Apoorva Goel was shocked when she saw a senior at college harming herself. She was not new to the nuances of mental health, nor was she unaware of the fact that her friend was combating bipolar mental disorder. But when she saw the act of self-harm, she knew she had to intervene.
What followed was the formation of a support system comprising a close-knit group of Apoorva Goel’s friends and those emotionally invested in her friend’s well-being.
As in the case of Goel’s friend, for other individuals suffering from critical mental health issues, too, their support system becomes the first line of defence against their mental agonies.
The support can come from anyone — including, but not limited to, the affected person’s family, friends, well-wishers and acquaintances. That is, anyone and everyone close to the person and who is ready to lend a helping hand.
“(My collegemate) was a strong person in college. So, it came as a shock when I saw her harming herself,” says Goel. “When her roommate was not around, I moved in for a couple of days to make sure that she wasn’t alone.”
She says, “It would have been difficult if I was on my lonesome, but luckily, we had a support system up and running to give her the necessary help. Rescheduling classes to accommodate her needs, always having one person with her, and even talking to her therapist to understand the practicalities of the care she needed.”
While this is the ideal action by the supporters, it also comes with an avoidable outcome: caregiver burnout. Due thought or emphasis is not given to providing therapy to the support system. This critical group remains a neglected lot, wrote Dr Rakesh K Chadda, Professor and Head of Department of Psychiatry, All India Institute of Medical Sciences, in a 2014 study published in the Indian Journal of Psychiatry.
The amount of stress and burden that caregivers face leads them to choose different coping strategies. These can be broadly classified into two groups, emotion-focused and problem-focused.
Emotion-focused strategies would include avoidance, denial, fatalism or looking to religion. Each of these strategies aims at diminishing the negative impact on the caregiver. Problem-focused form of coping mechanisms includes direct actions to change the situation. This includes problem solving and seeking social support to abate the stress of caregiving.
A problem-focused approach was the one Apoorva Goel took. Be it for her college senior or for her own sister. There were times when she felt inadequate to give her sister the care she needed. There were days when she used empathy to her advantage. Being empathetic to her problems and reassuring her that she will be there for her. But right now, there was a lot going on for her as well.
Self-help, education first
This brings us to the need for imparting psychoeducation to support systems. Proper psychoeducation includes understanding what their loved one is going through, how best they can help them, how to best deal with the issues that arise from caring for an individual and where they need to set boundaries.
“When you look at how essential it is for a support system to get help, it differs from individual to individual. Support systems need to be well taken care of. Whether it be for a caregiver of an individual with mental health issues or a caregiver of an individual suffering from any chronic physical illness, they need to indulge in self-care,” says Dr Samir Parikh, director of the mental health at Fortis Hospital.
He adds that caregivers may not need routine interventions, except in chronic cases. “In some chronic cases, like schizophrenia, for example, family therapy and group sessions tend to help.”
The same fact was highlighted in a small-scale study led by Verma PK from Ranchi Institute of Neuropsychiatry and Allied Sciences in 2019. A total of 30 caregivers of men diagnosed with schizophrenia were selected through the purposive sampling technique. It was found that in the case of caregivers who underwent psychoeducation, a significant improvement was also observed in the quality of life of the person in their care.
“Psychoeducation is the core to mental health,” says Dr Parikh of Fortis, “both in terms of awareness, understanding and more importantly, in seeking and finding treatment”
This is true not just for individuals but families as well. “If we know how to identify the issue, then we will notice the difference in the individual’s personality when we see something [unusual]. And once we are able to do so, the caregivers can find help earlier rather than later for themselves as well as their loved one. What we see today sadly is the opposite, with people seeking help later than when they should have taken it.”
Both in this country, and much of the world in general, there is a lack of psycho education of an affected individual’s support system.
Fear of rejection
Another problem is that many people who have mental health issues do not want to share their inner troubles with their near and dear. They are either embarrassed or do not want to trouble their loved ones. “Mental health is something our social system does not discuss openly,” says Dr Jini Gopinath, Psychiatrist at YourDOST, an online wellness platform.
“The fear of rejection is very significant in our culture. Individuals don’t share their mental health issues with their family because they don’t want to make them uncomfortable or be rejected by them.”
Too much can harm
At the same time, the support system needs to be educated about maintenance factors that arise from an individual’s surroundings. Extra attention given by society or the lack of it – both can cause a poor prognosis for the individual. If the affected person feels that the society around him or her and the support system are being too caring, they might tend to stay the same, which is bad for their mental well-being, says Dr Gopinath.
“Sometimes we take the support system as co-therapists. For example, if I asked a person to go on a walk and one of the family members takes up the responsibility and makes sure to accompany the individual every day, then that gives the person motivation to be better. People who are there to support you in this journey – (they are) both a maintenance factor and a protective factor,” Dr Gopinath adds.
A better and more robust state of mental health can be made possible if the affected individuals have these sustaining and protective factors. It could be as simple a thing as going out on a walk with a loved one regularly.
According to Dr Gopinath, “What needs to be done is to educate society to normalise mental health issues. That is a long way ahead.”
If it is about bringing a person with mental health issues back to a robust state of mental wellness, then, as experts agree, support systems need to receive therapy and psycho education just as those in their care.