The role of relationships
in mental health resilience

We’re often, and rightfully, reminded that strong, resilient mental health is core to our wellness, happiness, and success in life. What we may not see so much, is how experiences of mental health suffering and success are closely linked to the relationships we hold. 


 

The link between relationship health and mental health seems intuitive. However, relationship wellbeing is often undervalued in mental health services. Rather, a focus on relationships is seen to be supplementary to the work.

Partners, parents, caregivers, or social supports are literally left out of treatment, even though they may be critical to its success. While they might be offered some education about their loved one’s diagnosis, the assumption is that knowledge about illness will be sufficient to equip them for what’s ahead.

Left to then go home and manage, it is little wonder that relationships can end up strained, caregivers at risk of burnout, and caregiving arrangements breaking down.

 

Why does this happen?

In the traditional biomedical model of mental health, the person with the presenting problem is the primary focus of intervention, and the alleviation of that person’s symptoms is the goal. The mental health concern is managed within the health system, with the treating professional as the intervention expert.

This approach is still prevalent, despite the rhetoric for many years regarding client-centred practice. In the face of evidence that the person is commonly going to live at home or have regular contact with parents, a partner, children, friends, or flat-mates. All these people will likely be implicated, in positive and negative ways, in the outcomes for the person with mental health concerns.

Further, all these people may have different roles in caring, from the friend who says, ‘Let’s go out and I’ll cheer you up’, to the employer who is concerned but has a duty to company outcomes, to the parent monitoring a family member living in a darkened room.

These people are key resources in change, but also have needs of their own which need to be considered.

 

Challenges and opportunities of mental health within relationships

In some instances, relationship and family dynamics can seem to be part of the mental health problem. Longstanding conflict, estrangement, intrusive, abusive, or overbearing people, trauma, domestic violence or drug and alcohol problems can all take their toll.

Poverty, parents with mental health issues and a history of child protection concerns will all provide context that can make well-meaning professionals see the benefit of separating the individual from the context in which they live. Sometimes that is entirely valid and necessary.

It can also be the case that those most familiar with us get so used to the symptoms, that they no longer see when problems are escalating. They lose that ability to discriminate between something being quirky and something being closer to an emergency. Perhaps more than one person is suffering, and that belief that “we will all hang in together” becomes an impediment to change, rather than a caring support.

On the other hand, family, friends, and other caregivers know us at our best. They can speak most clearly on our behalf that something isn’t quite right.

They can tell if medication isn’t being taken, if we haven’t left our rooms, have given up on social opportunities and are losing confidence and hope. They can be our advocates, cheer squads and active agents to help us get back on track.

There is still a lot of stigma about mental health issues, and that negative blanket can extend over families and friends too, seeing them as part of the problem, enablers, perpetrators, and limitations to change, rather than resources to fuel success.

It can also be said that if the person suffering with ill-health is an adult, that shutting everyone else out of treatment is part of protecting their privacy. Again, this is an important principle, but let’s ask the people involved, and take care when we rush to assumptions and to create boundaries that will limit treatment success.

 

What role can friends, family and caregivers play?

Positive relationships have been demonstrated over many studies to be critical to positive mental health in terms of keeping us strong and well. Family and caregivers are important in reducing symptoms such as suicidality, anxiety, and depression, as well as increasing treatment compliance and self-empowerment.

Supporting someone with mental ill-health can be demanding and it can be rewarding. Indeed, we would all hope that if there are difficult times, we will have good people at our backs. Mental health challenges can be situational, temporary, and unusual, or they could be part of something requiring long term management. The circumstances may well impact on what you can offer.

Here are some helpful things to consider when supporting someone through their mental health suffering:

  1. Have some self-awareness: How are you placed in your own life? What other needs and demands do you have? Where do you feel best placed to assist? It is ok if you can only do weekly phone calls or an occasional night out. Being clear about this will mean you have a greater chance of committing and sustaining what you have offered.
  2. Supports for yourself: Many are not aware that caregivers can have mental health issues themselves, either at the same time or because of the caring responsibilities. It is critical that you look after your own wellness and resilience.
  3. Stay in role: If you are a good friend, then perhaps becoming nurse or advocate or lawyer might impact on that. Often assisting with finding the resources rather than being the resources will serve everyone better in the long run.
  4. Keep things in perspective: This can require a neutral place for you to debrief the caregiving experience. If you start to feel like a critical prop in the whole plan, and that if you don’t fulfil a certain role it will fall over, then that means there are not enough people in the mix. It shouldn’t all rely on you.
  5. Don’t make promises you can’t (or shouldn’t) keep: If you are asked to make commitments such as “never call the mental health team” or “don’t tell my partner I’ve stopped taking my meds” or “cover for me at work”, then this is an alarm bell that things might have moved from healthy assistance to sometimes less useful for all concerned.
Struggling with mental health challenges is something we will all encounter at one stage or another in our lives. It might be temporary and pass in its own time, or it might require greater intervention. Good friends, family, and employers who give time, space, and support to recover, will in many cases be sufficient. Where there is a bigger battle underway, these people will still be valuable, but will take their place alongside other experts who have key roles to play.
Successful recovery will depend on everyone being on the same page, with the cast of character stepping up and then stepping back as needs change over time. Getting this right requires careful, considerate, and respectful planning. It also requires support for the care network, not only the individual suffering.

Relationships Australia NSW offers individual and couples counselling and services to support individuals, couples and families work through difficulties and find ways to move forward. Contact us to find out more. A version of this article originally appeared on Body + Soul, and has been republished here with permission.

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