Wednesday, October 9, 2013

How do I MAKE someone get help?

With the latest incident of a Postpartum Mood/Anxiety Disorder (PMAD) in Washington, DC, where Miriam Carey was shot and killed and it is being alleged that she was struggling with some form of PMAD, getting help for mental illness is definitely a hot topic. On top of that, it is Mental Health Awareness and Suicide Awareness time (World Mental Health day is tomorrow, folks!!!), so it seems like a great opportunity to bring up this very difficult subject: Even if I know that someone is struggling, how do I convince them that they need help?

When it comes right down to it, this is about relationships: you can only do/say so much, and ultimately, the other person has the final say. But there are ways to have this conversation with someone that can improve the chances that you will be heard and the person will take action to get some help.

In his book, "You Need Help!", Komrad offers seven steps, which I will summarize here. Komrad's words are the actual step names, and I have offered my own summary following each one.
1. Before you Begin: This step is about planning. Before talking with your loved one, think about these questions: Why do you think this person needs help? What is your goal? Is it that this person seek therapy? Rehab? Accepting some other form of support? Put yourself in his/her shoes for a moment and think about why he/she may not have sought help already. Money? Insurance coverage? Shame? Fear?
2. Choose a Time and Place: This is SUPER important. You really need to think about where and when you are going to broach the topic of your loved one getting some help. Timing is key. Allow a lot of time to talk (for example, don't start the conversation at 10 pm at night when there are time limitations and everyone is tired). Think about where and how YOU would want to be approached. Initially, have some respect for their dignity and discuss your concerns in private, versus staging an intervention with a group of people. The person will likely feel defensive and ganged up on, and less likely to hear your concerns.
3. The First Approach: Be prepared that the first approach may not be the last. You may be planting a seed that you need to let grow for a while, if you can safely do that. Be open to their emotions, and let them know you are hearing what they have to say rather than trying to defend your viewpoint. Offer to help him/her get some help, go along to appointments, make phone calls (where HIPAA will allow this). Don't be discouraged if the first approach does not go how you envisioned.
4. Gathering your Allies: If your loved one is still not open to treatment, consider who else is in your village. Doctors, friends, clergy members, family members. Attend a support group for concerned people (such as Al-Anon). Or if you yourself see someone for mental health care, discuss this with your therapist or psychiatrist. He or she may have some good insight into how to talk with your loved one about it.
5. Persuasion and Coercion: This is pulling out the big guns. Be prepared to point out the consequences of not getting help, such as loss of relationships, jobs, health. It can feel very manipulative, but there is a fine line between helping and enabling and if you are continuing to let your loved one sit in denial, you are enabling.
6. "Hardball": Involuntary Evaluation: If all else fails, and you determine that your loved one is in danger to himself or others, you may need to pursue further action. This may be contacting an attorney to take legal action, or calling in the authorities to bring the person in for a psychiatric evaluation or detox. If this person lives with you, it may mean removing the things that are concerning- drugs, alcohol, weapons, access to the car, etc.
7. Continuing your Support: This can look different across situations. It may mean visiting someone in the hospital or in jail. It may mean offering to come to a support group or therapy session with him or her. It may mean being available to listen, or offering childcare so that he can attend appointments. Whatever the barriers to care are, try to find a way to have people help reduce or eliminate those barriers. Let them know they are not alone, and that you do not see them as less of a person because they are struggling with a chemical imbalance in their brain versus one on their other organs.

Ultimately, some people may choose to not get help. Some people may never even let on how much they are struggling- that's a whole other topic. But if you know or believe that someone is struggling, especially if they are harmful to themselves, do not let them become a statistic.