FAQ for Supporting Relatives

FAQ for Supporting Relatives of a loved one experiencing depression or bipolar

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  • Introduction
    The question that volunteers and staff of Aware get asked most frequently is: What can I do to help the person I care about to feel better?

    Before we make some suggestions in terms of answering that question, we invite you to have a look at the tool below – Reviewing what I have already done to help. This contains some actions that people who care about someone who has depression or bipolar disorder tend to do. You may have already tried one or more of them yourself.

    We suggest you read each action, note if you have tried it and whether it works ‘always’, ‘sometimes’ or ‘never’. This will help clarify what you have already done to help the person you care about to feel better. There is space at the end of the table for you to note other actions that you have already done, which may not be on the list already.

  • Reviewing what I have already done to help
  • Why do you want to help the person to feel better?
    Let’s go back to the key question: What can I do to help the person I care about feel better? While it seems to be a very understandable, reasonable question it may be helpful to stand back for a moment and ask another question: Why?

    Why do you want to help the person to feel better? The obvious answer may be because you care about them. Could any of these be factors too?

    • Because it is my job to help them feel better
    • Because if I don’t, no-one else will
    • Because I care about them so much
    • Because I feel better when they feel better
    • Because I won’t feel happy until they feel happy too

    As you have probably discovered, it is not always easy to make someone else ‘feel better’. We might think that things like buying them something as a treat, or bringing them somewhere nice will ‘cheer them up’. While we might receive a smile in reward, doing things like that for people whose mood is very low tends not to work in the long-term. This is because:

    • If someone has depression (or is in the ‘depressed’ phase of bipolar) it makes sense that they ‘feel depressed’
    • They cannot ‘feel better’ just to please someone else
    • Doing nice things for someone who has depression can sometimes backfire as the person may have thoughts such as -

    ‘I hate being a burden’
    ‘Why won’t they leave me alone?’
    ‘I wish they wouldn’t spend so much money on me, I don’t deserve it’

    • This might actually make them feel worse and they might beat themselves up, blaming themselves for not ‘feeling better’.

    Supporting someone who has depression or bipolar can be difficult, frustrating and distressing, particularly if despite our best efforts, nothing seems to work. We might live in fear of saying the wrong thing or of somehow making things worse. And yet, if we say nothing, we might blame ourselves for not doing enough.

    So how can we help someone who has depression/bipolar disorder?

    The truth is that often we actually can’t!

    That does not mean that we do nothing however. We just rephrase our question so that it becomes:

    How can I care for myself as I support the person I care about?

  • Why is caring for myself important?

    Many people resist caring for themselves when someone they care about has depression or bipolar disorder. Some see this suggestion as selfish and wonder how anyone could look after themselves when someone they care about is unwell. Others agree that it is a good idea but want to wait until the person they are concerned for feels better first. A third group of people recognise the wisdom in caring for themselves – really caring for themselves – so that they are then able to care well for someone else.

    We can only give what we have and if we give and give and give, the day may come when we simply have nothing more to give.There is a very good reason why, when flying, we are asked to put our own oxygen masks on first in the event of an emergency before we turn to help someone else. If we are not ok ourselves we may not be able to properly help someone else. Consistently prioritising someone else’s wellbeing at the expense of our own can cause harm both to them and to us.If you place all your energies on caring for someone else, hoping that when they feel better, you will too, you are leaving yourself at risk of ending up feeling exhausted, demoralised, upset, distressed, angry, and possibly even depressed!

    We suggest instead that you focus on helpful actions.

  • Helpful actions

    1. Become very clear on what depression (or bipolar) is. Become familiar with the signs and symptoms so that you are better placed to recognise the difference between someone ‘feeling down’ and experiencing depression / someone feeling ‘on top of the world’ who may actually have bipolar disorder.

    2. Become aware of the differences between feelings, thoughts, beliefs and actions, and how they can impact on each other.The basic principles of cognitive behavioural therapy (CBT) illustrate how our thoughts, feelings, beliefs and actions can all impact our mood. An example that you might relate to is as follows:

    You are in a shop waiting your turn to pay when someone you know comes to stand behind you. Immediately you anticipate her asking about the person you are concerned about and how they are. Notice how thoughts you may have such as ‘Oh no, here we go again’; ‘I know she is just being kind but I wish she didn’t ask’, or ‘I don’t want her to know how he is’ trigger you to feel differently than you had a few moments before. You may feel under pressure, anxious and/or annoyed. You may believe that you have not done enough, anticipate that the other person is judging you and you may react by being curt and changing the subject very quickly. Or you might believe that you have to answer all questions and may give a detailed explanation about the situation, while all the time wishing that you could end this conversation very quickly. However you may believe that this person genuinely cares about you, you may feel relieved, think ‘Oh it is good to have friends’ and you may suggest that you both meet for a coffee to catch up.

    The basis of CBT is that it is not the event, but the meaning of the event that is important.

    Aware provides two Life Skills programmes, free of charge, which help participants understand the link between thoughts, feelings, actions and behaviour. These programmes can be helpful for you by enabling you to understand a little bit better what may be going on for the person you care about, as well as helping you learn ways to manage the situation and its impact.When we are constantly in the ‘giving support’ mode it can be difficult to ask for and actually take support. So many of us tend to bottle up our own feelings and put on a ‘brave face’. There is a very real difference between talking to someone about a situation with someone we care about in a ‘gossipy’ way, and talking to someone we trust about the challenges we experience in caring for someone else.

    3. In the case of bipolar disorder it can be helpful for the person to have a ‘spotter’. A spotter is someone who can ‘spot’ when the person may be becoming unwell and can let them know. It can be difficult for the person themselves to be aware of the mood changes involved – particularly in periods of elation. It is important to discuss this with the person when they are well and to agree a simple plan.

    4. Practice actions that are helpful.

    These might include:

    • Giving the person you care about space to feel however they feel
    • Not taking things personally
    • Not rescuing, blaming, accusing or threatening
    • Planning and doing one healthy thing every day that you enjoy
    • Asking the person how you can help them
    • Suggest that they do more things that are helpful such as:

    • Following the advice of health care professionals where applicable
    • Going for a walk in the fresh air
    • Reducing or eliminating alcohol
    • Reducing sugar in the diet
    • Looking for and paying attention to one thing each day that is working well
    • Switching focus from how they are feeling to what they are doing
    • Doing things like going for a walk or having a shower rather than waiting until they feel like it
    • Acknowledging and catching any tendency to dismiss what is going well and focusing only on what is not going well
    • Ignoring conversations focusing on ‘feeling better’ and increasing conversations on ‘doing things’

    Two of the best ways you can help someone is to:

    1. Reach out and let them know you are there
    2. Get and take support for yourself

    This might seem to you to be selfish but it could well give the person you are concerned about space to take responsibility for their own wellbeing. If you are busy doing things to care for yourself, the other person may feel less under pressure and may follow your example.

  • Supporting someone who is/has been hospitalised for depression/bipolar

    If someone you care about has been admitted to hospital for treatment of depression or bipolar it can be useful to ask yourself what meaning this has for you. Are you fairly relaxed about it, or do you have concerns or fears? Your feelings about it can bring about a high degree of stress for you and can also impact your ability to be a support. It may be helpful to talk to someone about your own thoughts and feelings around this. The Aware Support Line and Support Mail services offer an understanding space to talk through any concerns you have and focus on helpful actions. Discussing your concerns and fears rather than bottling them up can make a difference.

    Where someone is in hospital

    Find out if the person would like you to visit while they are in hospital and, if so, if there is anything they would like you to bring. If you are asked or advised not to visit, don’t take this personally. Sometimes it is more helpful for the person to have a complete break from their usual life and routine while they focus on getting better. If you aren’t visiting, you may decide to send a card to let the person know you are thinking of them or maybe a magazine that you know they will like.If you do visit, it is often recommended to stay for short periods only. If the person you care about has received treatment in hospital previously you will know how important it is that you treat them normally.

    Coming out of hospital

    When someone we care about is in hospital or just out of hospital, it is important to manage our own expectations around their recovery, and to remember also that they will have their own expectations which may be putting them under extra pressure. It is important for everyone to remember that recovery does take time, and it can be really helpful to take time now and then to acknowledge and focus on the progress which has been made so far.Generally after a period of treatment a person will be discharged from hospital when they are able to cope with the pressures and challenges of day-to-day living. It may take some time to adjust and it is important that any follow-up plan agreed with the hospital is adapted. You can be an invaluable support during this phase by bringing them to follow-up appointments, encouraging them to take regular exercise and helping them eat healthily.However, don’t be surprised if the person prefers you not to be involved at all in this aftercare. If you think they are not taking enough care of themselves, consider discussing this with your GP who will be able to advise you how best to care for yourself in this situation. Further information on admission to psychiatric hospitals

  • Concerned about suicide?

    What if the person doesn’t do anything to feel better? What if he or she considers suicide? The fear that someone we care about might choose to end their own life is probably one of the worst fears that we can have.While we may feel frightened and distressed to know that someone we care about is considering suicide, we can still do something helpful. We can help the person – who thinks that they are better off dead and who feels hopeless and distressed – to know that their feelings make sense; their thoughts are just thoughts and may not be helpful; what they believe (e.g. that they would be better off dead) may not be true, and that there are always, always alternative options to suicide.

    How do we do that? By really knowing that:

    1. Just because someone thinks that they are better off dead does not mean that they are suicidal.
    2. Just because they think that they are suicidal does not mean that they have to do it: There are always other options.
    3. Just because someone has a diagnosis of depression does not mean that suicide is an inevitable outcome. There are many, many people who have depression or have had depression, and who are still alive and do not choose suicide.

    Stay alert for warning signs of suicide.These may include:

    • Talking about suicide in a way that describes it as a release and/or a solution
    • Withdrawing from social contact such as family, friends and work
    • Getting the means to carry out suicide
    • Excessive mood changes
    • Conversations centred on how helpless and/or hopeless the person feels
    • An unexplained lift in mood that may indicate that the person has decided on suicide as an option
    • Giving away belongings or getting affairs in order when there is no logical reason for doing so
    • Saying ‘goodbye’ to people as if they will not be seeing them again
      A preoccupation with death
    • Giving birthday or Christmas presents very early
      Increased use of drugs and/or alcohol

    Remember that sometimes there are no obvious signs that a person is considering suicide. If you are concerned that this may be a possibility please discuss your concerns with a medical professional and a trusted friend/family member.

    If you are concerned that someone you care about may be seriously considering suicide please:

    • Talk to them about your concern. Ask if they have had thoughts about suicide. If they have, explain that such thoughts can be normal though very distressing. Ask if they have made plans and pay particular attention to how they answer – having a detailed plan may indicate a higher likelihood of their actually attempting to take their own life.
    • Get and take help. Discuss your concerns with a GP, another family member, a friend. If appropriate contact the person’s doctor and/or medical health professional to inform them of your concerns.
    • If you are clear that the person is at immediate risk of suicide call the emergency services and ask for an ambulance or go immediately to A&E.
    • Make sure that the person is in a safe environment and remove things that could be used to harm themselves.
    • Ensure that someone trusted stays with the person until professional help arrives.

    If a person has been treated through A&E and is being discharged, it is important to enquire with one of the medical team about a follow-up care plan. For example, will there be a referral to mental health services and what is the likely process/time frame? It is also essential that the individual makes an appointment to see their GP as soon as possible.

  • Staying Connected

    One of the biggest ways of helping someone who has depression to do something to feel better is to stay connected. This might be difficult as the person might want to withdraw so we suggest:

    1. Let them know that regardless of whether they do or don’t do something to feel better, that you are not giving up on them and are there whenever they want to take your support.
    2. Access support services for yourself and encourage them to do so also.
    3. Get on with your own life, while staying connected as best you can with the person you care about.

  • Things to remember
    • Recovery from depression is possible.
    • Depression or bipolar disorder can lead to tension in relationships.
    • Support for the individual is important, and so too is support for those who care for the individual and are impacted by their experience.
    • There are many sources of support available.
    • Even where a person is refusing to acknowledge that they are having difficulties or refusing to get help, it is still possible for their relatives to seek support for themselves.
    • Thoughts, feelings and beliefs can all impact our mood: it is important to focus on helpful action.
    • Sometimes, though it may be difficult to accept, leaving a relationship which is causing significant distress may be best. If you are at this point we recommend that you discuss your options with someone who cares about you. This may be your GP, a family member or a trusted friend. A relationship counsellor may also be helpful.
    • There is a balance between doing too much and too little for someone who has depression. When someone is experiencing severe depression it can be such a relief for people who care about them to cook them meals, bring them shopping and help them with basic jobs such as cleaning. Later, as they recover, it is important that those same people who care about them resist the temptation to do everything for them.
    • Being a compassionate listener is one of the best ways of supporting someone you care about. And finding a compassionate listener for yourself is also vital.
    • People who experience depression do recover. Aware has a range of services and supports for people who experience depression and for people who care about them.

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