When a loved one is diagnosed with a mental illness, they may become withdrawn, anxious, unpredictable, or even aggressive at times. How should caregivers respond in the face of these changes? Psychiatric nurse Ms. Fong shares her advice.

Mental health problems are more common than you think. In Hong Kong, one in six people live with some form of mental disorder. Mental illnesses change people in a way that they are unable to act, feel, or think in ways they want to, the impact varies from day to day and from person to person. For some, this means experiencing extreme and unexpected changes in mood. For others, it means having hallucinations, and not being able to think or communicate properly. 

Having worked as a psychiatric nurse, with five years of clinical experience, Ms. Fong has seen how mental illness affects people, as well as their caregivers, in harrowing situations. Here are some of her strategies on how caregivers can help address some of the most prevalent mental health disorders.

This interview has been edited for length and clarity.

1. What causes mental illness?

Our minds, like our bodies, are shaped by a complex array of factors. While the exact cause of most mental illnesses is not known, it’s become clear, through research, that many illnesses are caused by a combination of biological, psychological, social, economic, and environmental conditions. From the environment we live in to our childhood experiences, from genetic variations to our access to resources, all of which can lead to mental health issues.

2. A lot of severe mental illnesses can be chronic and lead to relapse. What warning signs should caregivers watch out for to prevent a more severe episode from developing?

Warning signs vary between individuals, and may differ from one mental disorder to another, common ones include: 

Intense mood swings are one of the telltale signs of a relapse. Patients become tense, irritable, or agitated. For example, a person who has manic syndrome  gets annoyed more easily than usual. They might also go from episodes of very high energy to extreme lows of depression. 

In many cases, a relapse can put the patient at risk of self-harm. For example, patients who relapse into depression  may use self-harm as a way of dealing with intense emotional pain. Everyday objects can turn into unsafe weapons for self-harmers who are in a vulnerable state. I’ve seen patients harming themselves with a pen and chopsticks. 

Body language tells a lot about an individual’s emotional status. A person experiencing relapse might have aggressive body language; for example, they might hold their fist or pull their hair. 

3. What are some strategies that caregivers could use to cope with a loved one’s sudden breakdown?

While mental disorders such as bipolar disorder and depression can flare up seemingly out of the blue, learning to identify patterns can provide caregivers with clues on when their loved one is in a vulnerable state. The cycles of most mental disorders are not fixed and can stretch for days. By keeping a mood journal or using a mood-tracking app, you can get a better understanding of the triggers of a relapse, develop and refine your coping mechanism. 

When your loved one is hovering on the brink of a severe breakdown, a simple distraction is the best medicine. Starting a conversation, for example, is a common strategy psychiatric nurses adopt to redirect patients’ attention to focus on things that do not agitate them. Caregivers can invite their loved ones to engage in mindless activities, such as folding towels to distract them from their distress. 

Common mistakes made when caregivers try to de-escalate their agitated loved ones include arguing or taking the emotional state personally. Asking your loved one to calm down is not helpful and can easily increase the acuity of the situation. Instead, caregivers should identify their wants and feelings, listen, and approach their loved ones in a reassuring, respectful, and non-judgmental manner.

If you are caring for someone who’s struggling with mental health issues, it is normal to feel unprepared or confused. When you’re feeling inadequate, there is always professional help available. Evercare has a team of psychiatric nurses to guide you through it. Click here to learn more.