An interview with Kim T. Mueser and Bodie Morey Family Intervention Guide to Mental Illness

New Harbinger Publications: Early in your book, The Family Intervention Guide to Mental Illness, you say more than 54 million Americans have a mental disorder, yet only 8 million seek treatment. Why is this?

Kim T. Mueser: There are many reasons why so many people with a mental illness do not seek treatment. One simple reason is that people with a mental illness may not know they have such an illness, and their loved ones might not know either. People may know that something is wrong, be unhappy, and have problems functioning but still not know that they have the symptoms of a mental illness. Mental illnesses are different than physical illnesses since it is parts of the mind, not the body, that aren’t functioning properly. This can make it harder to “see” when someone is having problems related to a mental illness. Chapters 1 and 4 of our book are devoted to helping people know the signs of mental illness.

Another important reason people do not seek help is they may not know that effective treatments exist for mental illnesses. People may be more afraid to get help for problems they don’t believe are “fixable” than ones for which they believe effective treatments exist.

One more reason some people don’t get help is they may be afraid of public attitudes about mental illness, such as it being a sign of weakness or someone’s fault. Fortunately, as the medical community has learned more about mental illness and how to treat it effectively public attitudes have also changed. Mental illness is no longer viewed as a sign of weakness or something to be embarrassed about. In addition, there are many effective treatments for different mental illnesses.

All of these reasons underscore the importance of getting the word out that mental illnesses are common and treatable when brought to the attention of mental health professionals.

NHP: Bodie, you touch on a personal experience you’ve had with mental illness. Can you talk about this and tell us how it led you to become an advocate for the mentally ill?

Bodie Morey: My first husband had bipolar disorder (then called manic depression) but the early signs of his more and more manic behavior were not recognized as signs of illness. Nowadays of course the signs would be recognized early and he would have got appropriate treatment including medication. The whole family would have been better able to understand and deal candidly with Dad’s disorder through the years.

I first became an advocate for better public understanding of mental illness when I heard about NAMI, the National Alliance for Mental Illness. I began talking with other families with relatives with mental illness, and I started to learn all the many facts I had been oblivious to before.

I began hearing that my experience was typical! Families do not recognize the early signs of mental illnesses. Symptoms worsen for years until the person is so ill that a crisis of some kind happens and by then the person’s life has been severely affected.

But the wonderful thing is, I learned that this does not need to happen! Mental illness is not hard to recognize if you know what to look for. Nowadays people can have their symptoms identified, diagnosed, and they can get effective treatment. (All with no stigma attached.) The important thing is to recognize the signs early and start getting treatment promptly, just as for other illnesses.

Hopefully this book can help make it as accepted – and as acceptable – to recognize the signs of mental illness, as it is to recognize the signs of any other disorder.
  
NHP: What are some of the signs that a loved one is suffering from a mental illness as opposed to just feeling sad or anxious?

KTM: The major signs of mental illness are a person having persistent problems in at least one of the following four areas:

• Feelings (such as depression, anxiety, anger, guilt, or up-and-down moods);
• Thinking (such as problems concentrating, organizing, and planning, having delusions or hallucinations, not being able to talk clearly and understandably);
• Relationships (with family, friends, other students or co-workers, or teachers, or bosses);
• Functioning (such as performance at school or work, self-care tasks like grooming, hygiene, care of clothes, homemaking tasks like cooking and cleaning, independent living skills like use of transportation or budgeting, or child care.

The crucial question you should ask is whether the problem is persistent. Many of us feel sad or anxious once in a while, but this does not constitute mental illness. If it is persistent it deserves appropriate evaluation and effective treatment, like any other persistent symptom of malfunction.

NHP: You offer a nine-step program for addressing mental illness and step six is “Find the therapy or rehabilitation most suitable for your loved one.” What is the difference between therapy and rehabilitation and what are a few things that everyone should know about them?

KTM: Traditionally, the word “therapy” refers to when a mental health professional meets with an individual, couple, or family to help them through discussion to gain insight into their problems, and the word “rehabilitation” refers to programs that help people learn new skills to improve their functioning in areas such as social relationships, self-care, and work or school. However, in recent years there has been a shift to also teaching new skills in therapy programs, such as in cognitive-behavior therapy programs, and not just providing people with insight through discussion. Thus, therapy and rehabilitation programs often overlap. In current usage, the term “therapy” usually means having a close relationship with a mental health professional who provides support, guidance, and skills for coping with and overcoming mental health problems, such as depression, anxiety, or relationship problems. The term “rehabilitation” usually refers to programs that specifically focus on improving a particular area of functioning, such as vocational rehabilitation to improve work functioning, and social skills training to improve interpersonal skills. Many therapy programs are just as effective as medications for improving symptoms such as anxiety and depression, and often the two combined are more effective than either one alone. When people experience significant problems with their functioning due to mental illness, and these problems persist despite medications and/or therapy, a rehabilitation program may be necessary to improve that functioning.

NHP: What are a few dos and don’ts for initiating a conversation about mental illness with a loved one?

KTM: Speak openly, factually, kindly, and without blame. Think of it in the same way that you would initiate a conversation if you saw your loved one was having a problem with what appeared to be sore muscles or heartburn. You have noticed some problems or symptoms, and you are concerned. You are trying to start a conversation about your concerns in order to find out what’s wrong and to bring help and relief, to your loved one.

Do not hesitate to be specific in describing the behaviors in your relative that concern you—just be sure to express yourself in a manner that is simple, truthful, matter-of-fact, and calm. Here is an example: “Ben, I’ve would like to talk with you about something I am concerned about. I’ve noticed you’ve been angry a lot of the time lately. What can you tell me about that?” You have expressed your concern without blaming your relative, and showed him your desire to help. That is enough for a start. It lets Ben know you are concerned about him. With this simple step, you have taken the topic out of the closet, and calmly put it on the table, where it may be further discussed openly.

NHP: What should you do if your loved one refuses to seek professional help or refuses to believe there’s a problem?

KTM: People with a mental illness are sometimes reluctant to seek professional help. However, it is important not to construe this reluctance as a refusal. There are many ways you can help people overcome their reluctance, and get the help they need. Here are a few strategies. The right strategy of course depends on why your relative doesn’t want to see a professional.

Your relative may be reluctant to see a professional because he or she lacks the understanding that mental illnesses are common, are no one’s fault, and can be effectively treated (and often cured). Helping your relative understand that having a mental illness is nothing to be ashamed about, and that effective treatment can often bring rapid relief, may overcome his or her reluctance to seek treatment. These kinds of concerns are especially common in people who have difficulties related to anxiety or depression, although they are common in people with other disorders as well.

Some individuals are reluctant to seek treatment because they lack awareness about their problems, even when these problems may be readily apparent to others, such as family members. These individuals can be most effectively motivated to get professional help by linking the help to something they care about and are invested in changing or improving. For example she may be concerned about not having many friends, not sleeping well at night, losing jobs, or feeling down. Our book describes these and many other strategies for helping a loved one get treatment for a mental illness.

NHP: If you could get rid of three misconceptions about mental illness what would they be?

KTML That mental illness is someone’s fault. Mental illnesses are no one’s fault. That means there is no one to blame, neither the person with the illness nor someone else, when someone develops a mental illness.

That mental illness is a sign of weakness. Mental illness is not a sign of personal weakness. In fact, plenty of very strong people have experienced mental illness, so it’s not something to be ashamed of or embarrassed about!

That there are no effective treatments for mental illnesses. Wrong! There are many effective treatments for mental illness, including medications, therapy, and rehabilitation programs. Some treatments are so effective they can cure mental illnesses. Other treatments may not cure mental illness, but can greatly improve them, allowing people to live rewarding and productive lives.

NHP: You say that “medication can help mend the mind.” How?

KTM: The mental illnesses that benefit from long-term medication are a result of brain chemistry being out of balance. Psychiatric medications correct this by restoring chemical balance for healthy mental functioning. We could say they are “mind-balancing drugs.”
 
The brain works by sending tiny electric signals along a network of pathways containing chemicals called neurotransmitters. In very simple terms, psychiatric medications work by stimulating the production of chemicals that are being underproduced in the person’s brain and/or by preventing other chemicals from being overproduced. These chemicals must be in the right balance in order for the neurotransmitters to carry the brain’s signals accurately.

NHP: What are some of the most common reasons why people don’t want to take medication and what are some of the realistic and unrealistic concerns about psychiatric medications?

KTM: The most common reason people don’t take psychiatric medications is the same reason they often don’t take medications for physical conditions: they forget! Helping people fit taking medications into their daily routines often helps address that problem.

One unrealistic (or inaccurate) concern people have about psychiatric medications is that they are addictive. Almost all psychiatric medications are not addictive—that is, they keep working at the same dosage levels over time, and people do not develop physical dependency on the medications.

One more misconception about psychiatric medications is that people who need them must take them for their lives. While it is true that some people need to take psychiatric medications for their lives, there are many other people who benefit from taking medications for just a short period of time, such as a few weeks or months.

A realistic concern about medications is their side effects. Medications do have different side effects, such as weight gain and sedation. However, figuring out the right dosage and type of medication can often minimize any side effects.

NHP: Step 8 of your book is “Keep living your life.” What are some of the stresses that family members of someone with mental illness face and how can they keep living their lives in the face of those stresses?

KTM: Probably the major stress that some families face is when a member has a long-term mental illness. Most mental illnesses are not long-term if they are treated, but some are, and family members may be involved in helping the person manage his or her affairs, and getting the treatment he or she needs for the mental illness. That responsibility can weigh heavily on family members.

This is why it is so important for the family to stop guessing and take steps to find out what may be going on with their loved one when they first become concerned. Recognizing signs early and helping the person get the right treatment as early in the course of the illness as possible can give their loved one the tools to manage his or her mental illness successfully. This is just like other illnesses, in which the earlier the treatment is started the better the recovery.

Chapter 8 in our book describes some tips and recommendations based on what families have told us about that they have used to get their needs met while still giving help to their mentally ill relative. It is a question of achieving a balance. You are entitled to - and you should – live your own life, with the activities that “ring your chimes.”  And you want to empower your relative to take care of his/her own health as strongly as possible. Yet there are likely to be extraordinary demands for your help.