Caregiving for people with mental health concerns

Rating	Description
1	Extremely Low- Helpless and hopeless
2	Low- Upset, struggling, unmotivated
3	Neutral- Neither good nor bad
4	Good- Calm, optimistic, coping well
5	Over-energized – enthusiastic and restless

Bipolar disorders are characterised by fluctuations in the mood ranging from high and elevated (mania) to low and depressed (depression).

Common symptoms

Manic symptoms: These include an elevated mood, increased energy, decreased sleep, racing thoughts, impulsivity, and risky behaviour. While some may mistake the manic phase as a “fun” time for the care-recipient, it is important to understand that it can be distressing. The racing thoughts and impulsive behaviour may lead to feelings of being out of control. Additionally, the consequences of actions taken during the manic phase may be devastating for some care-recipients.
Depressive symptoms: These include feelings of sadness, hopelessness, fatigue, changes in appetite and sleep, difficulty concentrating, and suicidal thoughts. A care-recipient may experience periods of stability between episodes of depression and mania. While the cycles may not be rapid, they may change slowly over time, depending on the severity of the condition and the ongoing treatment.

Caring for your loved one with bipolar disorder

Tracking mood patterns

Early detection: Tracking your loved one's mood regularly can help predict when a manic or depressive episode may occur. Regularly tracking these mood changes can help you plan interventions and support them.

Managing medication

Consistency is key: Bipolar disorder is most effectively managed when medication is taken consistently. However, a care-recipient may forget or skip doses during a manic episode, as they may want to continue experiencing high energy. Conversely, during a depressive episode, they may feel too exhausted to prioritise their medication.

A caregiver can use alarms, sticky notes, and calendar reminders to ensure the care-recipient takes their medicines regularly.
It is also important to keep in touch with the prescribing doctor for support.

Managing manic episodes

Use energy positively: Instead of trying to calm your loved one during a manic episode, channel their energy into fun and productive activities, such as starting a painting project or writing.

Limit risky behaviour: Set clear boundaries around impulsive decisions, like overspending or overcommitting to events. For example, create a budget, or limit the number of activities or keep the credit card or phone away (if discussed previously). This can help prevent the excitement from turning into risky behaviour, keeping the situation enjoyable and safe.

Helpful statements for manic episodes: “You seem full of energy! Let’s start a painting project together; it could be fun!”

“I see you are excited about planning events. How about we choose just one event to attend this weekend? We can make it special!”

“It sounds like you want to buy some new things. Let’s set a small budget for shopping to keep it fun and safe.”

Managing depressive episodes

Offer emotional support: During depressive episodes, simply being present and offering quiet support can make a difference. You don’t need to talk constantly; just sitting together or watching a movie together can provide comfort.

Encourage self-care: Suggest light activities like short walks or breathing exercises. If they can’t eat heavy meals, ensure they are still nourished by providing semi-solid foods like juices, soups, smoothies, or fresh fruits. Help maintain a regular sleep schedule by encouraging a consistent bedtime and wake-up time. Encourage them to continue doing small, manageable tasks to create a sense of accomplishment.

Helpful statements for depressive episodes: “I’m here for you. We can just sit together if that makes you feel better.”

“Would you like to watch your favourite movie or play a game? We can make some popcorn too.”

“It’s okay to feel this way. You’re not alone in this. I’m here to support you, no matter how long it takes.”

“Let’s set a small goal for today, like getting out of bed or taking a shower. We can celebrate these little victories together.”

Holistic support for individuals with bipolar disorder and their families: Mental Health Support Foundation

Professional guidance can provide more comprehensive support. Feel free to share the contact information for our Free Counselling Helpline service with your care-recipient. Our helpline number is 8686139139, and operates every day of the week from 9am to 8pm. Additionally, to receive 1-to-1 appointment based online therapy, they can book the session by clicking on link.

Anxiety disorders are characterized by excessive worry, fear, or anxiety that interferes with daily activities.

Common symptoms

Restlessness or uncomfortable sensations
Irritability
Rapid heartbeat
Sweating
Difficulty concentrating or racing thoughts
Avoiding places, people, and situations that trigger anxiety

To learn more about anxiety, visit https://www.manntalks.org/anxiety/

Caring for your loved one with anxiety

Practice calm breathing together

Engage in deep breathing exercises: Help your loved one manage anxiety by guiding them through deep breathing exercises. This exercise can create a calm atmosphere and encourage relaxation. Example: “Let’s take a few deep breaths together. Inhale deeply through your nose, hold for a moment, exhale slowly through your mouth, and again hold for a few moments.

Suggest relaxing activities

Encourage calming activities: Recommend simple, soothing activities like listening to music, taking a walk, or practicing mindfulness. These can be effective in managing anxiety and breaking the anxiety cycle.

Listen with patience and empathy

Offer a listening ear: Being patient and allowing the care-recipient to share their thoughts can help them feel heard and understood. Example: “Would you like to talk about what’s on your mind, or would you prefer to have a quiet moment together?”
Provide reassurance: Offer gentle reminders that it’s okay to feel anxious and that their feelings are valid. Your kind words can bring comfort and reduce their stress.

Empower their independence

Offer assistance, not control: Empower them by only stepping in as needed. Providing help without taking over tasks can reinforce their autonomy and boost their confidence.

Encourage professional help if needed

Support seeking help: If your care-recipient is finding it difficult to deal with anxiety, gently encourage them to talk to a mental health professional. Professional guidance can provide more comprehensive support. You can share the contact of our Free Counselling Helpline service with your care-recipient. Our Helpline number is 8686 139139, and it operates every day of the week from 9am to 8pm. To receive 1-to-1 appointment based online therapy, they can book the session by clicking on this link.

Here is a guide to support someone experiencing panic attacks: https://www.manntalks.org/anxiety/panic-attacks/

Depression is characterised by persistent feelings of sadness and loss of interest in activities that were once enjoyable.

Common symptoms

Fatigue
Changes in appetite
Sleep disturbances
Difficulty concentrating
Feelings of hopelessness or worthlessness, including suicidal thoughts
Diminished interest in activities that were enjoyable before
Sluggishness

To know more about the symptoms, click here.

It is important to understand that depression is not sadness. Unlike feelings of sadness, which can often be alleviated in a matter of days, overcoming depression requires long-term care and support. Those dealing with depression may struggle to function in their daily lives, and it can become challenging for them to take care of themselves.

Being depressed is not a choice, it is an extremely exhausting condition and may take months if not years to get better. Supporting individuals going through depression can mean acknowledging what they are going through and providing the necessary support they need.

Caring for your loved one with depression

Offer emotional support without judgement:

Listen with empathy: Allow them to express their feelings without rushing to fix everything. Let your loved one know you care and are there for them.
Avoid making them feel guilty for their sadness: Sometimes the best support is simply being patient and nonjudgmental.
Be kind: Your warmth and understanding can go a long way in helping them feel heard and supported. Example: “I’m here for you, and it’s okay to feel the way you do. We don’t need to fix everything right now.”

Encourage healthy habits

Staying active: Encourage gentle, simple movements like walking or stretching to help boost their mood and energy levels. Example: “How about we take a short walk together? It could help you feel a bit better.”
Eating regularly: Gently suggest maintaining regular meals or snacks to stabilize their mood and energy. Example: “Would you like to drink your favorite juice? It might help you feel a bit nourished.”
Engaging in hobbies: Encourage them to engage in activities they used to enjoy, even if it's just a small step towards reconnecting with joy. Example: “Do you want to try painting again, even for a little while?”

Power of emotional mirroring

Humans naturally mirror each other’s emotional states, a phenomenon influenced by mirror neurons in the brain. This ability allows us to absorb and subconsciously reflect the emotions of those around us. While this can sometimes intensify distress in challenging situations, a caregiver can intentionally harness emotional mirroring to support and uplift their care-recipient, helping them feel safe, motivated, and hopeful.

For instance, when the care-recipient is upset or frustrated, the caregiver can maintain steady breathing, speak in a gentle tone, and adopt relaxed body language. These cues subconsciously signal calmness, encouraging the care-recipient to feel more at ease. Sharing positive yet realistic perspectives and expressing confidence in their ability to handle challenges can further build resilience and trust. Additionally, celebrating small victories or sharing moments of gratitude can foster a sense of accomplishment and connection.

Engaging in grounding techniques, such as deep breathing, mindfulness, alongside the care-recipient can be more effective than merely suggesting they do these activities independently. This shared approach not only demonstrates support but also reinforces the caregiver’s role as a calming and motivating presence.

If the care-recipient talks about ending their life, here is the guide for you: https://www.manntalks.org/helping-someone/gatekeeping/

Consistent support through therapy is one of the essential elements in managing this disorder. You can share the contact information of our Free Counselling Helpline service with your care-recipient. Our helpline number is 8686 139139, and it operates every day of the week from 9am to 8pm. Additionally, to receive a 1-to-1 appointment- based online therapy, they can book the session by clicking on this link.

Schizophrenia is a serious mental disorder characterised by distorted thinking, perceptions, emotions, language, and sense of self. They have difficulty figuring out what is real v/s what is not.

Common symptoms

Hallucinations: Hallucinations occur when a person sees, hears, smells, tastes, or feels things that aren't present, i.e., others can’t sense those things. For example, your care-recipient might hear voices talking to them when no one is around or see things that others can't see.
Delusions: A delusion is a fixed, false belief that is not supported by evidence and is held with conviction, even when contradictory information is presented. For example, your care-recipient might think they can fly like a superhero or believe they are a famous person, even though that's not true.
Disorganised thinking: Disorganised thinking is when an individual’s thoughts move very quickly from one idea to another, making links and seeing meaning between things that others don’t. Their thoughts may come across as jumbled and difficult for the listener to follow. They might start talking about one topic and suddenly switch to another unrelated subject.
Emotional flatness: Emotional flatness is when one has trouble expressing or feeling emotions, i.e., when something happy or sad happens, they may appear detached and unresponsive. It's like when someone is really quiet and numb all the time, no matter what is going on around them.

Caring for a loved one with schizophrenia

Create a safe environment:

Set Up a Relaxation Space: Designate a peaceful area in the home where they can retreat when feeling overwhelmed. Remove any sharp objects and minimise bright lights or any loud noises around the room. This could be a bedroom set up with pillows and blankets to create a soothing and safe atmosphere. For example, you could say, “Let’s set up this cosy corner where you can relax whenever you need to.”

Encourage positive social interactions:

Foster social engagement: Support their social connections and encourage them to step out, if safe for them and others and stay connected with friends and family, as social support can help manage symptoms.

Monitor medication consistently:

Manage medical routine: Ensure they take their medication regularly and help them adhere to their medication schedule. Abruptly stopping medication can trigger a relapse of symptoms. Set reminders or offer gentle prompts to help them stay on track.

Responding to distress or a psychotic episode

Stay calm and composed: Maintain a gentle and steady demeanour to help your care-recipient feel safe and understood. Example: “I’m here with you, and we’ll get through this together.”
Listen without judgement: Allow them to share their experiences, thoughts, or feelings without interrupting or dismissing their perspective. Example: “I’m listening; you can share what you’re feeling or experiencing.”
Speak reassuringly: Use a soft, comforting tone to reassure them that you’re there for support. Example: “I see you are feeling overwhelmed, and it’s alright. Let’s talk about what’s going on right now.”
Avoid confronting their beliefs: Don’t argue or challenge their thoughts, as this can increase agitation. Instead, acknowledge their feelings respectfully. Example: “Yes, I understand that somebody is bothering you.”
Encourage grounding techniques: Suggest deep breathing exercises or grounding practices to help them calm down. Example: “How about we hold this soft cushion that makes you feel protected?”
Seek professional help if needed: If the situation becomes dangerous or unmanageable, don’t hesitate to contact mental health professionals for assistance. Example: “It might help to talk to someone who can provide additional support.”

For holistic support for a care-recipient with schizophrenia and their family, visit the Schizophrenia Research Foundation (SCARF).

Substance use disorder is characterised by an inability to control the use of legal or illegal drug, leading to significant impairment or distress in day-to-day life.

Common symptoms

Craving: A strong, constant urge to use the substance, often hard to resist. It can be triggered by stress, places, or people associated with the substance use.
Inability to stop: Despite the desire to quit, individuals struggle to cut down or stop using the substance, feeling unable to control their behaviour.
Tolerance: Need for consuming more of the substance to feel the same effects, which can lead to alarming levels of use over time.
Withdrawal: Experiencing physical or emotional discomfort when not using the substance, such as anxiety, nausea, or irritability, making it challenging to stop.
Neglecting responsibilities: Focusing on substance use over important obligations like work, school, or family duties.
Time spent using: A lot of time is spent obtaining, using, or recovering from the substance, often at the expense of other activities or relationships.
Risky behaviour: Engaging in dangerous activities, like driving while under the influence or taking unnecessary risks while using the substance.
Loss of interest: Losing interest in activities or hobbies that were once enjoyable as substance use takes precedence over everything else.

A lot of people believe that individuals with substance abuse problems just don’t want help. However, the truth is, that many feel trapped by their addiction and are weighed down by shame, fear, or uncertainty about how to seek assistance. It’s also important to remember that while using substances may start as a choice, addiction fundamentally alters brain chemistry, making it incredibly challenging for individuals to regain control.

Similarly, there’s this idea that recovery is a quick and easy journey, but it’s often far from that-setbacks and relapses are common, and real change takes a long-term commitment. Lastly, the stereotype that people going through addiction are dangerous can be harmful; many people struggling with substance use are just trying to navigate their challenges and deserve understanding and compassion, not judgement.

Caring for someone with substance-use

Communicate with empathy

Express concern without accusation: Use "I" statements to share your feelings and observations without sounding accusatory. This approach reduces defensiveness and encourages open conversation. Example: “I’ve noticed you’ve been drinking a lot lately, and I’m worried about your health and safety.”
Acknowledge their struggles: Show empathy by validating their experiences and feelings. Being compassionate can make them feel supported and more willing to share their challenges. Example: “I can’t imagine how tough this must be for you. It’s okay to feel lost or scared. If you ever want to reach out for help, I’ll be right here.”

Encourage accountability

Discuss the impact of their behaviour: Help them understand how their actions affect others, without shaming them. This may motivate them to consider change. Example: “I know your situation is complex, and I understand. But I also worry about how this is affecting your relationships with me and others around you.”
Allow natural consequences: Avoid enabling behaviours by making excuses for them or covering up their mistakes. Allowing them to face the natural outcomes of their actions can help them recognise the need for change.

Share resources without pressuring

Provide information about treatment options: Share resources on support groups or treatment programs in a way that feels supportive, not forceful. Example: “I found some information about support groups and treatment options. I am sharing them with you; feel free to check them out.”
Support their progress if they are undergoing treatment: For those already in rehabilitation, encourage them to stay engaged in their program. Show interest in their treatment journey and celebrate small victories, as recovery is a gradual process. Example: “How has your rehab program been going? I’d love to hear about any challenges or successes along the way. Is there anything I can support you with?”

Set boundaries for your well-being

Establish clear limits: Communicate your expectations regarding their behavior, clearly defining what is acceptable and what is not. Let them know what you are comfortable with and what crosses your limits. This is essential for maintaining your well-being and encouraging positive changes.
Example: “I care about you and want to support you, but I need to be clear that I can’t be around when you’re using. It’s difficult for me, and I hope you understand.” Or: “You can’t carry drugs home and cannot engage with them here.”

Celebrate small successes

Be patient: Recovery is not linear, and relapses may happen. Encourage even small steps forward, offering continued support if setbacks occur. Patience and steady encouragement can be a strong source of motivation for them.

Why should I call the helpline when I can talk to a friend or a family member?

While talking to a friend or family member may be comforting, there is a risk that they might bring their own biases and judgements to the conversation. There may also be things that we don’t want our loved ones to know—thoughts and emotions that cause us anxiety, guilt or shame; or painful emotions that they might not be able to handle.

The mental health professionals at Mann Talks are trained in the art of listening and offer a safe space without any bias or judgement. This will allow you to speak more freely than you would with someone you know. They are also trained to be able to understand your pain and situation, and help you resolve your issues.

Will the helpline tell my family about the things I share?

At Mann Talks, we prioritize confidentiality, dignity and respect of the caller. Our mental health professionals will not share anything you discuss with anyone else. The only time confidentiality may be broken is if the mental health professional feels you might harm yourself, or those around you.

In any other circumstance, what you share remains confidential.

What if I don’t like who I’m talking to?

It is important to feel comfortable with the mental health professional you’re accessing treatment from. If you feel like the professional you’ve been assigned/are speaking to isn’t a good fit for you, it’s okay to request a different one.

Don’t feel pressured to continue to talk to a professional you don’t like—after all, Mann Talks is for your wellbeing, and your comfort comes first.

Date:	Day:
Time of the day	Morning (time)	Afternoon (time)	Evening (time)
Mood rating (using the scale below)
Activity and associated emotions (use the emotions wheel below)
Triggers (explained below)