How to support someone with mental illness at home: depression, bipolar, schizophrenia

How to support someone with mental illness at home

If you are wondering how to support someone with mental illness at home, the short answer is that your relative needs four things from you more than any piece of advice: for you to listen without judging, to help them keep a regular daily routine, to support their treatment without becoming their supervisor, and to be patient with a recovery that comes step by step. This is the message repeated in guidance from the UK's National Health Service (NHS) and the US National Institute of Mental Health (NIMH) for depression, bipolar disorder and schizophrenia.

The NHS, in its guidance on schizophrenia for example, says that families play a vital role in recovery and in making relapse less likely. But your role is support, not treatment: diagnosis and medication are the doctor's job, and you are an important partner in the plan.

What actually helps your relative day to day?

Medical guidance comes back to much the same advice again and again:

• Listen before you advise: tell them you care and are ready to listen whenever they want to talk, and accept them as they are, without judgment.
• A steady routine: regular times for sleep, meals and activity. Guidance on bipolar disorder stresses getting enough sleep and keeping a regular routine, because stress and lack of sleep are among the triggers for episodes.
• Support medication without smothering control: encourage them to take their medicine and keep their appointments, and help in practical ways, such as giving them a lift to the appointment or picking up their medicine. If they complain of side effects or want to stop, encourage them to talk to their doctor; medicine should not be stopped without the doctor's advice, even if they feel better.
• Gentle involvement without pressure: gently encourage them to be active and to do things they used to enjoy, such as a short walk with you, and accept it without blame if they say no.
• Patience and hope: remind them that recovery is possible with the right treatment, and praise the small steps.

Each condition needs something slightly different

• Supporting a depressed relative: stay in touch by message, phone call or visit, because someone with depression may withdraw and find it hard to leave the house, and gently encourage them to be active and eat a balanced diet.
• Caring for someone with bipolar disorder: learn what triggers their episodes, and watch for big changes in mood, activity and sleep.
• Family support with schizophrenia: help them stay in treatment, and be respectful and kind without accepting any dangerous or inappropriate behavior, as the NIMH advises.

Words that hurt more than they help: what to say instead

Some phrases come from a good place but leave your relative feeling accused, or feeling that nobody believes what they are going through. The NHS advises families of people with schizophrenia not to blame their relative or tell them to "pull themselves together", and a guide from Ireland's Health Service Executive (HSE) warns against phrases that dismiss or judge a person's feelings, because they leave the person feeling misunderstood and more isolated. Examples include:

• "Pull yourself together": suggests that what they are going through is their own failing, which it is not.
• "It's all in your head" or "You're overreacting": tells them you don't believe what they are living through.
• "It's not that bad" or "You shouldn't feel like this": plays down real suffering.
• "You're selfish and you never think about us": blame that deepens their guilt and isolation.
• "You'll be fine" before you have heard them out: hurried reassurance that can make them feel you don't want to listen.

Instead, try phrases that acknowledge their feelings and open the door to talking, such as "It sounds like you're carrying a lot at the moment", "I'm glad you told me" and "Take your time, I'm not in a rush". Don't hurry toward solutions: feeling heard matters more to them than advice.

How to respond when someone with schizophrenia believes delusions or hears voices

The NIMH reminds families that delusions (strongly held beliefs that are not true) and hallucinations feel completely real to the person experiencing them. That is why arguing does not help, and neither does agreeing. A guide for families from the UK charity Rethink Mental Illness offers practical tips for responding to these beliefs:

• Don't argue or mock: confronting the belief head-on can start a conflict, and laughing at it can hurt them.
• Don't agree with the belief: going along with it can make it stronger.
• Talk about the feeling, not the idea: say something like "That sounds really frightening for you", and make it clear that you are on their side and want to help.
• Give your view calmly: you can say that you haven't seen anything suggesting this danger, without insisting on convincing them.
• Keep it short and change the subject: don't let the discussion about the belief drag on, and gently steer the conversation toward another activity.
• If the belief is about you: ask someone else they trust to talk with them, and keep in touch in calmer ways, such as messages.

Encourage them to tell their doctor how they feel; some people refuse to discuss the belief itself but will talk about their fear and worry. If they talk about voices telling them to harm themselves or others, go straight to the crisis steps below. To understand the illness better, read our article on schizophrenia, its symptoms and treatment.

Early warning signs of relapse: what to watch for in each condition

Relapse is often preceded by small changes, and the family may notice them before the person does. The NIMH notes, for example, that someone having a hypomanic episode may not feel that anything has changed, while their family notices it. Signs mentioned in the guidance include:

Depression

• Pulling away from people and finding it hard to leave the house
• Lower energy and disturbed sleep
• Losing interest in things they used to enjoy, with obvious sadness or irritability

Bipolar disorder

• Needing less sleep, with extra activity
• Racing thoughts and impulsive behavior, such as sudden spending without thinking
• Or the opposite: sluggishness, hopelessness and disturbed sleep as a depressive episode begins

Common triggers for episodes include stress, lack of sleep and taking on too much. Read more about bipolar disorder.

Schizophrenia

• Unusual suspicion or fear, or worrying about other people's motives
• Hearing quiet voices
• Difficulty concentrating
• Loss of appetite, anxiety and disturbed sleep

The NHS recommends that the person has a written plan with their care team, setting out their early signs, the steps to take and emergency numbers. When you notice these signs, don't wait for a crisis: contact the doctor early so they can decide what is needed, such as extra support or a change to the treatment plan.

In a crisis: how to keep the home safe and who to call

The hardest moments for a family are when their relative talks about death or about harming themselves. The NHS notes that people with schizophrenia have a higher risk of suicide than the general population, and that the risk may rise after an acute episode or after leaving hospital. Warning signs it mentions include:

• Talking about death or about wanting to die
• Putting their affairs in order as if saying goodbye
• Self-harm
• A sudden, unexpected lift in mood

1. Ask directly and calmly: "Are you thinking about suicide?" The NIMH explains that studies show asking this question does not increase suicidal thoughts or behavior; instead, it opens the door to talking.
2. Listen without judging and stay with them, and don't leave them alone if they are in immediate danger.
3. Make the home safer: move things they could use to hurt themselves, such as sharp objects and stored medicines, out of their reach.
4. Get help straight away from the numbers below, then keep in touch after the crisis, because ongoing contact plays an important part in prevention.

For more detail, read suicide warning signs and what to do.

Your own health and sleep: who cares for the carer?

Caring for a relative with a mental illness is exhausting work, and the NHS advises people caring for someone with schizophrenia to seek support for their own feelings too. In an Egyptian study published in 2022 of 120 people caring for relatives with schizophrenia at El Mamoura Hospital in Alexandria, the burden of care was high, and half of the carers scored high for emotional exhaustion.

Looking after yourself is not selfish: the NIMH includes taking care of your own health in its advice for families. Here are some practical steps:

• Share the care: don't carry everything alone; divide tasks and night shifts among family members where possible, so that everyone gets some sleep.
• Protect your sleep: long nights drain your patience, and if your own sleep stays disturbed for weeks, that deserves a doctor's appointment for you too.
• Keep part of your own life: a friend to talk to, an activity you enjoy, or time to rest without feeling guilty.
• Talk about your feelings with someone you trust or with a professional. If you are irritable most of the time or have lost your enjoyment of things, you need support, not more endurance.

When does the family itself need sessions and support?

A Cochrane systematic review published in 2010 concluded that therapy aimed at the family may reduce relapses and hospital admissions in people with schizophrenia, and may help them stay on their medication, although the researchers warned that the quality of many of the studies was limited. The NIMH also states that family-focused therapy, alongside mood-stabilizing medication, has helped teenagers and adults with bipolar disorder.

Consider family sessions if:

• Arguments and shouting at home about the illness or the medication have become frequent
• You don't know how to respond to delusions, angry outbursts or withdrawal
• Relapses or hospital admissions keep happening
• Your relative refuses treatment and you don't know the next step
• One of you feels worn out, constantly sad or unable to sleep properly

As the NHS describes them, these sessions give information and support to the person and their family together, and they can help you agree on one shared way of responding instead of each person handling things their own way.

When to get help for your relative, and how treatment works

Book a doctor's appointment for your relative without waiting if:

• Early warning signs of relapse appear, or their sleep and behavior clearly change
• They stop their medication or follow-up, or complain of side effects that bother them
• They start using alcohol or drugs, which can make symptoms worse and interfere with medication
• Their studies, work or self-care are affected

Talk of death, or of harming themselves or others, is an emergency: follow the crisis steps above straight away.

How treatment works at Oxygen

The path usually starts with an appointment with a psychiatrist to assess the situation and set a plan, followed by therapy sessions and regular follow-up, and inpatient treatment at the center when needed. Appointments and sessions are open to men and women aged 15 and over (with a guardian's consent for those under 18), while inpatient stays are for males only. Family counseling is part of the program, and if your relative refuses to come, the family can come alone first to understand what is happening and learn their next step.