CARES model. So C A R E S Correct. And so we're going to use this acronym today to describe things that you can do. What I really like about this is it gives us a template rather than just kind of guessing or going off our gut. You're talking about, if I can do these specific things, it's going to be more helpful for our family member dealing with mental health challenges.

Correct. And. And I think before we get into the model, I want to talk about just two quick things. So some researchers from a while ago, they talk about how we can best deal with people dealing with any sort of illness, mental or physical. And they talk about two aspects that are really important. One is communion, and the other one is agency. And I think those need to be kind of at the top level before we get into this other aspect. The first part is communion is about the ability to connect with others. And thinking about that, you know, as. As people are struggling with a mental health concern, that disconnection from the world is really problematic for many people. And so. And also for the caregivers, right, that, you know, our family's different. Our family's having different challenges, and so sometimes they feel disconnected. So one thing we want to be thinking about is how do we increase that communion, that connection with others, for both the person struggling and their family. And the other aspect is agency, and that's the ability for people to make choices on their own. And, you know, it makes sense that, you know, if you have somebody who's struggling and. And they're. They're just really trying to figure out what they want to do with their life, and they don't have any control. A lot of times, mental health concerns take that control away from them, and then we start making all decisions for them. And so those two aspects are really important, that how are they connecting with others, and how are we connecting with others, and how are we allowing our family member to make choices that are the best for them and for the family as a whole. And so I think those things I'd like to kind of set as the foundation that community, the communion and agency being important aspects. And that leads us into kind of the CARES model.

All right, so before we get into the CARES model, specifically, I. I can just think about individuals who I've met with throughout my career, and individuals will say something like, when, you know, when my partner's dealing with depression or anxiety or whatever the mental health issue is, they typically pull away from me. They pull away from the family. They isolate themselves away. And. And so you're talking about that community, you know, that Community or that connection. Right. And yet at the same time, they're pulling away. How, how might I address that if I sense that they're pulling away from connection with, with me or with our family in general?

Well, I think that's an important point because that's oftentimes what mental, mental illness does to us is we, we want to just separate ourselves. Depression, we're just going to shut down. Anxiety, maybe we're going to pull away. But those, those points of disconnection make the condition worse. And so we can't force somebody with anxiety to come out to a party with 65 people. But maybe there's an aspect of the communion where they could have a smaller party at their house or maybe the grandparents could be invited over after the party so they can spend some time. And so it's not about forcing somebody, but it's allowing them for the opportunity to have some connection of the level that they can handle and slowly increasing that so that it's not overwhelming for them. And so that's gives them the ability to make choices for themselves, but also helping them see that just being completely disconnected from the world isn't helping your condition in any way.

So you're talking about adaptation, being able to adapt to a situation rather than force forcing somebody to do something or in some situations, allowing them to be completely isolated, which is, is not helpful either.

Right. And, and that's, that's the harder part as a family member is like that they'll, they'll sometimes get into this power struggle. So they want to take away the agency of the person saying, you're coming. This isn't working. Get out of your bed. And then you have a battle. And so we, when somebody's already struggling, we don't want to battle for you, for that person. And so that's really important to not get into those battlegrounds, but to help them understand that, hey, we're just trying to find ways to help re. Reintegrate you into life a little bit and helping you move forward. All right, great.

Great starting point. So now let's jump into the cares model. What does this C stand for?

So C. C talks about us being able to communicate actively. C. So a lot of times we don't really know what's going on with our family member. And it's really important for our family member to be able to express their experience. Even if I say, say I struggled with depression 10 years ago and now I have a spouse or a child with depression, I can't go up to them and say, I know exactly what you're going through because I had depression. And so this is how it is, and I completely understand. So this communicating actively is to really actively listen to what's going on, sitting with them, spending some time and allowing them to express what's going on for them. And that can. That can be really helpful for a lot of things. Showing that empathy, that this is really hard for you. I see that, and I know this isn't how you want your life to be, and. And that compassion goes a long way with our family members.

You know, what I really like about that is as I actively listen, I'm. I'm really trying to understand what they're experiencing rather than, you know, putting my perspective into what they should do. I'm really trying to understand what is this anxiety or what does this depression? What is it feeling like? What is it? What are you experiencing? Maybe even physiologically, where are you feeling it in your body? And I think that kind of awareness. Dan Siegel uses the word attunement, being attuned to people and what they're actually experiencing.

And if you think about that, if you want to start looking about healing, that connection with someone who's struggling is healing in and of itself. If they know that I have people on my. On my side. I have people who legitimately care for me, even though many times with anxiety, depression, bipolar disorder, all a lot of the mental health conditions that, that we see, they feel like they're hopeless. They feel like nobody cares about them. And. And that obviously makes their condition worse.

And even if we take that, nobody cares and nobody understands.

Right.

What I'm experiencing. And so the c. Really here is to communicate, actively being present with them, seeking to understand what they're experiencing.

And sometimes it is going into the bedroom, the dark bedroom with no lights on, nothing, and sitting with them. And sometimes it's taking them for a walk when they're in a place, when their anxiety gets out of control, but it's actively being engaged in their process. Instead of judging them for that, they're already judging themselves.

Extremely helpful. And yeah, they are, right? That self judgment, that self criticism. Why can't I just break out of this? And obviously we can make matters worse by saying something like, why can't you just break out of this? Right? Why, why can't you just stop thinking this way? Or, you know, stop feeling so anxious, right? Why can't you just stop that?

Yeah, that's the best advice we give to this world, right? Just stop it, stop it, stop it. Therapy, our jobs we wouldn't have jobs anymore if we just tell people to stop it. Unfortunately, I've tried it a few times. It doesn't help people. They're stuck in. Stuck in something for a reason. And just telling them to stop it does nothing but feel. Help them feel disconnected from you. Because you. It sounds like a judgment, like you. You're not trying. If you just try, you'd be better.

Which would be another line, right? Which would be another line, right? You're not trying. And again, that kind of message is. Is, you know, there's something wrong with your effort. You're not putting enough into this.

Right, Right.

All right. So that's the c. What does the A stand for?

I think part of our role is to advocate the. So the A stands for. Advocate for their needs. And so if you think about this, if. If you're not capable of doing something, then you're going to need some help with that. And so sometimes we have to advocate for their needs. Is the person living alone? And maybe they can't live alone for right now, and they need to move in with a family member or, you know, really importantly, do they need some help? Do they need to see a doctor? Have they. Have they been evaluated? Because sometimes these mental health concerns also have a physical component to it. And so if they haven't seen a doctor in a while, they haven't had any lab work done. You know, sometimes people have anxiety. I've treated people with anxiety disorders, and we find out they didn't have an anxiety disorder, they had a thyroid problem. We fixed the thyroid issue. Their anxiety went away. And so advocating for their needs, making sure that they have help on the biological aspect of the medications, the food, the sleep, all of that, the psychological aspects of their life, the social aspects, what do they need and what are they able to tolerate? And with many people, when I'm working with them, I look at the spiritual aspect of their life, too, that it doesn't matter what their religious beliefs are, but how do they make sense of the greater world? And sometimes these mental health concerns take that out from them. They don't have any hope for the future. They don't have anything that grounds them and helping them do that. And so we want to advocate for their needs when they can't do it for themselves. And this is pretty easy for people to do because we genuinely love these people. And you also know that that person would do it for you. And so. And maybe sometimes they'll get a little mad at you, like, leave me alone. I just want to sit in here and rotate. But maybe that process isn't so good and we need to get them to the point where they can actually start to take care of their own needs and get moving.

You know, one of the things that, that brings up in my mind is when I'm an advocate for somebody, what it really is saying is, I love you and I care about you and, and so I'm going to help in whatever way I can. I, I'll never forget a situation where I had a client who was dealing with some pretty significant depression and sen there in the office and looking at, when's the last time you've been to a doctor? When's the last time you had blood work? Right. And sometimes they can't. They, that phone call is really hard for them. Just making and setting an appointment and that a, you know, being that advocate and having a family member say, I would want you to set up that appointment, call up the doctor, get the blood work done. And when you do that for them or they do that, a loved one does that for them now they don't feel so overwhelmed because sometimes even making a phone call and is difficult.

Absolutely. That, that first step can be hard for a lot of people to, to get what they need. And, and maybe. And I think that goes along with a lot of things that we do in life. Like if somebody just lost a loved one, calling somebody up and saying, hey, what can I do to help? Instead of just showing up and, you know, taking the kids or bringing over dinner or in this case, calling the doctor or going with them to the doctor, taking them to the doctor or helping them get in, get in to see a therapist. I mean, that, that has been a real problem as of late, that getting access to a good therapist has been hard. And people, you know, sometimes people will call up and find out there's a waiting list for months and that was the only ounce of energy they had and they wasted it on that. And sometimes they need people that are advocating for their needs to say, okay, we couldn't get you in with this person. Let me call a few more and find out. Narrow it down, find out, find someone that can take you and, and helping them do that. And this part, doing for somebody you love isn't really that difficult because our mental faculties are, are okay. And that's the part of understanding where they're coming from. We just don't realize how, how, you know, it's kind of like walking through life in six feet of mud. It just slows you down sometimes. And and just the thought of doing one more thing is too much for.

Them, you know, and that's really that transition of not having somebody advocating for you to having somebody there, even that goes back with that relationship.

Right.

I've got this community. I've got a person who is really an advocate for me. They are engaged, they care about me. Even those two things together seem to be like, it would be helpful for a person who's dealing with a mental health challenge, anxiety, depression, or whatever it may be.

Right.

All right, so now let's look at the R. What does the R stand for?

So it kind of goes back a little bit to the agency, but R stands for respect their journey. Because we can't decide for our family member what they can or can't do. And sometimes we have to accept that, you know, maybe that's the best they can do right now. And that's really hard for people. Like, okay, so, you know, you're finally going to work, but then you come home and sleep the rest of the night. Well, that's progress. But maybe that's all they can do right now. And so we do have to respect their journey. We want to understand where they're coming from and realize that everybody's journey is unique. And so just because somebody up the street had depression and they were better in three months, and this has taken a lot longer for your family member, their journey can be different. And so we do have to respect their choices, their progress, and even their setbacks. Sometimes we have to respect the fact that maybe they don't. They're not willing to do anything right now. And that's really hard. That the. This one caveat I'd say with that is, you know, when it comes to somebody's life, we don't really respect their journey all that much. We as a society have decided that, at least in most countries, that suicide's not. Not a viable option currently. And so that's probably one. That is one point that we probably don't respect there their journey. And we say, hey, we need to get you some help now. And the reason why we do that is we've dealt with a lot of suicidal people over the years, and we find that once they get out of that hole, they're so glad that they live. They found joy after that. But it's during that whole part that they didn't realize that. And so there is that aspect of respecting the journey that we maybe ignore a little bit. Like, you don't want to get help and you're thinking of Taking your life. We don't. That's one point where I draw the line and say, okay, we're gonna do.

Something here which is important because really we're saying, I. I care about you and your life, and I want you to be a part of our life. Your life actually matters. It matters to me, and it matters to us as a culture and a society. And right now, you may not feel like life is worth living, but it's the one time in. What we're talking about here is respecting their agency, respecting, you know, their journey. But you're really saying here, look, that's the one time we say, look, we can't ignore that. And I think that's important for all of us to understand. But I think there's another true point here, and that is allowing them to make decisions, going back to this concept of agency, allowing them to feel like they're contributing. They're. It's, you know, what. Which would you prefer? How can I best help in these two options? Again, at least they've got some choice in, say, responding. You know, I want to go to the doctor. I want people at the house. I don't want people at the house. Whatever it is, you're allowed allowing them, and you're encouraging them to make. Make decisions.

Yeah. And sometimes we. We have to, like, finesse those decisions for them. Right. That, you know, if you have a kid, that you're going to some wedding, say, and you have a daughter, and, you know, you tell her to go get dressed, and she comes out in her Spider man outfit from Halloween. She did what you told her to. But if you want to be more accurate, you can say, hey, we have three dresses here because we're going to a wedding. You can choose any of the three, and any of them are fine. And I think that decision making kind of helps out in this way. Like, you know, we can go see the doctor, we can get you a therapist, we can get. Get you moving, and I'll get up and go exercising with you every morning. Whatever they're willing to start with, that's the best place to start. Wherever they're willing to start is the best place to start.

Awesome. Awesome. Now I want to now move on to the E. What does it stand for?

So it talks about educate yourself. Because too many people have these hidden agenda items, understandings in their brain about what mental health conditions are. So people kind of know, I know what depression is. I know what anxiety is. I know what bipolar disorder is. I know all of these things. But our job is to really, truly educate ourselves about the specific mental health concern of our loved one and find out what is this journey like for them. And so educating yourself about their condition, the treatment options, and once you do that, you're better able to advocate for your. For your loved one because you understand it better. It's not that I can jump in and say, I know exactly what you're going through, but I can jump in and say, hey, I've been doing some reading on here, and it looks like there's some options. I'm just wondering which one we could start with. And so if you don't know, if you've just gone and, you know, I have. I have a client right now who has significant anxiety. And he has been taught his whole life that doctors and medicine are evil and bad. And he has really struggled with his anxiety. And, you know, I've talked with him about the addition of medication because it's not getting better on its own, even with all the therapy that he's done. And, and that's been a real struggle for him because his family member had imposed these belief systems on him that he's really struggling. He finally went and got the medication, and it's sitting on his counter because he's so worried about all the things that his mother told him growing up. And so I think if we don't educate ourselves, because it's one thing to have a biased opinion against mental health care in general, but it's another thing if it's your family member who you truly love and you see them struggling just to survive each day, then you probably should do a little bit of reading to understand the options so that you're not making misinformed judgments, opinions, and possibly losing your family member because they don't get the help they need.

You know, and I want to add to this because we live in a culture today where some people believe in medication, some people absolutely reject medication. But even there, getting as much information as possible gives you awareness rather than a quick judgment. And what I found is there are many. There are truly many solutions to the issues that we're dealing with. Depression doesn't necessarily have to be done with medication, although in some situations it is probably the best option. Same with anxiety. The more information we get, we can make these informed decisions and say based upon research, your best approach is medication with this other form of treatment. And. And again, we have to understand the depth of what our. What our family members are dealing with. And sometimes that means we need to get more information. Now, some people will say well, where do I get educated? Where do I learn about these things? What, what would you recommend for individuals who want to understand, say, anxiety or depression on a more personal level? What would you suggest? Where do they read? Where do they learn? From a place that they can trust.

So I think what, what we'd be looking at is there's the national alliance for the Mentally Ill, so nami, and they have a lot of resources for individuals who struggle with mental health concerns and their family members. So it gives you research, easily understandable information about the different mental health concerns. The US Government also has a lot of resources where they've put some significant information in. The American Psychiatric association has a lot on their website. And so I think just doing a little bit of research, but going to these reputable sites is much more important because too many people get on and they just type depression in Google and it pulls up whoever, the first, you know, whatever comes up. And it can be somebody who has no information, has no knowledge about it, and they're just sharing their opinion. And so we want, we want well researched information and I think those are good places to start. There are also plenty of books about, you know, living with someone with, with depression, understanding anxiety in your life. There's a book, the Anxiety and Phobia Workbook that has some real good resources. And so I think there are a lot of resources out there. Our job is just to sort through and not get the, the fad of the day or just somebody's personal opinion. You want to make sure that there's some good resources behind them.

You know, and I want to emphasize what you're just saying there because again I, there are a lot of people with a lot of opinions. But when you look at nami, for example, they're research based, they're, they've done enough extensive research they're recommending. But it's not just that, it's understanding the symptoms.

Right, right.

It's really hard if you, you can't treat what you don't understand. And, and a lot of times people looking at anxiety, what they don't understand is our body's autonomic nervous system. It is constantly in a fight or flight response. It doesn't know how to slow down. And, and when you get stuck there, your body's in a constant state of stress and learning how to maybe get better sleep. And, and so sometimes as you get the information, you'll realize one of the best things you could do, let's just say for anxiety, is actually to get into patterns where your Body's learning how to relax, learning how to sleep. And, and so we might have to work sleep hygiene. But if I've read, I'm like, okay, I now feel empowered to help you because I understand some, some of the dimensions of what you may be physically experiencing, such as inability to sleep, racing mind. And, and now I can say, well, here's some things. Let's listen to some calming music. What is that like for you? And now I'm, I'm, I'm really with them, observing. How does that help? Does it not? What are you experiencing here? Now I feel like an advocate because I'm learned, I'm engaged in the process. I'm getting information.

Yeah. And I, I think that's a great transition to the last one, the S, which is supporting healthy habits. And so a lot of times when people aren't doing very well, they're not taking very good care of their body, as you said. And so they're not getting the sleep they need or they're sleeping too much, they're not eating a well balanced diet. And, and I'm a proponent of, I've done a lot of training on psychopharmacology and working with medication for people with mental health concerns. And the first thing I always go to is to make sure that they have the proper nutrition because our bodies do not function well if they don't have the proper nutrition. And we need to understand the aspects of our life. So if you live in Alaska and you're depressed every winter, it's probably because you're not getting enough vitamin D. And so we need to understand that, we need to understand where we live. So vitamin D, thyroid issues, all of those sorts of things. And so we want to support those healthy habits and, and it really needs to be very practical support. Are they getting the nutrition they need? Are they getting some sort of regular exercise, whatever that is. And that needs to start at the level they are at. So I had one woman who was not getting off the couch. Her depression was so profound. And so we started with let's have you stand up once for five minutes every hour. That was where she could start. And slowly we built to walk to the, walk to the other side of your house and then slowly walk to the stop sign. And then by the end of therapy, she was going out and going on walks around her neighborhood. But if I would have said let's walk around your neighborhood when she was so depressed, she wouldn't have been able to do that. So we want to start where they can feel some success and it's also not too much. And as you mentioned, sleep is, is essential. People do not function if who are not getting good sleep. And so that needs to be a number one. And the biggest problem I get from people who struggle with depression is they tell me, I've always gone to sleep with the television on. I said, yeah, that was before you struggled with depression and insomnia. And so now we need to transition and not have screen time right before we're trying to go to bed. We need to have things that help calm us down before we enter into our bedroom and make sure that we have everything set up in our bedroom so that it's conducive to good sleep. And then the last thing I'd say about supporting healthy habits is, is that sometimes substance use complicates these conditions. And I will clarify that it's not sometimes, it's most of the time. So if you think about it, for example, alcohol is a depressant. If somebody's struggling with depression, then they're actually, if they're taking antidepressant, they're taking something for depression and taking an depressant. So they're basically canceling that out. So sometimes we maybe need to take a break from alcohol drinking. You know, if somebody has a glass of wine for dinner, I think it's probably okay. But if they're really trying to work on something, maybe, maybe it's something to look at. And the other part of that is people with anxiety, sometimes they'll. They'll use alcohol to calm their anxiety, but the alcohol has such a short half life. It only stays in our body such a short time. It actually decreases our anxiety short term, but then makes it greater on the other side. And so those are the things you want to be thinking about when you're looking at healthy habits. That. Where is your substance use playing a role in helping keep you in whatever you're stuck in.

All right, so let me just close off a couple parts here that I think are really important. You know, the healthy habits. I always say this, and I say it jokingly, but I think it's really serious. I'm a better therapist when my clients are sleeping well, when they're eating well and they're exercising, sleep, eating, exercise, those three parts, and if I could add to it, have meaningful connections or people around them that are supportive. And so this cares model, really simple model, but at the same time, it is. So, I mean, it's simple, right? It's a simple model. And we will put some show notes for this, we'll put down these, the cares model for you so you can review it and look at it. Because we really want to make sure that if you're dealing with family members, dealing with mental challenges, mental health challenges, that you have a model that works for you and it's really a simple model to follow.

Yeah. And I just want you all to, to know that what you're trying to do matters. Even though it's hard, it matters. I've never worked with somebody who's, has had a family member who completed suicide that they were happy that it happened. And so it really is that we can make a difference in the lives of our family members and help them through their difficult time and help them, you know, live a fulfilling life again. And so, so kind of with what we've talked about today, I think our, our focus in the near future is we'll, we'll do another one of these to really look at how you can take good care of yourself as you're doing that, because that is an important aspect in this too, because it does take, it does take it out of us when we're, we're the one that has to be the one carrying the full load.

All right, I really appreciate that. So, yeah, we're going to have you back here again when we're talking about, you're the caregiver trying to help family members dealing with mental health. How do you take, do self care in, in those situations? That's a great topic. So we'll come back soon and we'll have another podcast on that. Any final comments today that you'd like to share with our listeners as they're going through this journey of dealing with a loved one, dealing with some mental health challenges.

Just don't give up. I mean, your loved one has played a role in your life at some level, and maybe they're a little absent now and sometimes we can get upset with them, like you're not trying or you're not doing anything, but, but, but I think that's, that's not as helpful as us just realizing that, hey, I can jump behind you. I'm going to support you. I'm going to carry you if, if I have to until you can get back up on your feet. And, and that, that's one thing I would say as a therapist that's the most fulfilling for me is to take somebody who's basically not functioning to living a full, fulfilled life. And mental health concerns nowadays do not have to be a death sentence. They don't have to be so hopeless there. There's a lot of hope, there's a lot of options, and there's a lot that we can do to make people's lives functional, happy and enjoyable.

What a great way to finish. So I thank you, Dave, so much. Dr. Dave Robinson with us. Thank you so much for your time. And really informative, helpful today, the cares model. If you've got family members dealing with mental health challenges, certainly share this with the podcast with others. We encourage you to just get the word out because we live in a culture today where we have more anxiety, more depression, and we really are in a situation where we need advocates for people who are really consistently struggling. And we never know, it may be us down the road. And we all need people who are going to. We care. We need to care about each other.

Right.

All right, Dave, thank you so much for your time today. Any final thoughts?

No, I. I wish you all well and I hope you find this. And again, I don't want you to be overwhelmed. Maybe just start with one of these aspects with your family member. Don't try to do too much all at once. Start, start slow for you and for them.

All right. That's a great thought. All right. To our listeners. Want to just thank you for your time today. May you be blessed in your efforts to create deep, intimate relationships. Thank you again for your time today.

Take care.