Advice and help for relatives

Jörg Stadler is the head of the mental health counselling centre at Diakonie Passau, which is responsible for the city and district of Passau. About 7% of people seeking counselling who come to him every year are relatives of mentally ill people. According to Stadler, some of the people seeking help have diffuse problems – it is only in conversation that it becomes clear that the problem results from the mental illness of a loved one. In an interview with the counselling centre, the 61-year-old talks about the effects of mental illnesses on interpersonal relationships and gives relatives tips on how to deal with the illness of their loved ones.

Counselling centre: how can I recognise if someone is not well and that they may be mentally ill?
Jörg Stadler: especially changes in people’s behaviour. There are usually two patterns that can indicate the onset of an illness. One pattern is when someone withdraws for a longer period of time, his reactions change, e.g. when he becomes more sensitive, more anxious or easily irritable. The other pattern usually involves someone getting very excited, being preoccupied with irrelevant matters, being overly active or exhibiting exaggerated sexual behaviour. This may indicate psychosis or bipolar disorder. If both patterns occur or one of them occurs repeatedly over a period of two weeks, extreme caution is required.

When should the problem be addressed?
Sooner rather than later. Even if it turns out afterwards that it was not depression, but rather just a depressive mood, relatives show compassion and understanding. The key is to always address the problem openly and honestly and with respect. This is not the place for accusations. Furthermore, it is advisable to speak from the heart instead of reiterating what others observed.

What is the best way to address the illness of a family member?
Just like that, with respect, transparency and honesty. Actually, there should be a great deal of mutual understanding and trust within the family, which should make it easier to address problems. Examples could be when a father becomes depressed and is no longer interested in his daughter’s studies or when a mother reacts excessively anxiously when moving out. Those affected should first make it clear to themselves that this behaviour is not directed against them. It may be difficult not to take it personally in cases like these examples, but it is enormously important to be able to help the family members.

How do I treat someone who is mentally ill?
Actually, not any different than before. First, you should determine how close you are to the person, for example, whether you are dealing with your own partner. The effects of the illness are also an enormous burden for oneself, which should be acknowledged. Mental illnesses have a very strong impact on people’s relationship skills. Again, this requires transparency, honesty and appreciation in dealing with each other. Well-intended tips and advice are usually not very helpful. Sick people do not behave strangely because they want to, but because they cannot help it.

How can one help?
The first step: to find out more about the disease. In other words, how the disease will progress, what the symptoms are and what the treatment looks like. After all, if the relatives know about it, they also have a better understanding of the sick person’s situation. Talking openly about the disease can help the patient accept it. Furthermore, people can support activities initiated by the patient, i.e. if the patient wants to go for a walk.

Where does a person’s own responsibility towards a mentally ill person begin and end?
I think there is no way to get out of assuming responsibility, precisely because mental illnesses have an enormous (negative) impact on living together. If you want to change something about it and hold onto the relationship, you will most likely address the problem. Although everyone is responsible for themselves, the key is to work together on a relationship.

To what extent can the patient be monitored during treatment?
Assuming that the relatives have informed themselves sufficiently about the illness, they can talk about the therapy and medication and exchange information about whether the medication is well tolerated or whether it was taken correctly. It is important to establish a common foundation so that the care is more readily accepted by the patient.

When does care become too much of a burden for relatives?
I think you can tell quite quickly. Relatives should always ask themselves the question: how much of my own life do I have to put aside to take care of the mentally ill person? If it takes up more than 30% of your life, it becomes difficult. The mood can then possibly turn into aggression against the sick person. Then you should ask yourself: is this commitment still appropriate? If this is not the case, then it is time to look for help. Self-help groups have proven to be very effective because it is good to know how others deal with a similar situation.

What is there to consider when living with someone who has recovered from a mental illness?
Again, it is very important to talk openly. It is also helpful to ask the previously ill person about their ideas for living together in the future, i.e. whether there is something special to consider or how to deal with each other. Furthermore, it would be good to understand and recognise the stress limits of the recovering person to avoid unintentionally exerting unnecessary pressure with certain suggestions for activities.

Thank you very much for the interview!