Mental ill health is seen as being caused by a combination of personality, biology and social background. This can mean that it is difficult to separate what is part of the condition from the relationship between the carer and the service user.

For partners of people with mental ill health, there can be a concern that the person's fears or worries are partly to do with the relationship between them. For parent carers, there may be uncomfortable feelings about being to blame. Whatever has happened or been experienced, it is important that both the carer and the service user try to be positive about the future and deal with their current situation.

There is still widespread misunderstanding and prejudice about mental illness, so caring for someone with mental ill health can make it difficult to maintain social networks. Generally people find it uncomfortable to be with people who have hallucinations, behave strangely or are withdrawn and unhappy. Often when someone becomes distressed they seem to be like a different person, which for the carer can feel like bereavement.

Carers can become angry at what appears to be laziness or disinterest. Most people do not realise that mental distress makes people unable to motivate themselves or to see how they affect other family members. People who experience psychotic illness may not be able to see how their illness affects them; the voices they hear and beliefs they have are real to them, and therefore they think that their actions are entirely appropriate.

Many carers find that at first they try to prove to the person that their beliefs are wrong, but it is a pointless exercise. It may be more helpful to explore their feelings and plan how to cope with them, or to distract their attention. Sometimes when a person is recovering they may remember what was going on inside their head, but often they cannot. Medication may make people drowsy and unable to think quickly and clearly; some medication can affect sleep or make people more anxious. Carers are often in a good position to notice when behaviour is worsening, or when medication is having an adverse affect. If the service user also uses alcohol or drugs it may prevent medication working effectively.

Dealing with unusual thoughts or behaviour

Unusual thoughts or behaviour often cause problems for families, friends and carers. The problems that can arise include:

• Disordered thinking and speech which often indicates paranoia and delusions
• Social withdrawal
• Loss of motivation
• Depression, attempts at self-harm or suicide
• Aggression (usually verbal)
• Risky behaviour

Some suggestions for dealing with and managing these situations:

• Respond calmly and with tolerance
• Communicate clearly, simply and without undue emotion
• Be patient, give time and space to let coping begin again
• Be realistic in your expectations
• Be clear and consistent in what you say and do
• Avoid letting their pessimism influence your thinking and feelings
• Take action in small steps

Disordered thinking and speech

It is important to avoide going along with or humouring the person you care for by agreeing with their perceptions and beliefs. You can say that you do not see or hear the things they do, and that 'delusions' are part of their illness/disorder - which you can help via distraction, talking about how they feel, encouraging them to ignore voices etc. 

Try to avoid:

• Confronting or laughing at their expressed thoughts
• Undermining them by telling them they are 'stupid' or 'mental'
• Ignoring them by remaining silent

Risky Behaviour

Aggressive or risky behaviour is often a response to a feeling of losing control.  It will help if you can try to:

• Understand ther person's response: although the response may be extreme, real problems have usually triggered it.
• Recognise the triggers: what are the situations that make them fear losing control: Learn to recognise the early warning signs.
• Have realistic expectations of what the person you care for can achieve, and give plenty of encouragement. Try to avoid nagging criticism or nagging.  However, let your personal knowledge of what works guide you.
• Give them space and time. The person you are caring for needs to regain control and learn to cope again.  If there is no risk to the person or others, you could leave the room or go out for a while until the emotional temperature has cooled.
• Provide reasurance.  The person you care for needs to know that you will support them fully as they regain control over the situation and cope again.
• If the service user is saying that they want to die, or to kill themselves, it may help to encourage them to talk about why they feel like this.  They may be afraid of being alone, of being unwell forever or they may be overwhelmed by feelign sof paranoia or guilt. It can also help to let them know that you understand why they may feel so desperate but that you will help them to get through it.  Discussing such feelings rarely makes things worse.  It will help the service user if you can keep calm and discuss how you can support them during this time.  Try to give them hope that it will pass.

Know whom you should contact and how to do this if you have real fears for your safety - see 'In a Crisis'

If the behaviour of the person you are caring for is causing you concern, speak to the professionals involved, they should be able to support you with this.