“Rehabilitation is the process of helping former patients to resume a normal daily life after a period of mental illness. Often it means preparing those who have spent some time in hospital to take up life in the community. Included is a learning of living skills and making the most of their present abilities.”_______________________________
by Priya Kodippily
(March 28, Colombo, Sri Lanka Guardian) An episode of mental illness or emotional problem may last over a few weeks or months. The patient may have benefited from one or more types of treatment and be ready to resume a normal way of life. If the illness has not been a long serious one, full recovery is possible, particularly if there are relatives and friends to help.
There are two groups of people for whom recovery is not so straightforward. The first are those who have had a long illness, perhaps requiring several years of hospital treatment, and have recovered sufficiently to leave the hospital and return home. The second group of people are subject to a chronic condition. Although they no longer need to be in hospital, they do not return to their former state of mental health and tend to remain below par for several years.
It is often said that not enough care is given to those people with a mental illness living in the community. This calls for non medical needs, many of which can be provided by the family. Included in this category of care giving is rehabilitation. Rehabilitation is the process of helping former patients to resume a normal daily life after a period of mental illness. Often it means preparing those who have spent some time in hospital to take up life in the community. Included is a learning of living skills and making the most of their present abilities.
• How can the family help?
Persons recovering from a mental illness may suffer from two types of problems. One is a serious lack of self- confidence in their ability to cope with stress, which causes them to shy away from any difficult task or situation. In the second situation they react as if nothing has happened and expect to resume their previous lifestyle immediately. The attitude of family members can have a significant effect on the extent of recovery. For example, you can encourage the person to join a day care centre such as Sahanaya. While day centres have a useful role to play, you can also help your relative to participate in other general activities - for instance a club or a group connected with a hobby.
You can persuade him to take medication which has been prescribed regularly, and to attend follow up appointments at the hospital. Ensuring that they persevere with treatment is not always easy, particularly in instances of serious mental illness that does not require hospital care. It helps to discuss the situation with the doctor if problems arise.
A family member may experience the same type of reaction as the recovering person, namely a lack of self-confidence. You may feel that the person should not be expected to help with the running of the house. But this will not necessarily be in their best interests. It may well be better for them to assume a gradually increasing amount of responsibility at home, while you continue to make the more demanding decisions. Another example is when the recovering person is not able to obtain a responsible or well paid job as you might have hoped for. This may be a temporary or permanent situation, but expressing your disappointment can only make the person feel disheartened.
When he is recovering, it is natural to fear a relapse. By remaining positive yourself about the future you can help to reduce anxiety. Respond to signs of the illness returning, but do not be over vigilant. Most people occasionally have sleepless nights, make nonsensical remarks or feel depressed. It does not necessarily herald an episode of mental illness.
• Your Feelings
As explained, it is not only the suffers who are affected by a mental disorder, but also those who live with them. Seeing a change in the mood and behaviour of someone close to you can be upsetting or even frightening. This is quite understandable that if you care about someone, you will be distressed by their suffering. What can be done to help? The following are some useful tips:
- you may feel impatient when your relative makes irrational comments - perhaps because of delusions or because of severe depression. There is however nothing to be gained by thinking these thoughts are ‘nonsense’ or ‘stupid’. The best course is sometimes just to listen and show that you are sympathetic, rather than discussing the actual context of what is said. Of course, if there are reasons for worries rather than symptoms of a severe mental illness, it is very helpful to discuss the reasons for his worries:
- bear in mind that severely ill people do not always express themselves well, or fully understand what is said to them. Make allowances for this;
- your relative may make harmful comments to you, which are especially difficult to bear when in fact you are doing your best to help him. However hard it seems, the most helpful reaction is not to be upset or angry at what is said;
- The phrase ‘snap out of it’ may spring readily to mind, but someone diagnosed as mentally ill will not be able to do so.
• Types of caring required
ELDERLY RELATIVES: By no means all elderly people become mentally ill, but of those who do, only a small percentage move into hospitals. Many of the rest are cared for by younger relatives. Two of the most common mental illnesses in elderly people are Depression and Dementia including Alzheimer’s disease. It is important to remember however, that mental problems in elderly people may have less serious causes that are quite easily treated. If confusion, restlessness, insomnia or other symptoms are particularly worrying, try to persuade the elderly person to see a General Practitioner, or contact him yourself.
It is also understandable if you feel resentful about the task of full-time caring of an elderly relative. This is especially likely if you have other plans, such as a paid job, or if you cannot devote sufficient time for your partner or children. These feelings in turn may cause you to feel guilty. This is unnecessary, as blaming yourself, or fretting about it, aggravates, rather than helps in coping with the situation. It is certainly not unknown for the strain or caring to cause such problems as insomnia, frequent headaches and depression. You should also get some professional help if necessary.
MARRIAGE: A brief spell of illness is not likely to put an intolerable strain on a marriage, unless there were already problems with the relationship. Persistent illness or emotional problems of one partner may however have a more serious effect. The mentally ill person may cease showing any affection, and a loss of interest in sex is a common symptom. While understanding the reason for this, a partner may still find the situation difficult to live with.
A marriage may also be strained when neither partner is suffering from a mental illness, but because the couple is caring for a mentally ill relative in their house - perhaps a child or an elderly parent, partner is an easy foil for frustration and anger felt about this responsibility. It is important to recognise the effect problems such as this has on the marriage. Discussing this openly in cancer moments, and acknowledging the value of this support to each other will help.
CHILDREN: When a child has a mental disorder it can be wearing on the parents and distressing for brothers and sisters. A family approach, if not formal family therapy is therefore often used. It is not easy for parents to cope with children who are experiencing mental or emotional disorders, so it is important to seek help before this harms your relationship with the child.
Most parents probably worry at some stage about an aspect of their child’s behaviour and wonder whether it is ‘normal’. This is a difficult criteron to define. Children have markedly different patterns of development which need not be indicative of any mental problem. Often departures in a child’s normal behaviour stem from a parent’s anxiety over the possibility of a child having a disturbance. Small children may have a problem which cannot be expressed verbally - but through bed wetting or eating problems. It is wise to consult your general practitioner before the situation reaches serious dimensions.
Adolescence can be a difficult time for the teenager and his family. Some rebellious behaviour is to be expected if he is going to become independent. Though your patience may be strained you need not worry about the occasional upsetting incidence. Prolonged difficulties may, however, warrant professional help. When problems arise in the family, a sensitive child may try to hid his own feelings so as not to add to your problems. Others become naughty or violent because they cannot cope with their feelings. While it is important for the two of you to discuss the subject, it may be easier for the child to talk to someone outside the home, rather than to voice such feelings to a parent.
• Conclusion
In conclusion I would like to suggest that families should try to form neighbourhood or community support groups to help with daily needs, such as transport, hobbies, day care, or setting up a volunteer group to stay with children or an elderly relative while you go out. Forming a relatives’ support group could serve two functions. One aim is to provide practical information, either by sharing experiences and ‘tips’, or through talks from professional workers. The other purpose of group meetings is to give moral support and a chance to express the frustrations and anxieties which every caregiver feels. It can be very helpful to her that others have similar feelings, especially if you had imagined that you were the only person to feel that way.
- Sri Lanka Guardian
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