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Mental Illness Guide: Care, Support, and Education
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Can I help my relative recover and stay well?

Coming home from the hospital:  What can I expect?

For the first few months after your relative comes home from the hospital, the family should try to keep the home setting as calm and stress-free as possible.  A low-stress living area gives the person with mental illness a chance to adjust to activity levels and the normal demands of life.  Here are some things you can do to help your relative recover and stay well.

1.      Set realistic goals

The goals of the first few months after a hospital stay are primarily to avoid being hospitalized again, and slowly fitting back into a basic family role. ANYTHING ELSE IS A BONUS.

The goal of the next few months is to slowly get the person with mental illness to start or return to work or school and to socialize with friends and family.  Here are some tips for the family to help your relative meet these goals.

Limit what you expect from your relative, at least for a while

Lowered expectations for the person with mental illness will enable families to be less surprised or “let down” by the things they may do or not do.  A short stay in the hospital does not mean that the person with mental illness’s illness is not a very serious one.  Think of your relative as a person who has had a very serious physical illness, or a serious accident, and as one who needs a long time to get better.  After a period of illness, it is common for the person with mental illness to not feel like doing anything, to lie around a lot, and to need a lot of sleep.

2.      Avoid stress in the home

Families can help their relatives better by learning to lower the level of stress at home.  Lowering stress will help the chances of your relative staying well.   A person with mental illness’s has a lowered ability to withstand stress including a lower ability to deal with the stresses common to family life.  Loud voices, yelling, shouting and arguing are upsetting to a person with mental illness.

Reduce stress at home by making a daily routine

Daily routines that can be counted on, such as meals, bedtimes, kitchen clean up after dinner or taking out the garbage can help to reduce stress at home.  Set a time when each of these activities will happen.  Write the schedule on a sheet of paper and post it on the refrigerator.

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Be aware that the person with mental illness might need some time alone, or quiet time, each day.  Perhaps he/she would prefer to listen to the radio in his/her room for an hour after dinner.

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Plan non-stressful, low-key regular activities, such as taking a walk or listening to music.

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Plan very few “big events,” such as going to a movie, or the mall, or family parties.

3.      Set limits

Families should not confuse the need for low stress with not having house rules or limits.  Limits are helpful to people with mental illness who may feel overwhelmed by the confusion in their own minds.  These limits are very important in preparing them to live in the real world.  The following guidelines are given to help families set reasonable and workable limits on most behaviors.

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Decide together what rules are needed for the person with mental illness to come home to live with the family.  Try to separate things that are just annoying from those that will not be accepted.  For example, you may decide to accept your relative wearing mismatched clothes, but be clear that aggressive behavior will not be tolerated.

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Set limits clearly and without a lot of discussion.  “That is just not acceptable” is often better than a long explanation.

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Keep your requests clear and specific.  “Your job is to take the garbage out every night after dinner.”   This is better than saying something that is less specific, like, “Help out more.”

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Set limits before the tension builds.  Anger that is out of control is more likely to upset your home life than the limits you have set.

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Do not be guided by your relative’s actual age.  If people with mental illness are not “acting their age,” it is important to set the limits they need rather than wait for them to “grow up”.

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Avoid threats.  Never set a limit or “punishment” if you are not prepared to back it up.  Say, “Please remember you agreed to wash the car so we can go the mall.”  DO NOT SAY, “If you forget to wash the car, I will never take you to the mall again.”

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Expect limits to be tested.  Many families give up too soon because they feel a limit has failed because they tried it once and it did not work.  Family members must be able to set reasonable limits and then give them some time before deciding they failed.

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Admit it when limits are more for the needs of other family members.  People with mental illness must learn to live with the fact that they and their needs cannot always be the center of family life.

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If you are not sure about whether or not to set a limit, or if you want to talk to someone before you do it, talk to the treatment team. The setting of comfortable and workable limits should be as much a effort as other parts of treatment.

Do not work on all “bad” behaviors at once

You cannot solve all of the family problems at once.  Pick what limits to set and what goals to strive for.  Family members should pick one or two issues to start with, then pick others after these first issues are being managed well.  While it is hard to ignore certain “bad” things, most families are able and willing to do so if they have set their own goals. Once they start to see progress in some areas, they can believe that the other issues will be addressed later on.

Learn more about how to set limits and solve family problems. 

4.      Keep communication simple and straightforward

Here are three key things to remember about talking clearly and in a simple way to better communicate.

Be responsible for what you say.   Let others speak for themselves.

Family members, and people with mental illness, should speak for themselves.  It is also important not to assume they know what others want or need.  They should accept and respect what others say, even if they do not agree with it.  This communication skill helps to remind everyone in the family of personal boundaries.

The ability to keep things simple, avoiding too much detail.

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When families are in crisis, it is not the time to discuss issues with no real answers, such as the meaning of life, sex, religion, or politics.  Everybody gets excited, and nothing gets resolved.

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Some family members tend to get very excited in discussions about even neutral topics.  People with mental illness are more likely to find these discussions too exciting or confusing.

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Family members should not try to explain to anybody the “hidden meanings” of strange things the person with mental illness might say.  Others in the “real world” will not take the time to think about these things.  People with mental illness should be helped to make what they say clearly understood.

The ability to say positive things and make supportive comments

Family members must learn to focus on and reward small, positive behaviors as an important goal.  They must not focus too much on the things that are wrong with their relative or home situation.  Do not ignore or downplay positive things that have happened.

5.      Support your relative’s medication plan every day

It is important for the family to know what medicine their relative is taking and how often it needs to be taken.  Although medications help, they can also have some unwanted side effects.  Side effects may include things like weight gain, shaking, getting tired, or movements with the tongue or mouth that cannot be controlled.  Naturally some people with mental illness do not like the side effects.  Others wish to stop medication as soon as they begin to feel better, since taking medicine is linked with being sick.

Some medicines commonly prescribed for people with serious mental illness are called anti-psychotic medications.  They help the brain to work by changing the levels of chemicals, called neurotransmitters, in the brain.  If the level of neurotransmitters is not right, it can cause problems.  For example, your relative’s brain may think it hears sounds an voices that are really not there.  People with mental illness who take medications often notice a decrease in their symptoms, such as hearing voices and seeing visions that other people do not hear or see.

Knowing about these medications makes it easier for people with mental illness and their family members to understand the link between medication and staying well.

For this reason, it is very important for family members to understand the way these drugs affect their relative, since the support of family members is often necessary to keep the person with mental illness taking medications regularly.

6.      Keep the family routine normal

Family members should keep their own routine as normal as possible to stay healthy.  Family members should not center their lives on the person with mental illness.  They should continue to work, socialize, visit with friends and do the things they enjoy doing.  People with mental illness must learn to live with their illness, and life must go on for those around them.  If this does not happen, the illness will hurt the whole family more than it should.

7.      Learn to recognize signals for help

The family must be aware of the things that seem to signal too much stress or hardship for their ill family member.  Over time, the family and the person with mental illness together will be able to identify which things simply signal your relative’s need for personal space.  To ease family tension, remember that some signals, such as your relative wanting some time alone, are not always bad.  At times they are your relative’s response to the threat of being overwhelmed.

Families have noted that the signs that point to people with schizophrenia getting sick again are usually the same as those that happened before they got sick the first time.  You and your family should make a list of these signs.  With help, people with mental illness can learn to know their own “early warning signs.”  Although these signals are different from person to person, there may be a number of warning signs that could allow someone to step in early and help the person with mental illness stay well.