BC Partners for Mental Health and Addictions Information and the BC Schizophrenia Society gratefully acknowledge the many family members and volunteers who assisted in the development of this handbook while providing care for their loved ones.

This guide also references The Workshop Manual by TEC Network of Pennsylvania. The original handbook was developed by the Schizophrenia Society of Ontario Schizophrenia Information & Family Support Centre in Hamilton, Ontario.

“A Guide for Spouses of Partners with Serious Mental Illness.” ©2004 (Updated 2018) BC Partners for Mental Health and Addictions Information. Permission is granted to reproduce this material for non-profit educational purposes. Updates have been completed by the BC Schizophrenia Society.

BC Mental Health and Substance Use Services, a PHSA agency, provided funding for this project.

Whatever you are feeling about your spouse’s mental illness, know that all feelings are acceptable. Feelings are natural human reactions like sweating or blushing. While you can’t control how you feel, you can make decisions about how to cope with your feelings.

Feelings do not have to control your actions

It’s not what you feel but what you do with that feeling that can make a difference in a situation.

How to deal with other people’s feelings

Other people may have strong emotional responses to your spouse’s mental illness, particularly other family members. Sometimes their reactions may be based on a lack of understanding about the mental illness.

Try not to judge feelings

Remember that all feelings are acceptable, and feelings are neither right nor wrong. You can’t change how someone feels, but you can help them to understand the situation better.

Be extremely patient with yourself in trying not to judge other people’s feelings. It is very difficult to give others permission to have feelings that differ from our own or make us uncomfortable.

Before you can acquire the techniques and skills for coping with your spouse’s mental illness, you need a better understanding of what your spouse is experiencing. Imagine the following:

YOU are so tired that you just don’t have the energy to take a shower.

• Would a “pep talk” give you more energy?
• Would nagging or threats make you feel better?
• What might you do?

YOUR mind keeps wandering no matter how hard you try to concentrate on what your spouse is saying.

• How would you feel?
• What might you do?

YOU can’t stand to be around your children. Everything they say and do irritates you and you can’t help snapping at them.

• How would you cope with your irritability?
• Once you’re feeling better, how would the memory of your behaviour towards your children make you feel?

YOU feel wonderful and just bursting with energy, but your spouse keeps nagging you to take medication that will slow you down and take away those feelings.

• What would you do?
• How would you feel towards your spouse?

YOU have been told you have a mental illness.

• What would you do?
• How would you feel?
• Possible reactions may include:
  • Withdrawing from other people
  • Denial – “There is nothing wrong with me”
  • Trying to cope by using alcohol or drugs
  • Blaming others – “You’re the one that’s crazy”
  • Spending money on things that make you feel better temporarily
  • Abandoning old interests or anything that reminds you of your life before the mental illness

The medication dilemma

• Did YOU ever not finish medication that was prescribed for you?
• Did YOU ever have medication that made you feel sick to your stomach? Did you continue to take it?
• Did YOU ever feel drugged or controlled by the medication you were taking? What did you do?
• Did YOU ever take a medication that did not make you feel better? What did you do? How do you think it would have felt if people had insisted that you continue taking that medication?

Answering these questions as honestly as you can will give you some idea of how your spouse might feel at times. Remembering these feelings will make it easier to understand their feelings and behaviour. This doesn’t mean that you can’t encourage and support your spouse to take their medication, but it helps to be aware of their perspective.

Sometimes people with mental illness don’t take their medication because they are not aware they are ill. Lack of insight into their mental illness, known as anosognosia, is a common symptom of mental illnesses like schizophrenia or bipolar disorder.

Imagine being told to take medication for an illness you do not think you have.

• What would your reaction be?
• How would you feel?

Talk to your spouse’s doctor if you are concerned they might be experiencing anosognosia.

Acknowledge the mental illness

For many spouses, the key to living with the illness is being able to ACKNOWLEDGE that their partner has a mental illness, a medical condition that involves behavioural symptoms. This means that, at times, they have little or no control over behavioural symptoms, even during treatment.

Acknowledging the illness does NOT necessarily mean that you accept the illness. For most people, coming to accept a loved one’s mental illness is a process that can take years and involves going through many different emotional reactions. It is not uncommon for a person to experience a series of reactions similar to the process one goes through when grieving the loss of a loved one. This process is outlined in the next section.

Once you have acknowledged that your spouse has a mental illness, you may find it helpful to learn more about the mental illness and how it affects people. This can help you understand when to attribute your spouse’s behaviour to the mental illness. Here are some places to start looking for more information:

• read books and other printed material
• visit websites (i.e. heretohelp.bc.ca, bcss.org)
• watch documentaries about mental illness
• attend educational or family training programs
• join support groups (i.e. those run by B.C. Schizophrenia Society or other Schizophrenia Societies in Canada, National Alliance on Mental Illness in the U.S.)

Make it your responsibility to learn as much as you can about the mental illness.

It is important to learn effective ways of asking for information from your spouse, the professional treating them, or their treatment team (i.e. physician, nurse, case manager, social worker). Be specific about what you need to know and why it is important to you.

Identify which symptoms of the diagnosed mental illness apply to your spouse, such as:

• disturbed sleep patterns
• unusual eating habits
• decreased sexual desire – withdrawal
• increased sexual desire – mania
• loss of interest in social activities
• financial mismanagement

If your spouse is displaying violent or severely disruptive behaviour, recognize that you should NOT tolerate this kind of behaviour even if you attribute it to the mental illness.

Example

You may accept that your spouse’s insomnia is a symptom of the mental illness, but you do not have to tolerate them keeping you up at night.

Approaches to coping with mental illness

Once you have acknowledged the presence of a mental illness, another challenge is learning to cope with it. Here are three different approaches to coping:

1. Avoidance

Always avoiding your spouse, avoiding conflict with your spouse or avoiding any painful feelings associated with your spouse. This approach may bring short-term relief, but it usually does not resolve issues and may create other problems, such as:

• Staying away from home
• Giving in to your spouse
• Compulsive behaviour such as substance abuse, workaholism, etc.

2. Co-dependency

Constantly trying to rescue and/or control your spouse. This approach may be comfortable at first, but usually leads to frustration, anger and a sense of being defeated and unappreciated:

• Believing you have the power to save your spouse from the mental illness – always putting your spouse’s needs ahead of your own
• Nagging
• Losing touch with yourself and your own needs
• Taking over all responsibilities when it is not necessary

3. Balancing your needs and your spouse’s needs

This means separating your needs/responsibilities from your spouse’s needs/responsibilities and knowing when to put your needs first. This approach is best for everyone in the long term, although it may be difficult and requires self-discipline:

• Do not do things for your spouse that they can do.
• Set limits on any of your spouse’s behaviours that you can’t or should not tolerate.

Take care of yourself, and go to activities that are important to you even when your spouse does not support you doing so.

Coming to terms with a spouse’s mental illness takes time. It is common to experience feelings of loss for the life you imagined and you may find yourself going through a process of grieving before you can accept what has happened. The five stages of grief outlined by Elizabeth Kübler-Ross describe how people move through different stages as they come to terms with a loss. It is important to note that everyone handles grief differently and these stages may not match with your experience.

Denial & shock

Denial and shock are common initial reactions that help people cope by numbing their emotions. Sometimes people deny the reality of a situation as a defence mechanism against overwhelming emotions.“It can’t be true!! I don’t believe it!! That wouldn’t happen to us!!”

Anger

Following denial, a person may express intense feelings of anger at the unfairness of the situation. This anger may be directed towards other people or unrelated situations.“Why me? Why did this have to happen to my spouse?”

Bargaining

In an effort to change the situation, a person may attempt to bargain with a higher power or consider what they could do differently to “fix” their spouse.“If we spend enough money on the best doctor, my husband will get better.” “I’ll try to spend all my free time with her to get her back to the way she was.”

Depression

As potential impacts of the situation set in, it can bring feelings of sadness and loss. This may include:

• Reflection on past losses: “My spouse has lost so much… her career, her self-esteem and many of her old friends. I’ve lost a lot too … some of my friends, my ability to be the parent I wanted to be, my sense of self.”
• Anticipation of impending losses: “My spouse may never be the same. He may not be the kind of husband and father I thought he’d be. Marriage is going to be different than what I expected.”
• Guilt: “If I would have done some things differently, maybe this would not be happening.”
• Damaged self-esteem: “Why did I choose this person?” “How could I have let things get this out of control?”

Acceptance

When a person comes to accept that their spouse has a mental illness, they are able to learn to cope with the new “normal.”

• “I’ve been in shock, enraged, guilty, depressed and even hopeless since I learned my spouse has a mental illness. Lately, I’ve been feeling better.”
• “I’m not happy about what’s happened, and I’m still hopeful of a cure, but I’m getting on with my own life. My old interests are returning, and I’m taking better care of myself and the children.”

Good communication skills will help you and your spouse work through challenges that arise. Even at the best of times, it can be difficult to discuss sensitive topics and request your spouse to change their behaviour. Communicating can become even more challenging when your spouse has a mental illness because their ability to think clearly or concentrate on the conversation may be affected.

Practice making requests in a way that is effective and respectful:

• Be assertive.
• Be clear in your mind exactly what you want and from whom i.e. spouse, psychiatrist, family physician, therapist, etc.
• Make an effort to develop clear and open communication in your relationship.
• Be realistic and reasonable.
  i.e. Don’t expect a very shy person to attend a social occasion when they are not well.
• Decide if what you want is likely to be productive.
  i.e. Your spouse agrees to attend a social outing even when they are experiencing a lot of symptoms. Do the potential risks outweigh the potential benefits?

When you have a realistic, reasonable and productive request to make, try the following suggestions when you make your request:

• Make your request when both of you are calm and not distracted.
• Limit your request to one specific issue.
• Be clear and specific about what you are asking.
• Make eye contact if you are face to face.

Try to use the following steps when making a request of your spouse:

• State what you would like the person to do. The more specific you can be, the less chance there is that the other person will misunderstand or misinterpret your request.
• State how the other person’s behaviour is affecting you.
• Say what it means to you or why it is important to you if the other person complies with your request.
  i.e. “I just need you to listen to me blow off steam about what has been going on at home. I feel hurt and angry when I try to talk about my experiences and you change the subject or give advice. It would really be a big help to me if you could listen and try to understand what I have been going through.”

Use “I” messages

When making your request, use “I messages”, not “you” statements. The “I message” is a basic communication tool that can be used to express negative feelings or make a request without coming across as accusatory or judgemental. It clearly communicates your needs to your spouse and expresses how their behaviour is affecting you.

The “I message” works like this:

I _____________________, when you ___________________.

Examples:

• “I feel relieved when you take your medication.”
• “I get scared when you raise your voice.”
• “I worry when you come home late.”

Prepare for negative reactions

Don’t expect the other person to be happy or comfortable about your assertiveness. If this is something new for you, it may take some time for them to get used to this type of communication. Expect that you may get some negative reactions in response to your request, for example:

• Threats
• Accusations of being demanding or pushy
• Attempts to evoke guilt or shame
• Attempts to change the subject

Remember that you have decided that your request is reasonable and important to you. Remain calm and firm if you encounter a negative reaction. Do not judge or try to change the other person’s negative reaction. You could say, “I’m sorry you feel that way, but I think what I am asking you to do is reasonable and it would mean a lot to me if you would do it. I’m not going to argue about it.”

If the other person changes the subject, re-focus the conversation back to your request.

Example:

• “I’ll be glad to talk about that later, but first I would like to finish discussing what we were talking about.”

The importance of listening

Good listening skills are critical to good communication. Listening attentively to your spouse will help you to better understand their thoughts, feelings and concerns which will enable you to work together to solve problems. Listening involves paying attention to the other person while they are speaking and ensuring that you understand the message they are trying to communicate.

To listen effectively when your spouse is talking, try to do the following:

• Look at them while they are talking.
• Focus your attention on what they are saying, try to remove or ignore any distractions.
• Indicate to your spouse that you are listening through verbal and non-verbal responses (e.g., Nod your head, say “Uh-huh”).
• Ask clarifying questions if you don’t understand their message. Identify areas where you need more information.
• Clarify what you’ve heard by paraphrasing or summarizing what your spouse said.

Communicating with others

Other people may have questions about your spouse’s mental illness. Here are some suggestions to keep in mind when communicating with others about the mental illness:

• Before talking to others about the mental illness, assume they may be uncomfortable and unknowledgeable.
• Be selective about whom you talk to. Don’t choose people who are defensive unless you have no choice.
• Keep the conversation short and contained.
• Be matter-of-fact, as if you were talking about any illness.
• Find out what they know about the mental illness, correct any false ideas and fill in any information gaps.

Be honest about your feelings and what dealing with the illness has been like FOR YOU.

Solving or managing problems effectively requires approaching them strategically:

• Identify one problem to work on at a time.
• Learn from mistakes and abandon solutions that do not work. Keep trying new approaches to the problem.
• Use flexible and creative thinking in looking at options.
• Stay open to suggestions from others.

Identifying the problem

Define the problem before trying to tackle it:

• Try to work on one problem at a time. Start with the most urgent or the simplest problem and focus on that problem only. Try to put other problems aside until later.
• Be specific about your one problem. The more specific you can be in stating a problem, the easier it is to address. Vague or general problems are usually impossible to solve.
  i.e., rather than say, “My partner is up all night,” say, “My partner plays the TV too loud for us to sleep at night.”

POW problem-solving formula

Once you have selected one specific problem, use the P.O.W. formula on it:

• “P” for past experience: List everything you and others have tried to solve the problem. Cross out any at­tempted solutions that have not worked at all after a fair trial, and stop using them!
• “O” for options: List every idea you and others can think of for solving the problem. Be creative! Circle your favourite idea. Be sure to clarify with each person involved what exactly it is that you want them to do to carry out the plan. Now try it!
• “W” for what-if: Check your second favourite idea and use it as a backup plan if your first choice becomes impossible or does not work. Having a backup plan prevents you from feeling helpless if your first plan fails.

Behaviours that should not be tolerated

Violent or destructive behaviours should not be tolerated, even if they are part of the mental illness. The following are examples of behaviours that should not be tolerated:

• Physical abuse
• Clear emotional abuse
• Sexual abuse
• Destruction of property i.e. punching holes in the walls
• Setting fires or creating fire hazards i.e.:
  • Smoking in bed
  • Stealing
  • Illegal drug use
• Financial mismanagement i.e. spending sprees
• Severely disruptive or controlling behaviours i.e.
  • Insisting all family members eat only certain foods
  • refusing to let anyone use the phone.

Allowing yourself or other members of your family to become a victim of any of these behaviours poses danger and creates an extremely stressful atmosphere for the entire family, including the person with mental illness.

Behaviours that are typical symptoms of mental illness

Trying to stop any of the following behaviours in someone with a mental illness can be like trying to stop someone with a cold from sneezing:

• Periodic departure from normal eating habits
• Unusual sleep/wake cycles i.e. Sleeping all day and staying up all night
• Delusions or disordered thinking
• Hallucinations
• Withdrawal to a quiet, private place
• Inappropriate social behaviour
• Compulsive rituals

The reasons for these behaviours are much more complicated than a person trying to manipulate others. They are symptoms of their mental illness or attempts to cope with their symptoms. It is very unlikely that your spouse will be able to stop these behaviours upon request.

Even if a behaviour is a symptom or an attempt to cope with a symptom, you do not have to tolerate it if it is destructive or severely disruptive, or if it is causing harm to someone else in the household. For example:

• You should not tolerate your spouse’s excessive drinking which often leads to abuse, even though drinking is their way of coping with their depression.
• You do not have to tolerate your spouse discussing their delusions if this is distressing to your children, even if discussing their delusions helps them cope.

For people with schizoaffective disorder or bipolar disorder, symptoms of mania can cause them to engage in destructive behaviours that may be extremely harmful to themselves and/or others. Both schizoaffective disorder and bipolar disorder typically involve swings in mood from depression to mania. During an episode of mania, feelings of euphoria or irritability combined with an increase in energy may cause a person to engage in harmful behaviours without consideration of safety or potential consequences. For example, they may display irresponsible sexual activity or reckless spending.

If your spouse experiences episodes of mania that cause them to act destructively, you may need to make difficult decisions about what you are willing to tolerate and how to set limits on their destructive behaviours.

Your spouse may not be able to control their symptoms, but they can control their reactions to them.

The following suggestions may be helpful if some of your spouse’s behaviours are not destructive but are annoying:

• Adjust your expectations. i.e. If your spouse refuses to go out socially, try to get comfortable with the idea of going alone.
• Do something that makes the behaviour more tolerable. i.e. If your spouse stays up all night, develop a plan for avoiding disrupting the rest of the family.

If you decide you should not or cannot tolerate a particular behaviour, you need to use limit-setting. You have the right to take care of yourself and your children.

Limit setting

What is limit-setting?

Limit setting can be thought of as taking measures to protect yourself or your children from unacceptable behaviour from your spouse.

When do you use limit-setting?

Use limit setting for any of the destructive or severely disruptive behaviours listed at the beginning of this section. You can also use limit setting for any behaviour you have tried to tolerate but just can’t.

What can you expect when you use limit-setting?

• Your spouse will probably get angry.
• Your spouse will test your limit-setting skills.
• You may have your own emotional reactions, like sadness or anger at having to set limits. It can feel like being a parent to the person who used to be your partner.
• You cannot expect that you have the power to control your spouse’s behaviour. This unrealistic expectation will only leave you feeling defeated, angry and frustrated.
  i.e. You can set limits on your spouse’s cigarette smoking in the house, but you will not be able to stop them from smoking.

How do you set limits as a partner?

1. Pick ONE problem behaviour. Be as specific as possible about the problem behaviour. i.e. Instead of saying, “He’s lazy”, define the problem as “He never picks up his clothes.” It is impossible to set limits on laziness, but it is possible to set limits on someone who does not clean up after themselves. Be specific about what you will and will not tolerate regarding that specific problem behaviour. i.e. You will tolerate your spouse watching TV late at night when they can’t sleep, as long as they watch it in a separate room and keep the volume low enough to avoid disturbing others.
2. Think of a consequence that meets the following conditions:
   1. The reason for selecting a particular consequence should be to protect yourself and/or the children. i.e. When your spouse goes off their medication, either they have to leave, or you will leave until you have proof that they are back on it. Though you would like your spouse to continue taking their medication, the primary motivation is protection from the abusive behaviour that happens when they are off medication.
   2. It will be possible for you to carry out this consequence when your spouse tests you. Remember, drastic consequences are very tough to carry out. i.e. Threatening to leave.
3. Inform your spouse of what you will and will not tolerate, as well as the consequences for the intolerable behaviour, preferably when you are BOTH emotionally calm.
4. Emphasize to your spouse that you know you cannot control their behaviour but must take measures to protect yourself and/or the children.
5. Answer your spouse’s questions to clarify the plan, NOT to defend or argue about it (un­less part of your plan is to negotiate it with your spouse before you decide on a final plan).
6. Consistently check whether your spouse is behaving within the tolerable limits you explained to them.
7. Make every effort to consistently carry out the consequences you explained to your spouse whenever they exceed the limits of what you said you would tolerate. Consistently and successfully carrying out your plan will make your spouse more likely to be respectful and responsive next time you set limits.

What can you do to manage violent or disruptive behaviour?

When you and your spouse are BOTH calm, explain to them what kinds of behaviours you will not tolerate, and the specific consequences that you and other family members have decided and agreed upon for specific violent or disruptive behaviours.

Example: “Next time you threaten to harm any of us, the police will be called.”

Get to know and recognize signs that your spouse is becoming violent or disruptive. Your own uneasiness or fear is usually an indicator.

Tell your spouse that their behaviour is scaring or upsetting you. This feedback can defuse the situation, but proceed with the next suggestion if it does not. Saying you are scared does not mean you act scared.

If you and other family members have made a plan for dealing with a particular behaviour, now is the time to carry out the consequences. If you have not already warned your spouse of the consequences when they were calm, use your judgment and past experience to decide whether to warn them or to just go ahead with the plan without saying anything.

Give your spouse plenty of space, both physical and emotional. Never corner a person who is agitated. Verbal threats or hostile remarks constitute emotional cornering and should be avoided.

Give yourself an easy exit and leave the scene immediately if they are scaring you or becoming violent.

It is sometimes helpful to call other people from outside your home. Describe what has happened and ask two or more people to pay a visit to your spouse. Just bringing in other people, particularly the police, can quickly defuse the situation. It also sends a clear message that there are consequences for losing control. If you send the police, make sure they understand that your spouse has a mental illness.

If you, or someone else, has witnessed your spouse committing a violent or dangerous act and your spouse refuses treatment, the police may be able to intervene. Under the BC Mental Health Act, police can intervene in certain circumstances to take a person to be evaluated by a physician for involuntary admission. The evaluating physician will decide whether or not your spouse should be involuntarily admitted to the hospital for treatment based on specific criteria.

Criteria for involuntary admission

According to the BC Mental Health Act, four criteria must be met before a person will be involuntarily admitted to hospital:

• The person is suffering from a mental disorder that seriously impairs the person’s ability to react appropriately to his or her environment or to associate with others.
• The person requires psychiatric assessment in or through a designated facility (such as a hospital).
• The person requires care, supervision and control in or through a designated facility to prevent the person’s substantial mental or physical deterioration or for the person’s protection or the protection of others.
• The person is not suitable as a voluntary patient.

– Guide to the Mental Health Act, Ministry of Health

If the physician decides your spouse meets these criteria, they will complete a medical certificate that allows your spouse to be admitted for a 48-hour period. Two medical certificates by different physicians are required for hospitali­zation beyond 48 hours.

What you should NOT do

Do not try to ignore violent or disruptive behaviour. Ignoring the behaviour may cause your spouse to believe that this kind of behaviour is acceptable and repeatable.

Do not give your spouse what they want if they are trying to get it through bullying you. Giving in only reinforces this behaviour and makes it likely that they will use it again. ONLY give in if it is the only way out of a dangerous situation.

Do not try to lecture or reason with your spouse when they are agitated or losing control.

Never be alone with someone you fear.

Example: Do not drive them to the hospital by yourself.

Managing self-destructive behaviour

Mental illness is a major risk factor for suicide, therefore it is important to be aware of warning signs that your spouse may be thinking about harming themselves.

Remember your limitations:

Nobody has the power to make a person attempt or commit suicide. Also, nobody has the power to stop a person if they really want to end their life.

Recognizing warning signs:

The following are warning signs that a person may be at risk of suicide.

• Exhibits feelings of worthlessness
• Expresses hopelessness about the future
• Perceives life as unbearable
• Expresses a sense of powerlessness to change their situation
• Experiences hallucinations or delusions that encourage them to harm themselves or convince them that they are immune to harm
• Neglects their physical appearance and personal welfare
• Withdraws from other people and activities
  Displays a sudden lack of motivation in their usual role at work, school or home
• Exhibits sudden changes in mood from severe depression to inexplicable happiness
• Feels indestructible in a manic or delusional state
• Talks about suicide or makes suicide threats i.e. “Everyone would be better off without me”
• Has made previous suicide attempts or engages in other self-destructive behaviours i.e. cutting
• Has access to lethal means i.e. weapons or pills
• Has a specific plan for how they would commit suicide – the more specific the plan, the higher the risk
• Makes “goodbye” gestures such as making a will or giving away favourite possessions

What to do if you suspect someone is suicidal

If you suspect your spouse may be suicidal, try to talk to them about it.

Ask: “Are you thinking about killing yourself?” You will not be putting ideas in their head by asking this question. Most people who are thinking about suicide are willing to talk about it.

Ask: “Do you have a plan?” and, “Have you taken any steps to carry it out?”

Show interest and understanding:

• Statements like: “You should appreciate how lucky you are!” or “But you have everything to live for!” can make your spouse feel guiltier, worthless or misunderstood.
• Remain available to talk. Try not to turn off the discussion.
• Try to remain calm.

Stay with them or ask someone else to stay with them and contact a mental health professional, suicide prevention worker or police.

Get professional help, even if they have sworn you to secrecy or claimed they will get help. Petition for an involuntary commitment if:

• They have made self-destructive acts.
• You have any doubt that they will seek help for themselves.

Even if you suspect the suicidal threat is manipulative, getting a professional involved is important for three reasons:

• It will show your spouse that there are serious consequences for this way of trying to get what they want.
• Even non-serious attempts can end in death or serious injury by mistake.
• If anything unfortunate does happen, you will not be burdened with the guilt that you didn’t seek professional help.

Do your best to remove anything they could use to harm themselves from your home.

Examples: Pills, razor blades, knives, or guns.

When your spouse has a mental illness, you may encounter challenges with household finances. Your spouse’s mental illness may affect their ability to get or maintain employment due to symptoms of their mental illness, periods of hospitalization or stigma. If your spouse is unable to work due to their mental illness, your family may experience financial difficulties. Other common challenges you may face include increased medical expenses or financial mismanagement. This section offers suggestions for managing these challenges.

Disclosing mental illness at work

It is a good idea for you and your spouse to discuss whether to disclose their mental illness with current or future employers and when to make such a disclosure. Informing employers of their mental illness can have both advantages and disadvantages.

Points to consider if your spouse has a choice about disclosing their mental illness:

• No disclosure about the mental illness is usually better than minimal disclosure. This runs the risk that the employer will make assumptions about the situation.
• Disclosure before hiring can decrease the chances of getting the job due to stigma.
• There may be advantages to waiting until after they have been hired to inform their employer.

Potential advantages to disclosing once your spouse is hired:

• No need for secrecy.
• Greater likelihood that the job will be held during hospitalizations.
• Co-workers can inform you and your spouse when they see warning signs of relapse.
• Employers and co-workers may be more supportive and make fewer demands.
• It will clarify your spouse’s mental illness and make employers and co-workers more likely to trust them. They will probably sense something is wrong without being told.

Potential disadvantages to disclosing:

• Employers and co-workers may overreact to spouse’s normal anger or “bad days”.
• Increased risk of being “laid off”.
• Increased risk of being stigmatized by employer and co-workers.

Here are some tips you and your spouse can use for speaking with an employer or co-worker about the mental illness:

• Arrange a time when you will both have uninterrupted time and privacy.
• Choose your wording carefully.
• Answer questions in a straightforward manner, drawing analogies to diabetes or high blood pressure.

Hospitalization due to mental illness disrupts a person’s ability to work and can be a major obstacle to maintaining employment. The following are suggestions for dealing with an employer once a hospitalization due to a mental illness has occurred:

• Employers will probably feel more reassured if they hear directly from your spouse.
• You or your spouse can tell the employer that there has been a hospitalization, they are being evaluated and the employer will be notified as soon as it is clear what will happen and how soon they can return to work. Don’t say much else until the facts are known.
• If the employer or co-workers want to send something to your spouse, ask them to send cards or flowers to the home.

Maintaining household income

It can be challenging for someone with a mental illness to maintain employment. Symptoms may make it difficult for them to work and frequent hospitalizations may disrupt employment.

Here are some tips for financially surviving your spouse’s unemployment:

1. Assess whether your spouse is really too ill to work.

• If you are not convinced, it may be helpful to learn more about the condition by talking to the treating professionals i.e. physician, psychiatrist, nurse, social worker, case manager, or reading more about the illness.
• If you are unable to understand your spouse’s problems with employment as illness-related, you will probably be paralyzed with resentment.

2. If your spouse is unable to get or keep a job due to their mental illness, consider asking them to apply for financial assistance from the government. Your spouse may qualify for Canada Pension Plan disability benefits or provincial disability benefits. Generally, a person is considered disabled under the Canada Pension Plan if they have a physical or mental disability that is both severe and prolonged and prevents them from working on a regular basis.If you decide that you would like your spouse to pursue government assistance, find out which type of assistance would be the most appropriate. Then make a firm “I message” statement to them about your desire that they apply for financial assistance. You can support them in the application process:

• Offer to go with them when they apply.
• Offer to call the appropriate office well in advance of the appointment to find out exactly what you need to bring and what you can expect.

Learn more about available government assistance:

• Canada Pension Plan Disability Benefit
• BC Employment and Assistance Program for Persons with Disabilities

You and/or your spouse may be eligible for a credit on your tax return through the Disability Tax Credit. To learn more, contact the Canada Revenue Agency or visit the Government of Canada website.

3. If your spouse is not eligible or refuses to apply for government assistance, take a hard look at the reality of your situation and your priorities.

• If you are not already employed, would you consider getting a job to help with the family finances?
• If you are already employed, would you consider looking for a better-paying position?
• What are you willing to sacrifice to lower expenses
• Could your spouse do temporary work to help generate income?
• Would you consider borrowing money?
• Would marital separation or leaving the marriage help or hurt your financial situation?

Managing medical expenses

If your spouse loses a job or their employer drops employee medical benefits, ask your spouse to convert the group policy to an individual or family policy. Do this during the “grace period” because there will be no physical exams and no questions asked. Although you will have to pay for the benefits, you will not lose them.

Ask your spouse to check if their employer has, or is willing to get, a waiver from the medical insurance company so that coverage will not be withheld due to pre-existing illness.

If your spouse is able to apply for government assistance, they may be automatically entitled to medical coverage.

Dealing with Financial Mismanagement

Your spouse may have difficulty managing finances or may engage in reckless spending as a result of their mental illness. The cognitive symptoms that accompany many mental illnesses make it difficult for a person to concentrate, remember and problem-solve, which are all skills involved in managing finances. As mentioned previously, some mental illnesses may cause a person to engage in behaviours without consideration of safety or potential consequences, including reckless or unusual spending.

Having your own source of income will greatly expand your options and protect you from financial mismanagement by your spouse.

Familiarize yourself with the family’s assets and debts.

• 1Make a list of all assets with identifying information. Consider institutions, branch, agent, account number, policy number, vehicle identification number.
  Examples: Property (Home, Car), Bank Accounts, Insurance Policies
• Make a list of all creditors, again with identifying information.
  Examples: Mortgage (or rent), Monthly utility bills, Credit card accounts

Make a note of what time of the month each of these bills normally arrive. If your spouse is intercepting these bills and will not comply with your requests to let you see the bills and bank statements, you can get a post office box. Have the bank transfer the account to your name and send the bills to you there. Most creditors will not make this change unless you assume responsibility for the unpaid balance.

If there is any history of financial mismanagement by your spouse, use your communication skills to request that your spouse cancel credit cards and ATM cards and put all accounts and insurance policies in your name.

Whether or not your spouse agrees to the above requests, you can:

• Ask the bank to take your name off the accounts.
• Open new bank accounts jointly with someone other than your spouse, so that these accounts are protected.

If you want to earmark any of your assets for your children or anyone other than your spouse, consult a bank or a lawyer about putting accounts in trust for the designated individual(s).

It is a good idea to consult a lawyer for technical assistance in order to protect yourself financially, including “living wills” and “power of attorney.”

While financial mismanagement is very stressful for you, consider that it is also stressful for your spouse.

Imagine how you might feel if you blew $3,000 over the weekend and then didn’t have money to buy the family groceries or pay the rent/mortgage.

Children are often confused when their parent shows symptoms of a mental illness, because they don’t know what is happening. Explaining the mental illness to children can help alleviate this confusion and clear up any misunderstandings.

Some advantages to explaining the mental illness to children include:

• Children often imagine that things are worse than they really are.
• Being honest with children helps them to trust you.
• Understanding that there is a mental illness involved can help the child empathize with and respect the parent with mental illness.
• Gaining a better understanding of mental illness may reduce some of the anger and guilt about what is happening.
• It may reduce some of their vulnerability, sensitivity, confusion and surprise when confronted with negative comments from others about their parent.
• Research indicates that information aids coping.

Tips for explaining mental illness to children

1. Start with yourself. Assess your attitudes and knowledge about the illness.

• The more you know, the better you can answer the questions factually.
• The more you believe the mental illness is somebody’s fault, the greater risk you run of saying and doing things that can:
  • Put your children in a loyalty conflict.
    Example: “Mom says it’s Dad’s fault. Dad says it’s Mom’s fault. Whose side should I take?”
  • Teach children to blame others when bad things happen.
    Example: “Mom says it’s Grandma’s fault that Dad can’t handle any­thing.”

2. Build on what children say:

• Acknowledge any truth in what they say.
• Respectfully correct anything that is based on wrong information or misunderstandings.
  Example: “Mommy isn’t acting this way because of anything you or I have done.”

3. Use language and explanations that are appropriate to each child’s age and developmental stage.

• Try to relate mental illness to examples that are familiar to them.
• For example, it can be helpful to compare mental illness to a physical illness that children are familiar with:
  Example: (for a 5 year old)
  “Do you remember when you had the chicken pox? You cried a lot, you didn’t feel like doing anything and you were grouchy toward all of us. It wasn’t because you didn’t love us or wanted to be that way, but because you didn’t feel good. Well, right now Daddy doesn’t feel good. That’s why he’s crying a lot, not doing anything and acting grouchy. He still loves you and me, but he can’t show it right now.”
  Example: (for a 10 year old)
  “You know how parts of our bodies get sick sometimes, like when we get stomach aches or sore throats. Well some people get sick in the part of their brain that controls feelings. That’s what is wrong with Mom. She has a sickness in the part of her brain that controls feelings. This sickness has a name. It’s called schizophrenia.”
• If your child has seen violent or suicidal behaviour, situations requiring police intervention or any other traumatic incidents, don’t underestimate how terrifying these experiences can be. The following is an example of an explanation for any forcible removal of a parent from the home.
  Example: “Daddy didn’t know just then what was best for him. He didn’t know that the hospital is the safest and most comfort­able place to be in while he is getting well. You know, there were times when you had to do things you didn’t want to, but which we knew were good for you. It was that way with Daddy as well. Other people needed to decide what was best for him.”
• You may want to consider getting your child help from a mental health professional if they have witnessed a traumatic event.

4. Set a positive example for your children.

Children usually learn more from what their parents do than from what their parents say. Try as much as possible to practice using whatever information or attitudes you are telling your children to use.

Examples:

• As your child’s role model, be straightforward and factual when talking with others about the mental illness or relating to your spouse.
• Be a good role model by protecting yourself from unacceptable behaviour even though your spouse’s behaviour is the result of their mental illness.
• If you can be firm and clear about your need to set limits with your spouse, it may help children through any temporary distress and teach them that being in a relationship and caring about someone does not mean sacrificing one’s safety.

Help children cope with feelings
As outlined above, children may experience a variety of feelings in response to their parent’s mental illness. Predominant feelings may vary depending on a child’s age and level of understanding. For example, guilt or fear are often the predominant feelings for younger children, while anger and embarrassment tend to be common for adolescents.

Whatever feelings your child may be experiencing, here are some suggestions to help them cope with these feelings:

1. Create an atmosphere that encourages children to talk about their feelings:

• Talk about your own feelings so that they have a role model.
• Take advantage of moments that provide an opportunity for discussion of feelings.
  Example: Watching a TV show about a parent who becomes disabled may be an opportunity for discussion.
• Be available to listen, but don’t pressure a child to talk about feelings if they are not willing.

2. When your children do try to express their feelings, show them that you are listening:

• Give your full attention. Make eye contact.
• Check out what you are hearing in their words or interpreting from their behaviour.
  Example: “You’ve been slamming doors all night. Are you angry about something? I’m here if you want to talk.”
• If the feelings shared by your children arouse strong feelings in you (i.e. anger, sadness, guilt), resist the temptation to join in the conversation.
• Getting judgmental or emotional might stop them from talking, now and in the future.
• It is very difficult not to judge your children’s feelings if you don’t agree with them.
  Example: Instead of saying, “You shouldn’t be angry with me. You should be thankful. I’m the one keeping the family together.” You could say, “I understand you are angry, would you like to talk about it?”

3. Help your child develop skills for handling strong feelings:

• Explain that feelings are neither right nor wrong. It’s okay and natural for them to have the feelings they are having.
• Emphasize that talking about feelings can be helpful, and that you will al­ways try to make time when your children need to talk.
• Explain that feelings do not have to control our actions. Give examples.
  Example: “It’s okay that you are angry at your father and I, but the way you are acting towards us now is not okay.”
  Example: “Being embarrassed about your mother’s mental illness does not need to stop you from explaining it to your friends.”
• Help your child come up with strategies they can use when they feel angry, sad or stressed to cope with these strong emotions. Helpful strategies might include talking to someone, taking a break, doing something they enjoy, spending time alone or using breathing or other mindfulness exercises to calm down.
• Humour can help to make the communication more positive, but do not use it to discount or ignore your child’s feelings.

Help children learn effective verbal and behavioural responses

Practical suggestions for helping children to respond to their parent with mental illness:

• Share with your children any of the discoveries or skills you have learned about what works and doesn’t work when dealing with your spouse.
  Example: “I know it is upsetting when Daddy talks about the food being poisoned, but arguing with him about it doesn’t help.”
• Make sure your children understand that even though their parent has a mental illness, it is okay for them to protect themselves from any behaviour that seems scary or dangerous.
• Give specific suggestions for how to protect themselves:
  • Make a rule that your children tell you whenever a situation involving your spouse has scared them or made them uncomfortable.
  • Teach your children to tell your spouse whenever they are scaring or up­setting them.
  • Create an emergency care plan with your child – a list of numbers they can call if they don’t feel safe, including emergency numbers and people they trust.
• Let your children know that showing their parent they still love them is very important.

Practical suggestions for helping children respond to others

• Involving children in keeping the mental illness a secret can be extremely burdensome to them.
• What you say to others about the mental illness and how you act will probably influence your child more than anything you tell them to say or do.
• Explain to your child that many people don’t understand mental illness:
  • It may scare them.
  • They may make fun of it.
  • They may have ideas that aren’t true.
  • They may change the subject or say nothing.
• Teach your child how to explain mental illness to others. The more your child understands, the easier it will be for them to explain it to others.
• Practice with them how to respond to other people:
  • “I wouldn’t make fun of your Mom if she was sick.”
  • “If you understood what is wrong with my father, I don’t think you would say what you are saying.”

Find out what community agencies are available to help your child

BCSS Youth: Kids and Teens in Control are support and education programs offered through the BC Schizophrenia Society for children and youth ages 8-18 who have a family member with mental illness. These programs help children and youth understand mental illness and develop healthy coping strategies while connecting with peers who share similar experiences.

If you are feeling “trapped” in the relationship, it may be helpful to consider why you are staying. Identify what your reasons are for staying.

If you think your only option is to stay or leave, remember that there is always a third option – staying in a different way. How might you do that? Here are some tough questions to ask yourself:

• Have I mourned my unrealistic expectations for the marriage? Am I still trying to bring back what was or what I hoped would be, even though it is highly unlikely?
• Do I make decisions that affect my spouse without involving them?
• Am I doing more for my spouse than I really have to
• Do I expect my spouse to know what I need without telling them? How well do I communicate?
• How often do I make time to try to connect with my spouse emotionally?
• How well do I balance my needs with my spouse’s needs?
• Are my arguments constructive?
• Are my spouse’s criticisms of me valid? Maybe they are.
• Are my spouse’s requests of me realistic and reasonable? Maybe they are.
• Do I come across as a partner or a parent when I try to set limits with my spouse?
• Do I see my spouse as a whole human being with strengths, talents, limitations, etc., who happens to have a mental illness, or do I see them only in terms of their mental illness?
• Is there anything I still love about my spouse?
• Of the things I dislike about my spouse, which are due to the mental illness and which could be the result of other factors?
  • Could some be caused by:
    • Unresolved issues with my own family
    • My spouse’s unresolved issues with their family
    • Medication side effects
    • Our relationship dynamics
    • Outside stresses

Learning more about mental illness and finding support from others can help you cope with challenges that arise in your relationship. You might find it helpful to:

• Read books, magazines or websites to get more information
• Attend educational programs to learn more
• Attend support group meetings to connect with others with similar experiences
• See a counsellor/therapist for professional help

BC Schizophrenia Society offers educational programs and support groups for family members and friends who have a loved one with a mental illness. Find out more at www.bcss.org.