How do you support an adult child who has a mental illness? How do you as a caregiver hang in there when your adult child, who so clearly needs help, refuses it? I get requests from parents and caregivers just like this every week.

Some of you reading this right now may be facing these very situations. Your adult child may be struggling with addiction, maybe it’s a severe chronic mental illness, or maybe it’s both.

I wish there was a simple three step solution. Do this, this and this and your adult child will accept the help they’re being offered. Put these five strategies in place and the rehab program they’re in, the out-patient program they’re involved with will, all of a sudden, turn things around once and for all. 

But it doesn’t work that way of course. Recovery is possible. Recovery should be the expectation. But the cold truth is recovery isn’t guaranteed. Recovery is also relative. Recovery varies for each individual depending on myriad factors – especially how chronic, how severe the mental illness is that the person is dealing with.

There is still reason to hope. There are solutions, though the road may be arduous. 

With this in mind I want to share with you an issue of the Canadian Mental Health Association BC Visions Journal: Supporting Adult Children: Helping Them Find Their Way.

You’ll find first person experiences from parents and caregivers. Like Holly Horwood, whose daughter lives with severe schizophrenia. She describes what they have gone through as a family and explains what has helped and what hasn’t. 

You’ll read about the pivotal part support groups play in the lives of caregivers. Other articles offer strategies for setting and reviewing boundaries, how to hang in there as a parent when your adult child doesn’t want help and tools to support them when they do. 

You can learn about additional resources, and communication strategies to help your adult child in this Psychology Today post: “Help Your Loved One with Mental Illness with These Resources”.

In particular look at #6 and watch Dr. Lloyd Sederer’s TEDxAlbany talk ‘When mental illness enters the family’, where he describes key steps to help someone who doesn’t want help.

Watch how my parents coped and navigated my unwillingness (or perhaps better said my inability) to accept help in my theatrical keynote (available for purchase here should you be so inclined).

If you love an adult child with a mental illness and/or substance use issue, my wish is that you realize you’re not alone and as a result feel some relief and hope and also discover some new resources for your journey.

Visions Journal is a free magazine produced by the British Columbia Division of the Canadian Mental Health Association. Electronic subscriptions are free to anyone. Print subscriptions are free to anyone in BC. The cost is $25 for a yearly subscription outside of BC. Click here for more info.

You can view past editions here.

© Victoria Maxwell



September is fast approaching. In light of this, I thought it apropos to write a post regarding accommodations for students with mental health issues in a post secondary setting. 

Creating accommodations help students who have mental illness reach their academic potential. Whether you’re advocating for yourself, or helping to advocate for someone else here are points to keep in mind.

1. Accommodations are a right, but are negotiated.

2. Determine what changes would be most effective for your specific illness or illnesses. It may take some experimentation.

3. Role-play asking for the accommodations to gain confidence before actually requesting them.

 With few exceptions, teachers and schools are very amenable and experienced in accommodating students with disabilities. As part of the American Disabilities Act and the Canadian Human Rights Act, they have an obligation to fulfill reasonable accommodations requests.

Dr. Sarah Helm, Diversity and Inclusion expert, cites “according to the National Center for Education Statistics, individuals with depression, mental, emotional, or psychiatric conditions now represent approximately 24% of college students with disabilities and have become the largest cohort of post secondary students who identify having a disability” (Helm, 2012; NCES, 2009).

Despite this, fellow students and teachers still can lack understanding, sensitivity and patience. The more comfortable you are with your mental health needs the easier it will for you to communicate with teachers. In the classroom, you are not required to disclose what illnesses or disabilities you have. But you will need to be able to discuss what accommodations will be helpful. You can, if you choose, to disclose voluntarily. But that is a decision that is very personal, and should be made carefully.

There are both informal accommodations (strategies students can implement on their own) as well as ones that are formalized through disability services on campus. Two people with the same condition may not need the need the same classroom strategies. Here are a few examples of formal accommodations:

– Due date extensions

– Time extensions on exams

– Quiet and/or alone place for taking tests

– Ability to complete work at home

– Advance notice of course expectations

– Study buddy or academic coach

– Alternative forms for assignments

– Alternative types of study resources

– Pre-arranged breaks to get fresh air and move around

Dr. Helm explains “counseling centers and disability services offices have been increasing their level of support for students with psychiatric disabilities; yet despite these existing support structures, students are not seeking assistance from disability services offices due to fear of disclosure and the negative stigma” (Collins & Mowbray, 2005; Helm, 2012).

So it is imperative students with psychiatric disabilities understand they have a right to reasonable accommodation as well as protection from discrimination stemming from stigma. Colleges need to recognize that insidious stigmatizing attitudes towards those with mental illness have subtle yet far reaching ramifications. On-going dialogues about mental health and mental illness on campuses are crucial so stigma and it’s consequences are lessened. In doing so, students can be propelled from the fear of disclosure and requesting support to the freedom of accommodation and academic success.

 An excellent resource is the Higher Education Support Toolkit: Assisting Students with Psychiatric Disabilities from Boston University Center for Psychiatric Rehabilitation.article continues after advertisement

© Victoria Maxwell


 References:

Helm, Sarah PhD Career Development Experiences and Employment Concerns of Job-Seeking Students with Psychiatric Disabilities PhD diss., University of Tennessee, 2012 http://trace.tennessee.edu/utk_graddiss/1304

National Center for Education Statistics (NCES). (2009). 2007-2008 National Postsecondary Student Aid Study (NPSAS: 08). Computed by the Data Analysis System (DAS-T) Online Version 5.0 on June 29, 2009

Collins, M. E., & Mowbray, C. T. (2005). Higher education and psychiatric disabilities: National survey of campus disability services. American Journal of Orthopsychiatry, 75 (2), 304-315.


Diagnosis doesn’t equate acceptance (as many of you well know). I certainly took my sweet time in accepting my conditions. Mental illness, particularly psychosis, wasn’t something I had been striving for in my 5-year life plan.  

Below are questions and approaches my family, psychiatrist, other health professionals and my friends could have used to help me become more aware and more accepting of what I faced.

A caveat however. If someone is experiencing a psychosis or a severe lack of insight (anosognosia*) these suggestions may not be appropriate or at the very least will need to be adapted. For tips about how to communicate with someone in a psychosis these videos might be helpful. Though neither is a psychiatrist they have good information (suggestions start at 6 minutes 48 seconds).  I don’t like his finger pointing (which you’d think he’d know isn’t a good way to communicate). Some advice and examples are a bit flip and graphic, but some information is excellent.

Another video to watch is: https://www.youtube.com/watch?v=_ss_CMUdH2U She makes an excellent point about being a ‘comforting force not a challenging force’.

Here are 10 strategies that could have helped me feel understood, empowered and more willing to investigate the treatment and help being offered:

1. I wish…someone asked me exactly why I didn’t want to accept the diagnosis. Why I didn’t want to take medication. When the reasons for resistance are shared, erroneous assumptions can be discussed, potentially corrected and new actions can take place*. E.G: I believed medication was a ‘cop-out’ and meant I was weak. I believed if I did enough therapy and got to the ‘root’ of the psychological reason I was depressed, I wouldn’t experience it anymore.

2. I wish…someone validated and empathized with me regarding my resistance to medication instead of trying to get me to see it their way. That doesn’t mean agreeing with me but it meant acknowledging my position. Arguing with me and telling me to take it only made me feel more misunderstood, and forced me more into myself.

3. I wish…someone validated and empathized with me regarding my resistance to medication instead of trying to get me to see it their way. That doesn’t mean agreeing with me but it meant acknowledging my position. Arguing with me and telling me to take it only made me feel more misunderstood, and forced me more into myself.

4. I wish…someone helped me understand the truth about mental illness, and showed me how to investigate those objections, allowing me to come to my own conclusions. That is, do some basic stigma busting with me.

5. I wish…someone asked me if I wanted to talk about my psychoses. Because I did want to talk about it. I wanted to, needed to make sense of it.

6. I wish…someone validated and explored with me the profound, life-changing spiritual elements of my psychosis. It’s important to note, not all aspects were negative and not all were meaningful. Instead, what happened was my insights and experiences were labelled as pathological and part of the illness, something to be discarded and forgotten. It wasn’t until I met my psychiatrist, Dr. Dillon, who discussed my experiences with neutrality, curiosity and compassion.

Questions like these would have helped:

  • What did I learn?
  • What was it like?
  • What happened?
  • What aspects did I want to talk about, but was afraid to? And why?
  • What am I sad about? What did I lose? What do I need to grief?
  • What am I afraid of, concerned with and how can it be addressed?
  • What am I confused about?

7. I wish…someone could have helped me integrate a medical model with a spiritual perspective sooner and explained to me that it is possible to have both a spiritual experience and a mental illness; that one does not negate the other.

8. I wish…more people praised my scepticism; it meant I was deciding things on my own and the choices I made were intrinsically motivated.

9. I wish…someone informed me sooner the severe negative and anxious feelings I was experiencing could be part of a mood disorder not just a set of emotions and low self-esteem.

10. I wish…someone had explained cognitive therapy more clearly. When I was told my thinking creates my feelings, I felt I was being blamed for my depression.

Kay Jamison states in her book ‘An Unquiet Mind’ that we don’t know why some people walk through the door of acceptance or walk through it easily and others don’t. We also don’t know when people will do it. What I know for sure is, when we meet people where they’re at, when we’re curious and respectful, it helps people feel safe. People who feel safe are more willing to take risks and try things. That’s what happened for me at least.

© Victoria Maxwell


*NAMI defines anosognosia “when…someone is unaware of their own mental health condition or they can’t perceive their condition accurately”. Click here for information about it in the context of mental illness.


Anxiety has been giving me a run for my money. Diagnosed with generalized anxiety disorder, I’m used to dealing with my uber easily triggered flight and freeze response. But in the last year anxiety has been screaming at a high pitch for long periods of time in my body and my mind. It is UNCOMFORTABLE. Side note: Having an anxiety disorder it’s rather ironic I chose to be a self-employed public speaker.

Working for myself, which consists of on-going financial uncertainty, and doing the one thing people fear more than death. However, that isn’t driving my current state of dread and sweat. Among other things, menopause has kicked me in the butt.  Since I’ve entered that oh so lovely transition, anxiety has spiked more than I’ve ever experienced it. I didn’t know anxiety was a symptom of menopause. I didn’t know a lot of things about menopause. It’s not exactly a sexy cocktail party topic. Regardless, my husband has been suffering through it with me.

Anyway…the big ‘M’ and other life ‘stuff’ has ratcheted up my adrenals and kept my system revved up for far too long. My usual wellness tools haven’t been working as effectively either. To find some relief, I signed up for a 6-week ACT group course at our local mental health and substance use centre. An ACT group. Sounds like it would be right up my alley, yes? ACT. I’m an actor (or actress depending on your preference) right? Well it’s not that kind of acting group. ACT stands for Acceptance and Commitment Therapy. It’s developed from Cognitive Behaviour Therapy (or CBT). Its basic premise is using mindfulness to become comfortable with (ie: accepting) your uncomfortable physical sensations and difficult thoughts and distressing emotions. Then use your core values to guide your actions so you can live the life you want.

What’s important to understand is that accepting them does not mean liking them. It means I give them room to ‘be’ without trying to change them. It was a mind stopper this one. Allow myself to be ok with feeling this intense anxiety? Not try to change it? Fix it? Fix me? One of the meditations recommended in the group was the 3-minute breathing space meditation. Three minutes of meditation. That I can do. At the outset it was wonderful. Each time after doing it, I felt peaceful, like a gentle parent holding me. But then weeks later, some proverbial crap hit the fan and I experienced unrelenting anxiety.

This 3-minute breathing space felt more like a 30-hour jail cell. I’d sit and immediately want out. Breathing, and allowing my anxiety, seemed only to magnify it. My heart beat faster, louder, or wait was that a skipped beat? No now all I could hear was the blood rushing in my ears and feel my stomach tighten – even more. I. AM. OFFICIALLY. GOING. CRAZY. Again!!! When the tail starting wagging the dog, and my anxiety overwhelmed me, this whole letting it be and noticing seemed like, well, a really bad idea. Until I listened to a podcast reminding me of one paramount ingredient I’d forgotten to include in my mindfulness practice.

A dear friend sent me a recording of a talk from Thich Nhat Hanh, a Vietnamese Buddhist monk and peace activist, and author of over 100 books. I’ve never been much of a fan of ‘Mr. Hanh’. Not that he isn’t wise, or walks his talk. He definitely is and he definitely does. It’s just that I’ve never quite jived with how he expressed his wisdom. Until this talk. Until, I guess, I needed it. Maybe it will help you. Using metaphor, he describes how mindfulness works. It broke open my heart and changed my practice.

Paraphrased from his dharma talk ‘You are Both Depression and Mindfulness’. This segment starts at around 18 minutes. “When depression manifests, we should invite mindfulness. The energy of mindfulness will recognize the energy of depression. There is no fighting between the two kinds of energy. Because the job of mindfulness is to just recognize things as they are. Then to embrace whatever is there in a very tender way, like a mother would embrace her child when the child suffers.” That is what got me. “The mother is working in the kitchen, but she hears the baby crying. She knows the baby suffers. She goes into the baby’s room and picks the baby up and she holds the baby tenderly in her arms. The energy of tenderness of the mother begins to penetrates into the body of the child. And after a few moments the child feels better. This also happens with the practice of mindfulness. With the practice of mindful breathing or walking we generate the energy of mindfulness. With this mindful energy we recognize the other energy (depression, anger etc.) and we can embrace the other energy with tenderness.

There’s no fighting. There’s only supporting, helping.” When I practice mindfulness, I simply watch what is going on inside of me. But instead of a clinical dispassionate watching, I add tenderness. The watching becomes an embrace of kindness. This way the sensations and thoughts are easier to stay with. A softening usually happens (not always, but often). This loving kindness I practice generating soothes those other energies within me. Like the wise ol’ Mr. Hanh said it would!

Try the 3-minute practice with the pointers from Thich Nhat Hanh yourself. Share your experience and thoughts. I always love hearing from you.

© Victoria Maxwell

Supporting a loved one with mental illness can be trying. I’ve witnessed the toll it takes on my husband. I’ve experienced it as a daughter of a mother and father who both had psychiatric conditions. A chronic mental health condition is like addiction. Even when well managed, its presence is still felt in the relationship.  

My husband has taught me a lot about what it means to support someone. With practice, I do it more and more for myself. Some I already knew, some I only discovered by being with him at my most vulnerable, my most messy.

Think psychosis. Think oozing self-loathing. Think unrelenting anxiety. I know. Yuck.

What Works

Someone who…

  1. Walks beside me on the journey
  2. Watches a movie with me
  3. Can stand my company even when I can’t
  4. Listens without fixing
  5. Listens and helps me problem solve
  6. Sets boundaries and let’s me know when he’s reached his limit
  7. Reminds me it’s ok to take my beta-blockers; that I DON’T always have to tough it out
  8. Talks with me about ‘trivial’ things that have nothing to do with how I feel
  9. Requires honesty
  10. Tells me to un-pretzel myself when I’m in my most challenging yoga pose. You know that one of navel gazing and head up my butt. It’s surprising how long I can hold that posture.
  11. Helps me name things I’m ashamed of – like when he asks ‘peeled grape’ day? Yes – that’s how I feel, frequently, more frequently than I’d like to admit.
  12. Explains naps are good medicine and gives him a break too!

What does your partner do that helps you when you’re in struggle mode?

What do you do as a partner to help your loved one?

© Victoria Maxwell



There are many reasons why people don’t accept a diagnosis of mental illness.

I received an email the other month from someone whose spouse had psychotic experiences and was later diagnosed with bipolar disorder. However, the spouse believes they had a powerful spiritual experience.

The spouse has agreed to see a psychiatrist, and continues to see their counsellor, but won’t take medication.

I’ve been in that very position, refusing both the diagnosis and medication. Understandably. The experiences I’ve had (two, quite recently) from a science approach typically are called psychosis. I like to call it non-shared reality. Regardless how you describe them, elements of these experiences are profound for me.

I’ve always had difficulty with the ‘either/or’ perspective. Either my experience is an illness as seen through the medical model OR it’s strictly a spiritual experience as seen through alternative perspectives such as the anti-psychiatry movement or transpersonal psychology.

What I experienced was more nuanced. To cavalierly categorize it as either only alienates me from potential help.

But what to do?

In my case, I encountered a brilliant psychiatrist who helped me understand what I experienced could be both. Or, more accurately, they could exist simultaneously.

I had undergone (and continue to undergo) spiritual experiences meaningful to me. While at the same time I have a mental illness that would benefit from some medical assistance.

I’ve come to understand the diagnosis of bipolar disorder, anxiety and psychosis does not diminish the importance of these personally transformative events. Mental illness and spiritual awakening are not mutually exclusive.

This was life-changing for me. It allowed me to embrace the spiritual path I held so dearly while also accepting much needed treatment for psychiatric disorders which were, in no uncertain terms, ravaging my life and relationships.

I am of the belief, for some people, we need to blend both approaches, spiritual and medical. If either one excludes or denigrates the other, it won’t be helpful. For me, the litmus test is this: does the person have the quality of life they want? Is the approach they are using causing them more suffering or less?

I wanted to be someone who didn’t need to take medications. But I’m not that kind of person. Some people don’t need to or can manage without. For me, I needed to be open to the possibility of needing meds and not needing them. I needed my support circle to be on board with that too. Or to be honest with me about any bias they had. That built trust. Trust in the end is the best bridge to help build a life worth living.

Allowing for ‘Both’ rather than forcing an ‘Either/Or’ stance made getting better, well…better. I am able to comfortably hold both my spiritual and medical model perspectives. It’s a fine line, but that’s fine with me.

The following are resources to help those of you grappling with the ‘either/or’ situation. Whether you are supporting someone who identifies only with the spiritual, even to their detriment, or for those of you given a psychiatric diagnosis and trying to reconcile it with your profound experiences, I hope these shed some light and offer insight.

1. Visions Magazine – This edition focuses on spirituality and how it related to mental illness. Visions is an award-winning magazine that brings together many views on mental health and substance use.

https://cmha.bc.ca/wp-content/uploads/2016/07/visions_sprirituality.pdf

The following I wrote or created in partnership with others. Each describe in different ways my journey integrating both a spiritual perspective and medical model approach to help my life come into balance so I could begin to flourish.

2. Bridging Science and Spirit – a 7-minute documentary https://www.youtube.com/watch?v=sXq9B9a3sOI

3. Does God* Have A Place In Psychiatric Treatment Plans? – blog

https://www.psychologytoday.com/ca/blog/crazy-life/200910/does-god-have-place-in-psychiatric-treatment-plans

Note: I use the word ‘God’ but don’t mean it in the strictly religious sense, per say. I use it interchangeably with Love, the Divine, Universe, Spirit, Goodness, what-have-you. Please replace it with what you are most comfortable with.

4. I Went Off my Meds to be More Spiritual: Spiritual Growth and Psychiatric Medication – an oxymoron?  http://victoriamaxwell.com/i-went-off-my-meds-to-be-more-spiritual/

5. Crazy for Life – My theatrical keynote (aka one-person stage show) focusing on my struggle to reconcile the mental illness diagnosis with profound spiritual experiences. In it, I describe how medication, for me at least, needs to be part of my wellness tool box. Not the only one, but one nonetheless. View a clip from the show here (watch at 1min 25sec): https://www.youtube.com/watch?v=z-CU5DaOl74&t=7s  Also available for download purchase. http://victoriamaxwell.com/product/crazy-for-life-a-story-about-accepting-help-for-mental-illness/

Have you had spiritual experiences within your mental illness? Do you think it is one or the other? I’d love to hear from you to learn about how you made sense of it.  

© Victoria Maxwell

In a previous post, I described the O.A.R.S. framework (Observe, Ask + Actively Listen, Refer + Support).  A simple protocol outlining how to approach someone in the workplace who may be struggling with a mental health condition. The 4-step system along with the ‘do’s and don’ts’ helps make difficult conversations more comfortable and effective. For a copy of a handout click here .

Besides good communication strategies, employers and co-workers need resources – resources beyond your typical EAPs (Employee Assistance Programs). Mental illness, a multi-faceted issue, needs multi-faceted solutions.

These are some workplace resources I recommend. I’ve chosen not to list the well-known and well-respected Mental Health First Aid or the Mental Health Commission of Canada’s workplace webinars. Likely you’re already aware of them. If you’re not, please do check them out.

I’ve decided to highlight ones that may not be on your radar.

Please note: I am not affiliated with any of the following organizations or individuals. I know them as reputable resources offering services and information to effectively help employers and co-workers address difficult mental health issues.

Mind: A UK based non-profit providing advice and support to empower anyone experiencing a mental health problem.  Included is a free download about how to support staff experiencing mental health problems: www.mind.org.uk/media/550657/resource4.pdf  

Visit www.mind.org.uk  to find other good resources.

 

Job Accommodation Network (JAN) is a free on-line resource that offers expert and confidential guidance on workplace accommodations and disability employment issues.

Unique to JAN is their Searchable Online Accommodation Resource (SOAR) system and their A to Z listings by disability, topic, and limitation. The databases lets users search for a specific disability (IE: anxiety disorder, ADHD) and then offers disability-specific accommodations, case studies and questions to consider. https://askjan.org/a-to-z.cfm

 

Not Myself Today: A fee-based program developed by the Canadian Mental Health Association for employers to help create mentally healthy workplaces. It’s evidence-informed, with practical solutions, focused on building understanding, reducing stigma and fostering supportive work cultures. www.NotMyselfToday.ca Visit https://cmha.ca/programs-services for other programs.

 

Mary Ann Baynton & Associates: Mary Ann Baynton and her staff offers various services to improve or resolve workplace issues related to individual or organizational mental health issues. Well-respected across Canada and beyond, she has been a pioneer in workplace mental health consulting since 2008. https://maryannbaynton.com

 

Deborah Connors offers training to develop psychologically healthy workplaces and transform culture. https://deborahconnors.com/

 

 

Hayley Peek Consulting: In partnership with Kim Sunderland, Hayley Peek offers programs that teach people how to have a supportive conversation with someone who may be struggling with a mental health challenge or illness. www.hayleypeek.com

 

Provides various free resources such as tools, training, strategies, assessments for employers, staff, managers to improve workplace mental health. https://www.workplacestrategiesformentalhealth.com/

What workplace mental health resources do you recommend? Send me your go-to websites or resources and I’ll list them in a future blog post with your suggestions.

© Victoria Maxwell

Feeling powerless over symptoms often goes with the territory when you live with mental illness. At least it can for me, particularly with anxiety and depression. This isn’t just the case for those of us diagnosed but also those who love and support us. They can feel at the mercy of these debilitating conditions when they’re at their peak.

Like a ragdoll in a tug-o-war between two kids or one in the washing machine (the ragdoll, not the kids) I can feel like I’m at the whim of my symptoms: negative self-talk, extreme fatigue, racing heartbeat, racing thoughts, incessant worry, rumination, lack of focus, aches and pains, hopelessness, emptiness – and those are just the pleasant ones. Kidding.

I enjoy feeling in charge of my mental health. Most weeks I am. But not always. Not by a long shot.

So what do I do? What can you do if you feel like this?

This is a strategy I’ve set up with my husband. It’s not a miracle solution, but it can help lessen the blows of bipolar disorder, psychosis and anxiety that I live with. It can help my husband better weather them too.

Let your loved ones help you. Enlist them into your wellness journey:

My husband knows me well. He catches signs of things shifting up or down better than (and before) I can sometimes. We all have our blind spots.

He’ll see me filling the Britta jug over the top line, or I’m getting up earlier (much earlier) than usual. Or like today, he’ll catch me making a grocery list and doing laundry at 5:00 in the morning. We’ve created a code word so to speak to signal I might be hypomanic. With kindness and enthusiasm, he’ll say ‘Oh. Spazzy Maginty is visiting us today!’

Another day, I fidget a lot in my favorite chair when we eat breakfast together. Or I won’t look him in the eyes when we talk. He might gently ask me ‘How are you doing?’ or more specifically ‘How’s your anxiety?’.

A different instance, he mentions my complexion looks grey and I’m sleeping longer than usual. Or he might recognize I haven’t run in a couple weeks. He’ll smile, look at me and ask if everything’s ok, knowing that likely it’s not.

His comments aren’t criticism but instead observation. Facts that I’ve changed from my baseline of wellness. It’s meant lovingly and delivered that way. It’s information I can use to my advantage. If I take steps to care for myself, I may prevent the anxiety, depression or hypomania from blossoming further. It’s not guaranteed, but it can reduce the intensity.

I’m not to blame for my conditions, and he’s not saying I am. I am however responsible for my health and reaching out for help when I need to.

My next steps are to be on the alert. Revisit and perhaps double up on my wellness tools. I check to make sure I’ve taken my meds and taken them properly. I’ll review and adjust my sleep patterns. Ask myself if I’m putting too much on my plate and if I need to, take things off. I’ll look at my exercise and aim to do a bit more, or do any if it’s fallen off the radar. I’ll call a friend and spend some quality time with them – phone or in person, doesn’t matter to me. As the incomparable Julie Andrews sings (sort of) these are some of my favorite (‘wellness’) things.

Ideally this will result in the levelling off of my symptoms. This isn’t rocket science. But it’s amazing how if I don’t see my warning signs early enough, and make the needed adjustment, how off course I can really go. And I’ve gone off course. Really off course in recent months. Think psychosis (twice) and major anxiety. But with the help and delicate diplomacy of my husband and my own willingness to accept assistance, getting back on more stable ground is possible.

3 Step to Help Prevent Relapse of Mental Illness

Note: Do these steps with your loved ones while you’re well, not when you’re struggling with acute symptoms.

To set the stage ask yourself:

What are your cues? Be specific. Ask your friends and loved ones to chime in about the warning signs they see. Compare notes.

Who do you want to be your ‘cue companion’? How do you want your loved ones or friends to approach you? Decide who and what’s most comfortable for you. You don’t need a husband, or even someone who lives with you. Just someone who cares.

What will your next steps be when they mention something? Have a list of your most effective wellness tools that you’re willing to commit to. Then pick one and do it. Be honest and clear about what you’re willing to do when warning signs start to rear their heads. Set yourself up for success Think tiny adjustments.

Then:

  1. When warning signs arise, your ‘cue companion’ has permission to mention what they see.
  2. Review your wellness tool list (with your loved one if you like)
  3. Take action: add, adjust said tools as needed.

Sometimes I worry, even feel ashamed at times, how much focus it takes to ‘manage’ my mental illnesses; that I might be a burden with all my mental health problems. But Gord has told me when he’s asking me about them, he wants to know. It’s ok, more than ok to talk about my mental health. Go figure?!

I’ve come to realize that this little 3-step system is as much of a sanity saver for him as it is for me.

Try this out with your loved ones and let me know how it goes. Or, if you have a similar system already in place, let me know how that works for you!

© Victoria Maxwell

Every month I receive emails from parents (just like you perhaps) of adult children who have serious mental illness. You tell me many things, but the one on which you all agree is how painful it is to see your son or daughter in anguish yet at the same time not accept help. She’s angry with you, blames you, yells at you, yet needs your help desperately. You tell me how helpless, how lost and how hopeless you feel. It is a journey of great pain. But there is also great hope. I know. My parents were on this very same journey. For 5 years, I was in and out of the hospital because of psychotic episodes. I not only refused help but refused to accept the diagnosis of bipolar disorder with psychosis and generalized anxiety disorder.

“H.O.P.E.: Hang On Pain Ends” ~ Unknown

There are myriad reasons a person refuses treatment. They can (and for me did) include: denial, anosognosia1 (ie: the inability to recognize you are ill), shame, emotional overwhelm, stigma, lack of access to good treatment, insufficient education about mental illness, fear of change and lack of skills or support to move through change.

But there are steps you as a parent or support person can take, at least initially, if you are facing this situation.  The suggestions may help you feel a little less powerless, a little less alone and a little more hopeful.

Know this: change is inevitable, recovery is possible and your adult child can get her life back; maybe not the exact life she had before she got ill, but a life worth living.

 

“Recovery is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness…(it’s developing) new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” ~ Bill Anthony

 

I’m not a parent of someone who has a mental illness. But I am someone who saw what my parents went through as I struggled to make sense of my own psychiatric disorders and find my road to recovery. (On this  previous post on my Psychology Today blog my dad offers advice to parents trying to help their adult child. This post describes strategies to help someone with a mental illness who doesn’t want help.)

This is not only your adult child’s journey, the entire family embarks on it together. Mental illness becomes a whole family condition – chaotic and frightening. You know this.

But I also know this:

  • You can do it. But you can’t do it alone.
  • You can’t change your loved one. But things will change.
  • Recovery (for the adult child AND family) is possible.

Here are seven suggestions to help make your current difficult situation a little more tenable.

7 Steps for Parents who Love an Adult Child with Mental Illness

1. Stop the power struggles with (or judgements you have) of your daughter or son.

How do you do this? Listen to what your adult child is telling you. Don’t correct her, don’t try to change her or convince her. Just listen. Summarize what you hear her saying. Just because you are listening and reflecting back what she says, does NOT mean you agree with her. It does mean you are doing everything you can to understand her and her experience.

Like anyone, someone with mental illness wants to be heard, wants to be understood. And frequently for someone with a mental illness, this doesn’t happen. Really understanding what she is feeling (ie: empathizing) can rebuild trust. It’s not easy. Believe me. But it can build bridges where bridges were previously imploded. Check Dr. Amador’s website and book (I Don’t Need Help! I’m Not Sick) for more instructions on what it means to empathize and actively listen.

2. Remind her (and yourself) you are both on the same team.

But don’t just tell her, show her. Show her by working collaboratively: listen without an agenda; partner in decision making, set boundaries when necessary. Telling your adult child what she needs, what she should do, or what YOU know will help her will only make her dig her heels in more. You’ve probably already experienced this.

3. Recognize you might not be the best person to help her.

It may not be fruitful to say you are on the same team. Sometimes there’s too much animosity, so much trust broken (on both sides) that your adult child only see you (at the moment) as an enemy. Because of the current (yet temporary) volatile nature of the relationship it may be best to find out who, if anyone, she does connect well with. Is there someone who she will listen to; who she does trust or confide in? That person needs to be someone who has her best interest at heart (obviously), not someone who enables her or aggravates the situation. For example, not a person who she drinks with or who encourages her to believe you are an interfering parent.  A close friend, a trusted Uncle, a former teacher she admires, are options.

4. Ask your adult child what she needs to feel safe.

She may not know. She may not be able or want to calm herself down in order to express what she needs. It may be about helping her learn to calm her anger. Is she willing to go to counselling , not for mental illness but to sort out some life dilemmas; to solve some issues or secure some essential basics (housing, sleep, friends). Even if she blames everyone else for her problems, you can mention counselling can be a place to talk about that. And with that, a good therapist can help her gain insight and learn problem solving skills.

5. Let her know you are there for her.

Sometimes the only thing left to do (but also the most important) is letting her know you are there and not going anywhere. When or if she wants to reach out, you’ll be there, without judgement, with love and curiosity.

The most important element for me was to know that my parents (even as I pushed them away and argued with them), loved me unconditionally, and would be there. They might not like how I was behaving, but I knew they loved who I was. Even as I refused their help there was a part of my consciousness, a part of my soul that heard them, that registered how much they cared. This is true for your son or daughter.

6. Set boundaries.

You do not need to nor should you tolerate verbal or physical abuse (nor should your adult child). You may have to say ‘I love you. I’m here if you want help, but I will not allow you to berate me (yell at me, swear at me, threaten me etc). It might be about giving her space, you taking space or telling her she’s needs to leave. Always ensure she is safe and not at risk of suicide or harming someone else.  If she is at risk, then taking her to the emergency ward (or in the worst case scenario, the calling the ambulance or police) will be necessary.

For further excellent strategies watch Dr. Lloyd Sederer’s Chief Medical Officer, NY Office of Mental Health video ‘When mental illness enters the family’. https://www.youtube.com/watch?v=NRO0-JXuFMY

7. Don’t do this on your own.

Make sure you get help for yourself. The old airplane emergency adage applies: take care of yourself first, before you help someone else. You are no good to anyone if you are overwhelmed. There are other families willing to help and talk with you. Find a support group for parents of someone with a mental illness. The expertise in those rooms is invaluable, life saving even. Check with your local mental health clinics, your doctor, your community resources and local mental health organizations (DBSA, CMHA, SSC, NAMI)2. These connect you with people who have similar challenges, link you to community resources, and offer you emotional support and encouragement. The resources and support groups are usually offered at no charge.

This path may be long. It may be arduous. But it gets better. It’s not your fault. There is help. There is hope. You are not alone.

Please email me with your own strategies and feedback about my suggestions. I’d like to put them into a future post (anonymously of course, if you wish) because there is strength in numbers and wisdom comes from diverse and multiple perspectives.

© Victoria Maxwell

  1. If you’d like more information about anosognosia please watch this video which includes a talk from Dr. Xavier Amador, an expert in the area.
  2. Depending on where you are located, check with your local Depression Bipolar Support Alliance (DBSA) or National Alliance on Mental Illness (NAMI) chapter or if you are in Canada: your Canadian Mental Health Association (CMHA) or Schizophrenia Society of Canada (SSC) branch.  The SSC helps families dealing with ALL types of mental illness.

For all the talking we’re doing, for all the well-meaning campaigns, I still believe we are woefully under-trained (or untrained for that matter) in how to effectively and comfortably talk to someone about their mental health, particularly in the workplace.

This was the focus of a workshop I facilitated at the recent, successful Working Stronger conference hosted by the Canadian Mental Health Association – Alberta provincial branch.

The heart of this annual event is to bring together leaders and staff from various sectors and companies to acquire skills and engage in dialogue to increase the psychological health of their workplaces.

I performed my “Funny, You Don’t Look Crazy” about my lived experience with mental illness and my eventual return to work. Then I led an enthusiastic group of individuals in an interactive breakout entitled: “Ready, Set, Recognize: Detecting Mental Illness and How to Help”.

To be quite frank, I was nervous. I had several years employed in the not-for-profit health sector. But my corporate experience has consisted of a two-year stint in a small company (really small – 6 people including me!). 20 years ago.

I was hired as a marketing-assistant-slash-receptionist. Heavy emphasis on the receptionist part. Well, actually, heavy emphasis on the slash part. It was my first job since getting my “sea legs” back after being in the psych ward several times over the previous 5 years. Handling conversations, let alone their phone system, was going to take courage.

I held jobs both when I was struggling and in denial of my mental illnesses and also after when I was learning to manage them. It wasn’t easy for me. I know it wasn’t easy for my bosses or co-workers either.

4 simple steps to make the conversation easy and effective.

Working with well-meaning but misguided managers, and exceptionally talented ones, I’ve learned some strategies about what works and what doesn’t when it comes to addressing mental illness in the workplace.

The result is the framework I created called: O.A.R.S. (Observe, Ask + Actively Listen, Refer and Support). A simple protocol to support an employee or co-worker who may be facing a mental health issue.

The steps of O.A.R.S. are simple, but not necessarily easy. We aren’t used to having these conversations. The only way we’ll get confident is by practice.

One solution for companies is to offer safe learning opportunities and ‘rehearsal’ time for these dialogues in low-stake/no-stake situations.  We can be as awkward and unsure as we need to be and gain experiences of success that we can take into real-world scenarios.

I call the framework the Wizard of O.A.R.S. because, well, who doesn’t like a nice play on words? (Actually, I do know several people who don’t. But that’s beside the point.) And because oars bring balance, stability and direction to a boat. Just like oars, people can give support and guidance to those around them who may be facing mental health issues.

This is not a quick fix. The steps don’t work instantaneously. They can in rare cases. But they will gradually, over time, make a difference.

Observe – Changes in behaviour, length present + document

Ask + Actively Listen – Discuss concerns in terms of behaviour, its impact + needs

 Ask open-ended questions

 Mirror + validate

 Be patient + wait

 Be curious

 Discuss impact of behavior

 Focus on collaborative problem solving + actions

Refer – To resources in the workplace and/or community

Visit my resource page to download a Mental Health Resource Guide for additional tools.

Support – Continue to communicate and encourage; find agreement + set healthy objectives

Click here to download the detailed step by step O.A.R.S. e-guide with links to a fun video of Everyone Loves Raymond using active listening!

Observe, Ask & Actively Listen, Refer and Support: the Do’s & Don’ts

Before you have a conversation with someone at work about their mental health, here are some do’s and don’ts to keep in mind.

DO…

  • Set the conversation up for success
  • Check in with yourself: is it a good day for YOU to speak to them?
  • Check in: is it a good day for THEM?
  • Play it out: where, why now, how, what will you say, what might they say, how will you respond?
  • Have the facts: make sure the facts you have are correct
  • Determine your objective
  • Focus on building trust, rapport, safety + open dialogue so they feel free to talk
  • Speak to them as early as possible
  • Document behavior changes + note impact
  • Be clear about what you need from them
  • Prepare for own internal emotional reactivity
  • Plan + prepare for resistance
  • Listen without judgement
  • Use an icebreaker

DON’T…

  • Avoid talking about impact of behavior
  • Make assumptions about the behavior or jump to conclusions
  • Interrupt
  • Minimize or dismiss feelings
  • Try to fix or offer advice
  • Enable

Please note: The O.A.R.S. framework is for non-urgent situations. If you feel the individual is at risk of harming themselves or others, immediate care should be sought at the nearest emergency ward. If the individual refuses help and is actively suicidal or at risk for harming others, the police should be called to assist. Please consult your company policies and guidelines.

Do you want to make a positive impact? Have that conversation NOW.

Effectively talking to someone who you think may be struggling with a mental health condition at work can be fiddly and unclear. As a result, managers and supervisors postpone or avoid these conversations, especially if we think the person is going to respond with resistance. Maybe we hope the issue will resolve itself. It almost invariably doesn’t though.

Sometimes individuals dealing with mental health issues aren’t ready to admit it to others or themselves. I certainly wasn’t. It’s not an easy thing to accept. The stigma of mental illness, especially in the workplace, has decreased but it still exists. This can lead people to refuse assistance or refuse to acknowledge the problems directly.

Unfortunately, if left unaddressed, behavior resulting from mental illness may cause difficulties at work and result in discipline, termination or other negative workplace consequences.

As a manager, co-worker or ally you can be proactive and discuss the behavior with the person before it escalates into discipline or termination. The earlier you speak with someone, however uneasy this may be, the higher the chance for optimal outcomes. Early conversations also offer the best opportunity to prevent a condition (if present) from escalating or becoming chronic.

Letting a person who you’re concerned about know you’re willing to listen without judgement, support them and problem solve can open the door for discussion.

This is what Liz, my boss at the marketing company did when I went to her for help. Even before that, she prepped the ground for positive interactions. From the start of my time there, she focused on building a personal rapport with me. One based on trust, respect and active listening. She was frank, firm, fair, kind and honest. When I had difficulties, I knew she was the person I could go to and receive wise counsel and fair treatment.

My experience with Liz gave me confidence that has influenced me to this day. THAT is the kind of impact you can make.

 

 

© Victoria Maxwell

Could your workplace benefit from learning how to comfortably address mental health issues? Contact Victoria to discuss the Workplace Mental Health Awareness package: a performance of ‘Funny, You Don’t Look Crazy’ followed by the ‘Ready, Set, Recognize’ workshop. You’ll learn the simple O.A.R.S. protocol to make those awkward conversations easy and effective. Contact me.