A person with mental health challenges needs constant support of key family members. A study called the ‘International Pilot Study Of Schizophrenia’ was done by the World Health Organisation. It was found that patients in India had better recovery than patients from Western countries and this difference was due the high quality of support they got from family members. So, a lot depends on the contribution of caregivers. We, mental health professionals look upon patient’s friends and family as important members of the treating team and caregivers are a great resource for us. Then, what makes a great CAREGIVER?
The 3Cs
Several personal qualities have been studied as essential to the caregiving role. These include empathy, love, compassion, competence, caring attitude, financial stability and so on. In my experience, the most important among them are- CONNECTION, COMMUNICATION and self- CARE. Any person who has found himself/ herself in the caregiving role can cultivate these qualities to help their loved one.
CONNECTION
The connection that a caregiver feels is mainly of compassion. Caregivers feel a deep concern for the patient and are invested in their well- being. It is also true that sometimes one becomes a care-giver because there is no one else to take the responsibility. At such a time, one has to learn EMPATHY. Empathy means to visualize the patient’s situation and try to understand the effects that it has. When you have empathy, you will maintain your own point of view which may be different from that of the patient. As they say ‘we can disagree and yet stay together’. Caregiving does not mean that patient and the carer remain with each other all the time, to the exclusion of everything else. The caregiver supports by becoming available to the extent that is healthy for the patient and that does not lead to dependency. The connection between the patient and caregiver has to allow for freedom and individuality. Neither the patient nor the caregiver exerts control over the other.
COMMUNICATION
Caregivers are the ‘first responders’. Whenever a person feels turmoil, it is the caregiver who soothes them. Caregivers have to therefore be good at communication. Good communication means to ‘speak less and listen more’. The caregiver uses both verbal and non- verbal means to give comfort. Caregivers must avoid ‘çounseling’, ‘motivating’ or ‘logical reasoning’. Patient’s condition is usually due to brain responses that are beyond control. So trying to talk the patient out of their symptoms or their behaviors causes more stress to them. Best is to be available to the patient when they want to express and listen calmly to what is being said. You don’t have to agree to everything they say but there is no need to try to change the patient’s beliefs- that is the professional’s job. Often non-verbal means like being nearby to the patient, looking at the patient softly, holding hand, patting the shoulder or holding them close- all done without uttering a word, help the patient to feel secure and better.
Another important communication role is to coordinate with the rest of the treating team. As caregivers are in close contact with the patient, they can share their observations. It helps us to correctly understand the behavior, effects and side effects of medicines. It is a useful habit to write down observations and carry this to the consultation. Caregivers also have to remind the patient about treatment instructions that they may be not following properly. They will need to learn to be tactful and assertive when some of the instructions are not to the liking of the patient.
SELF CARE
Being a caregiver is a very stressful situation. Research has shown that due to the demands of this role, sometimes caregivers themselves go through a lot of problems. The problems vary from boredom, anger, lack of a sense of well-being to the development of chronic or serious health problems. Taking care of a person with mental illness is not a short term task but a long term commitment. The problems are sometimes complicated and resources are limited. It taxes the abilities of even the strongest of people. The best course of action is to work on remaining strong enough to be able to handle all the challenges. Some people see their problems as arising out of the patient’s mental condition. This makes them feel that continuously trying to improve the patient’s condition is the only way. This is not true. While the patient’s condition is being addressed, the caregiver has to make separate efforts to restore themselves. These efforts are called ‘self -care’ activities. Some time and resources are required to do self- care activities. Also self- care activities are effective only when done regularly. Caregivers should not feel guilty about taking out the time or spending some money to take care of themselves.
Activities for self- care
- Time out and diversion
Caregivers must take regular, daily breaks from being with the patient. They should pursue their hobbies and social activities to the extent possible. This is possible by sharing responsibilities.
- Diet, sleep and exercise
A balanced diet with plenty of fluids, vitamins and minerals is as important for the caregiver as it is for the patient. Ensure proper hours of restful sleep as that refreshes the system. It is also important to avoid using cigarettes, alcohol, sleeping pills and such substances.
- Daily exercise- whether it is yoga, brisk walking or dance is essential
- Health monitoring and health care As per the age, caregivers need to get regular check- ups for their own health problems. If advised some medicines or treatments, they should meticulously follow them and maintain health
- Stress Management
Caregivers have to face many issues other than taking care of the patient. So there is a lot to be handled at the same time. Some form of purposeful stress management will need to be learnt. Maintaining healthful habits, diet, hobbies and regular schedule helps to manage stress. In addition, you can seek counseling and treatment for yourself from the treating Psychiatrist. There are also support groups of caregivers where people can support each other by sharing coping strategies. Meditation and mindfulness are helpful for many people.
- Living a full life
Sometimes mental health issues completely envelop the caregiver and drown out every other aspect of life. This is not recommended. Mental illness is a huge challenge but let it be only a part of your life; do not allow it to take over your whole life. Caregivers should pay attention to living life to the fullest, as much as possible. This means to continue your work, hobbies and friendships with good planning and to the extent that it is possible.
- Attitude management
Caregivers go through guilt, fear or shame. They feel a sense of defeat when mental illness is diagnosed in their loved ones. But the fact is that mental illness is not caused by any one factor and no person is to be blamed for causing it. One has to cultivate hope and confidence. A scientifically informed approach and ‘can-do’ attitude is required.
In conclusion the Caregivers are the bedrock of the patient’s recovery. In the caregiving role one has to pay attention to developing the 3Cs for success.