The old adage for physicians, “First, do no harm,” seems like an obvious statement. In fact, it could easily be replaced with the positive alternative: “First, offer help.”

In the treatment of mental illness, we family members have often witnessed how the “system” ends up harming our loved ones rather than helping them. In the spirit of helping doctors, clinicians and health care managers, here are some ways you can tell if you’re harming or helping.


When you discharge someone who is still in psychosis and expect them to find housing on their own, you’re doing harm. When you treat them as if they were your own family member and prepare a proper transition plan, you’re offering help.


When you ignore calls from family members caring for someone with a serious mental illness, you’re doing harm. When you listen to families’ concerns, provide general guidance and encourage your client to engage his/her family, you’re offering help.

When you pretend that someone who’s clearly ill and unable to recognize their illness still has the ability to make informed decisions about treatment, you’re doing harm. When you educate yourself about dealing with someone with Anosognosia and actually engage them so they want treatment, you’re offering help.

When you allow someone to languish all day alone and isolated in a hospital room with minimal human interaction, you’re doing harm. When you provide a friendly, supportive environment with staff that genuinely care and programs that are engaging, therapeutic and adequate, you’re offering help.

When you’re in a position to improve policy but scoff at families’ legitimate concerns, you’re doing harm. When you honestly listen to concerns and apply them in a way to improve policy for your patients, you’re offering help.

When you damage the relationship between your patient and their family by revealing information the family has given you in confidence, you’re doing serious harm. When you recognize that family members are lifelong caregivers and therefore the familial relationship is vitally important to your patient’s well-being, you’re offering serious help.


These statements may sound obvious or even trite, but these harmful actions occur on a regular basis. Fortunately, the helpful actions also occur.

Those working in health care, particularly mental health, carry a huge burden and may get complacent or discouraged. Family members don’t want to add to your burden; we want to work with you for the sake of our loved one – your patient. We hope you’ll see that as an offer of help, not something that will do harm.