When Katharina Nagel’s son returned from a trip to Australia in 2011, she quickly felt that the 23-year-old was not doing well. At times he was barely responsive. The family felt he was losing touch with reality. “The situation was very scary. We didn’t know what that was. Nobody in our family has ever had anything like that,” reports the mother from that time ten years ago. Her son fell ill with a psychosis – so severe that the symptoms have haunted him to this day.
schizophrenia at a young age
Lisbeth* has repeatedly experienced episodes of madness since she suffered from schizophrenia at a young age. Then she calls her friend Sabine Heffner*. “Lisbeth sometimes sees men following her. But there are only trees there,” reports Heffner. She has been accompanying her friend for decades, and yet she says: “I know far too little about the disease. It would be helpful to be able to see at least the first signs. But even then I often wouldn’t know what to do.”
Environment can help in the crisis
While band-aids are readily available when a friend cuts their knee, few know what to do when the wound is emotional. Every third person in Germany suffers from a mental illness at least once in their life. Friends, family or close work colleagues usually see the signs quickly – and yet they often hesitate. They fear stepping into a hornet’s nest, making things worse. But experts agree: the social environment can buffer mental stress and help in times of crisis.
Dealing with mentally ill relatives
How can relatives help mentally ill people? In which situations should they become active? When is professional help advisable, under what circumstances does an emergency service or even the police have to be called? The boundaries are not always very clear. Nevertheless, there are indications of when which support is advisable.
Better in private
Friedrich Kiesinger. © picture-alliance/ ZB
If a friend, family member or work colleague suddenly and clearly changes their behavior or external appearance, these can be signs of a crisis or mental illness (see first aid). Then the following applies: “An open discussion can be very relieving,” says Friedrich Kiesinger, senior psychologist at the Berlin Crisis Service. He advises addressing the observed changes directly, without reproach.
Don’t force help
“I should only offer my help to someone if I’m serious and willing to invest the time,” says Kiesinger. Rarely can a problem be solved in ten minutes. The frame should also be right. “Don’t talk to the person about possible problems in front of others, rather in private,” says the psychotherapist.
Don’t take rejection personally
Cornel Binder-Krieglstein gives courses on “First Aid for Mental Illnesses”. © Binder-Krieglstein
But how to start? “A simple ‘How are you? ‘ would be a good first sentence,” says Cornel Binder-Krieglstein, a psychologist from Austria. For around ten years he has been offering first aid courses there for people with mental illnesses. In it, laypeople learn how to help others in emotional distress and also how to have an initial conversation. It helps to follow a few rules. “Before you start the conversation, you should be aware of your role: you want to show compassion and support! Then formulate and act like this,” advises Binder-Krieglstein.
bring patience
It is not helpful to give unsolicited advice. Soothing phrases like “It’ll be fine” or “Pull yourself together” hurt and signal that the suffering is not taken seriously. The helper should hold back with his life story, he is not the center of attention. As a listener, he has to be patient: the other person usually needs time to talk, to cry, to be silent.
reluctance to touch
Too much physical proximity is also not advisable. A hand on the shoulder can offer comfort, a hug is better to be avoided – except with close friends. It may also be that the other person does not want to speak to you at all. Then helpers should not impose themselves when dealing with a mentally ill person. “Don’t take this personally. Signal that you will still be there if the other person needs help,” says Binder-Krieglstein.
When professional help is important
At a certain point it makes sense to recommend professional help to the person concerned. For example, if he has repeatedly failed in his own attempts to solve the problem. Or when his suffering is great or he finds it difficult to live everyday life with work, leisure time and relationships. However, relatives can also experience that a mentally ill person cannot be helped.
Research offers
Anyone who advises professional help can better support those affected if they have previously found out which offers are available. If the person concerned is open to this, the relative can also discuss options – self-help groups, advice centers, family doctor, specialist or psychotherapist – or help with the often difficult search for a therapist. Nevertheless, everyone has the right not to seek help in mental crises.
Coping with acute crises
However, there are exceptions to this rule: friends and relatives can do little if a person is in an acute crisis in which he threatens to kill himself or is very aggressive towards fellow human beings lost in madness. Then you should definitely consult professionals – to protect the patient and yourself. This puts many in a dilemma: they want to help their friend, family member or colleague. Calling a psychiatrist or the police against their will can cost them trust.
Outside helpers can calm things down
Sabine Heffner drove straight to her when Lisbeth called delusional. Her friend did not open, raged in her apartment. Heffner was very worried. “I knew then that I had to hand it over to someone from the field,” she says. She called a psychiatric ambulance. The staff came and talked to Lisbeth through the closed door until she opened it and accepted help.
Psychiatrist asked for advice
Katharina Nagel turned to her son’s doctor when he became increasingly ill, but did not realize that he needed treatment. The psychiatrist advised her to see a legal guardian. “Such a supervisor is always necessary when someone cannot regulate their affairs in various areas of life themselves,” explains lawyer Rolf Marschner (interview Everyone can suggest a supervisor).
In an emergency, the social psychiatric service and the police will help
If a person threatens to hurt themselves or others, if they lash out madly or if they are very agitated, the social psychiatric service is an important point of contact. It is available in all federal states, often affiliated with the health department. In an emergency, he calls the police. If the situation is acutely heated up and dangerous, relatives should call the emergency number directly (How to find professional help). Important: If the person concerned is feeling better again, an open discussion about this acute situation can be advisable – and have a conciliatory effect for the future.
* Names changed by editors.