Nearly one-third of a Americans have symptoms of depression or anxiety—the two most common mental disorders in the U.S. The symptoms vary from person to person but may include:
- Feeling sad, irritable, or frustrated
- Not wanting to do activities that were enjoyable
- Difficulty sleeping or sleeping too much
- Increased or decreased appetite
- Having aches and pains
- Trouble concentrating or making decisions
- Feeling tired‚ even after sleeping well
- Feelings of guilt or worthlessness
- Thoughts of suicide or hurting yourself
Taken together, it means that those diagnosed with depression or anxiety can struggle with routine tasks, personal care, and work and childcare duties, leading to an increased need for caregiver support.
“There are many instances where someone [with a mental illness] needs a loved one to help them with practical matters as well as give them emotional support,” says Dawn Brown, national director of HelpLine Services at the National Alliance on Mental Illness (NAMI). “The success of their recovery is greatly dependent on whether they have a committed caregiver to assist and partner with them.”
Currently, fewer than half of adults with mental illnesses receive treatment, according to the latest data. Stigma is often a barrier to receiving help but there can also be excessive wait times and a lack of affordable options that make it difficult to get treatment and put more burden on caregivers.
Providing care for a loved one with depression and/or anxiety is a difficult job. These strategies can help.
Get educated
Learning about a loved one’s diagnosis from reputable sources such as NAMI, Mental Health America, or a mental health provider will help you empathize with their experience and offer informed suggestions to help them stick with their treatment plans.
Remember, people with depression and anxiety aren’t unmotivated, lazy, or trying to be difficult. They may desperately want to feel better but are unable to take steps to help themselves. Your patience and understanding is critical, though not always easy.
Being informed will also allow you to recognize when their symptoms are worsening and when they may need additional support.
Brown suggests doing some research before starting any conversation and ensuring your interactions are free of judgment and accusation. Ask open-ended questions, express your concerns and offer support.
“Do the homework and then focus on communication,” she says.
Learn the best way to comfort your loved one
A loved one experiencing depression or anxiety needs empathy and a commitment to understanding their experience, not judgment, explains Dr. Anna Lembke, psychiatrist and professor at Stanford University School of Medicine.
“A mistake that a lot of caregivers make is making suggestions based on what works for them,” Lembke says. “Saying, ‘Try this because it works for me’ is not helpful. It makes them feel ashamed. Express empathy first and then be curious and wondering about their subjective experience.”
Work to protect your relationship
Supporting a loved one with depression or anxiety can be disruptive for a relationship and caregivers may unintentionally say or do things that put the relationship at risk. In addition to considering how your behavior helps or hurts your loved one, setting boundaries can help.
“It’s always hard to set boundaries with our loved ones and very easy to convince ourselves that our vulnerable and mentally ill loved ones can’t tolerate our needs,” Lembke says. “But we need to be especially vigilant about setting boundaries [with someone who has depression or anxiety] because the nature of mental illness almost universally is a kind of self-absorption.”
Establishing boundaries for your time and the kind of care you can provide will help avoid feeling resentful about being in a caregiving role.
Implement a treatment plan
Finding the right antidepressant often requires trial and error. Studies show that about 50% of those who are prescribed selective serotonin reuptake inhibitors (SSRIs) for depression respond to the medication and it can take four weeks to determine if a medication is working.
Caregivers might provide transportation to doctor’s appointments, fill prescriptions, set medication reminders and encourage their commitment to treatment. Your insights about how your loved one is responding to their medication is also valuable.
“The psychiatrist just sees one small slice of that patient in our office and it’s just what they tell us,” Lembke says. “There have been so many times in my career when a patient presented one way in the office and was totally different in the rest of their lives.”
Health Insurance Portability and Accountability Act (HIPAA) rules don’t prevent you from sharing information with the psychiatrist or therapist and it might warrant a call if you notice that a medication isn’t working or a medication that once worked no longer seems to be effective.
You can also talk to the psychiatrist about alternative treatments. New research is exploring whether a blood test that identifies biomarkers could help doctors determine the best antidepressant medications. Psychedelic drugs like psilocybin have also shown promise for treating major depression.
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Take a team approach
Depression and anxiety are chronic and episodic and the kinds of support required can vary over time, depending on your loved one’s specific diagnosis and level of disability, says Carrie Ditzel, Ph.D., director of neuropsychology at Baker Street Behavioral Health.
Your role is not to step in and take over, she adds. Instead, work together to create a plan to manage tasks that would be most helpful to your loved one. Your role as a caregiver could range from managing finances, making medical appointments and filling prescriptions to preparing meals.
Tackle paperwork
Ask your loved one if they’ll sign a HIPAA authorization. The document allows their healthcare providers to share vital details about their diagnosis and medication regimen, so you can attend healthcare appointments as an ally and help them stick to their treatment plan.
During acute periods in a mental illness, you may need to take a more active caregiving role and, in extreme cases, seek legal guardianship to take over managing their basic needs.
“There is a legal instrument called an advanced directive that you can work with them to develop so that they can have input into what decisions are made at a time when they’re not able to make those decisions,” adds Brown.
Create an emergency plan
You need an emergency plan before your loved one experiences a mental health crisis. Caregivers should have a list of emergency contacts, including local hospitals, mental health services and mobile crisis teams, stored in their r phones, says Brown.
It’s also a good idea to have a one-page document that lists all of your loved one’s healthcare providers, medications and short health histories that can be handed to police, mobile crisis teams or emergency room staff in case of emergencies, she adds.
During an emergency, dial 988, a free crisis lifeline for mental health support, to get referrals for local mental health providers. Dhaval Desai MD, director of hospital medicine at Emory Saint Joseph’s Hospital and author of Burning out on the COVID Front Lines notes that there are ways to navigate mental health emergencies as an outpatient, going to the hospital emergency room is also an option. The ER has a team of doctors who can provide immediate care.
“If you feel like this person’s imminent threat to themselves and you have no other way to protect them, call 911 or get them to ER,” he adds.
Engage your employer
A lack of paid leave is a significant issue facing caregivers, according to Meredith Hughes, assistant professor and a senior policy analyst at the Pitt Health Policy Institute at the University of Pittsburgh. More than 60% of caregivers work full-or part-time in addition to their unpaid caregiving duties—but there are efforts to better support caregivers.
Some workplaces offer unpaid leave through the Family and Medical Leave Act but a growing number of companies recognize the financial strain associated with caregiving and offer additional leave, often paid, in addition to the leave offered to caregivers through FMLA, according to a new report.
Caregivers should review their employer’s FMLA policies and ask about informal workplace policies, like flexible scheduling, that could make it easier to provide caregiving support to loved ones with a mental illness.
Seek out resources
- For information about state and local prescription programs, contact your state Medicaid office or use the Medicine Assistance Tool to find out about medication assistance programs offered by pharma companies.
- Brown also encourages those caring for a loved one with a mental illness to seek peer support, noting, “The scarcity of mental health resources, particularly the ones offered on the community level or funded by Medicaid, are so scarce that you have no what resources are available, what your rights are or what services you may be entitled to. Your peers who have traveled that path can tell you.”
- Peers can also empathize and offer hope, which is particularly important because caregivers who provide care for those with mental illness have higher rates of mental health issues than the general population due to the stress of their roles.
Ask for help
Caregiving can take a toll on your mental health and could put you at increased risk of depression and anxiety. Desai believes the “oxygen mask theory” applies to caregivers too, explaining, “You have to take care of yourself before you can take care of someone else.”
Making an appointment with a therapist to develop healthy coping strategies is a good idea for caregivers, according to Desai. It’s also important to set boundaries to prioritize your mental health and avoid feeling resentful about your caregiving role. Boundaries could include prioritizing sleep, healthy meals and workouts or waiting to respond to voicemails or text messages (assuming it’s not a mental health emergency).
“People with mental illness often don’t have the cognitive ability or emotional bandwidth to think of other people,” Lembke says. “It’s especially important to remind them of that in a gentle and caring way before we become resentful and rageful about it.”
Prioritize self-care
Burnout is a major issue for caregivers. Feelings of resentment or depression or forgoing medical appointments, skipping exercise, cancelling plans or ignoring self-care are all potential signs of burnout. Seeking counseling can be a helpful tool, Ditzel says.
Research also shows that self-care practices like seeking social support and engaging in religious and spiritual practices were linked to lower levels of stress and burden among those caring for loved ones with mental illness.
When caring for a loved one with a mental illness, Ditzel believes that the most important thing a caregiver can do is focus on the process, not the outcome.
“Remind yourself that’s an illness [and] decide how you are able to support them and then feel good about doing it,” she advises. “You’re going to navigate the journey in a different way than you would if you feel like you can save them.”
