Supporting a Loved One

When a family member becomes ill with mental illness, the whole family is affected. Besides dealing with the impacts of the illness – which may be accompanied by bizarre and frightening behaviour – family members also struggle with navigating the mental health system (and often the legal system) to get treatment for their loved one.

Serious mental illnesses, including schizophrenia, schizoaffective disorder, severe Bipolar disorder and borderline personality disorder, are devastating. Often they are accompanied by Anosognosia – the inability to recognize the illness by the one afflicted by it. Family members, though, recognize severe changes in behaviour and affect – and the natural instinct is to try to get help. All too often, that help is hard to find. That’s why FAMI-Alberta was formed: we’ve been through this and want to help others.

Serious mental illnesses may have lifelong impact on your loved one, which may be mild or severe – or somewhere in between. These illnesses can cause permanent changes to the brain. There may be:

  • loss of motivation affecting the ability to work and engage in social activity
  • impaired ability to relate to others
  • social withdrawal and isolation
  • impairment of ability to plan or organize day to day living
  • disruption of thought patterns and inability to perform tasks

As well, you and your loved one may experience grief, shame, loss and fear.

Your loved one may require support for the rest of their life. Families provide 90% of the support in these situations, but families’ role as caregivers is generally not recognized by the health care “system” and families are left on their own to figure out what that role involves. This can be especially hard since these illnesses often strike in late adolescence or early adulthood – when young adults are legally independent but still depend on their parents for financial and other support.

What to do when a mental illness first occurs

Onset of a mental illness (known medically as the Pronodal Phase) can be a terrifying, disruptive time in a family’s life. Every situation is different and each may need a slightly different approach; however, the following tips from families who’ve been through it may help when you notice severe changes in behaviour that you suspect may be a mental illness

  • Contact the Edmonton Early Psychosis Intervention Clinic (EEPIC), which offers services to individuals 16 to 35 years of age who have a suspected psychosis or are displaying early signs and symptoms of psychosis. Phone number: 780-342-5523
  • If your family member is a young person (16-25), Access Open Minds is a walk-in clinic providing a welcoming, non-judgemental, and inclusive space for youth and their families seeking addiction and mental health supports.  The clinic is at the Bill Rees YMCA, 10211-105 Street NW, Edmonton. Walk-in hours are Tuesday to Friday 12:00 noon – 5:30pm (no appointment necessary), or call them at 780-415-0048 (you’ll need to leave a voice mail message).
  • Alternatively, try your family doctor. If your family member is willing, take him or her to the doctor to rule out a physical cause. If they won’t see a doctor, go yourself and describe what you’ve noticed – your doctor may know of resources in your community, and may be able to suggest some strategies. However, many family doctors don’t have much training in mental illness and may not know which options are available.
  • If someone is experiencing a mental health crisis but is not in immediate danger, call Access 24-7 at 780-424-2424. If you or someone else is in immediate danger, call 911.
  • Keep a written or electronic record. Every day, record what behaviour you observe – be specific and factual. Also note any medical professionals you contacted, and what they said. It’s best to record these things at least once a day, when they’re fresh. The records will be handy when you consult with medical professionals, and may be useful if you ever need to seek guardianship, etc. They also help to get the events of the day out of your head and onto paper or into your computer.
  • If your loved one doesn’t acknowledge having a mental illness, read I Am Not Sick, I Don’t Need Help!: How to Help Someone with Mental Illness Accept Treatment by Dr. Xavier Amador and use the LEAP technique (listen, empathize, agree, partner). You can download the LEAP section here.
  • Check out the Advanced-Caregiving video series on prevention parenting, inspired by Emotion-Focused Family Therapy.
  • Talk to other families who’ve been through this – or check out support groups on our resources page. You’ll likely find others with suggestions on how to navigate the system.
  • Understand the illness and how it has affected your loved one – see the links on our resources page.
  • Look after yourself – you’re likely experiencing feelings of guilt, shame, frustration and unconventional grief. It may feel like nothing you do is right. The causes of mental illness are complex and include genetic and environmental factors. It isn’t caused by faulty parenting.

What if my loved one doesn’t believe they are ill?

  • This is a common occurrence; often serious mental illness is accompanied by Anosognosia – inability to recognize the illness.
  • Anosognosia is different from denial; it’s being unable to recognize the presence of the illness. No amount of reasoning or arguing will convince someone to believe something they’re unable to.
  • Read these sections of Dr. Amador’s book I am not Sick, I don’t Need Help and practice the LEAP method of interacting with your family member.
  • Enroll in a LEAP course (see next section).
  • Remind them that you love them, and be as supportive as you can.

LEAP Training

Do you have a family member with a serious mental illness who won’t acknowledge it, and isn’t willing to accept help? If so, then LEAP can help.

The LEAP (Listen – Empathize – Agree – Partner) approach was developed by Dr. Xavier Amador, author of I Am Not Sick, I Don’t Need Help!: How to Help Someone with Mental Illness Accept Treatment LEAP can help you quickly gain the trust of someone who needs your help. The goal is to get your loved one to accept treatment and adhere to medication; this is accomplished by strengthening your relationship.

FAMI-Alberta has a family member certified as a LEAP trainer. The next sessions will be held on Saturday January 11 and February 1, 2020 from 9:00 am to 4:30 pm in south Edmonton. Coffee and lunch will be provided. Topics include:

  • Identifying Anosognosia vs. “denial”
  • Lowering anger, resistance & defensiveness
  • Re-establishing trust & broken relationships
  • Creating an alliance that leads to treatment.

These are free of charge for family members of someone with mental illness who doesn’t acknowledge their illness and won’t accept treatment.

REGISTER HERE

We’ll offer more classes when we have enough interest; please contact the LEAP trainer for more information. To learn about future LEAP sessions, sign up for our newsletter.

Note: training can also be arranged for health care professionals, law enforcement, or any other group that works with persons who have a serious mental illness. Please contact the LEAP trainer for more information.

DOWNLOAD THE LEAP POSTER

Getting Medical Treatment

This can be difficult when a loved one isn’t willing to accept help. Often, intervention is required. In Alberta, the Mental Health Act defines how someone can be committed to hospital without their consent – known as an involuntary or formal patient. For involuntary admission, these three criteria must be met:

  1. suffering from a mental disorder,
  2. likely to cause harm to themselves or others or to suffer substantial mental or physical deterioration or serious physical impairment, and
  3. unsuitable for admission to a facility other than as a formal patient.

Some mental health professionals may refer to an outdated, more restrictive criteria (“danger to self or others”) to keep your loved one from getting needed treatment. If this happens, this page provides a clear explanation of the changes.

Here are some suggestions for how to get help:

  • If you’re in immediate danger, call 911.
  • If someone is experiencing a mental health crisis but is not in immediate danger, call 780-342-7777 for the Community Urgent Services Team (CUST). They will assess the situation and may dispatch medical and/or police personnel.
  • Under the Mental Health Act, there are generally three ways a person can be brought to a facility in order to be examined by a physician:
    • a physician may issue an admission certificate (Form 1);
    • someone who believes a person is suffering from a mental disorder and meets the criteria may appear before a provincial judge who may issue a warrant (Form 8);
    • police may apprehend the person and take them to a facility to be examined by a physician (Form 10).
  • If two doctors issue admission certificates within 24 hours of being detained, the patient can be kept for up to 30 days. The family may be contacted by the doctor to provide information for the certificate. At this point the patient is known as a formal patient. However, the patient still has the right the refuse treatment (i.e., medication).
  • If the patient persists in refusing treatment, a doctor can complete a Certificate of Incompetence (Form 11) that would allow treatment without consent. If that happens, parents or other family members may be called in to sign as a Substitute Decision Maker.
  • The involuntary admission can be extended by the doctors at the facility.

Navigating the System

If your loved one is admitted to hospital, you may feel like you’re being treated as an outsider. The patient, whether admitted voluntarily or not, can refuse to let the medical team discuss their condition with you. Still, there are ways to be involved.

  • Let the medical team know you’re there to support and advocate for your loved one.
  • Try to find out what the treatment plan is and include yourself in the plan, if you can.
  • Find out who the social worker is and make contact with them. The social worker should be working on a discharge plan – let them know whether or not you’re willing to take your family member back into your home.
  • Even if your family member won’t permit the hospital staff to share specific information with you, you can provide information to them. Keep in mind that they aren’t obligated to keep that information confidential, and may share it with their patient.
  • Even if the staff won’t give specific information, they can still give general information about the illness and resources to help you.
  • Prepare to be frustrated at the lack of information. Try to support as best you can.
  • Visit as often as you can. The staff will know by your presence that you’re actively engaged with the patient.
  • Always treat the staff with respect, even if you disagree with them. If there’s a major item of disagreement, ask to speak to their supervisor or unit manager.
  • For specific questions in the Edmonton region, call the CMHA-ER Advocacy Coordinator at 780-414-6317.

Mental Health Court

The Edmonton Mental Health Court (MHC), established in April 2018, deals with accused that are in trouble with the law at least in part because of mental health issues. The Court uses a therapeutic model, which involves a collaborative and healing approach. The Court has the help of a dedicated prosecutor, a dedicated duty counsel, a Legal Aid resource person, a dedicated mental health worker, and a psychiatrist.

When an accused meets the criteria and volunteers to participate, the Court uses a collaborative approach to find a solution, with the help of the team of professionals. The solution always includes a therapeutic or healing objective. Currently, Edmonton has the only MHC in the province.

Only a Judge can formally refer accused persons to the MHC, but counsel can recommend a referral at any stage, based on their own observations or based on input from others such as police, a Justice of the Peace or family members.

Similar to other criminal courts, the Crown counsel and the defence counsel are the principal parties in the Mental Health Court, and the Judge attempts to arrive at a decision that is fair and effective. However, in this Court the process is slowed down, the specific circumstances of the accused are taken into account, and the Judge has the help of a group of legal and health professionals to guide the decision. The focus is on addressing the problems that cause the behaviour, rather than on punishing the offender.

FAMI-Alberta held its sixth Love You Forever workshop at the MHC in May 2019, where we met with the judges and other professionals involved. We learned that the MHC is more friendly and less intimidating than a standard courtroom. Family members of the accused don’t have any official standing in the Court (even with guardianship), but can speak with one of the officials if desired. Note that some accused with mental illness may not want to attend MHC if they have anosognosia (are unable to recognize their mental illness) or due to stigma.

 

Provincial Mental Health Diversion Program (PMHDP)

The primary goal of the Provincial Mental Health Diversion Program (PMHDP) is to divert individuals charged with a minor criminal offence who have a suspected or diagnosed mental or concurrent disorder from the criminal justice system to appropriate mental health, addiction treatment, and social supports in their community.

A partnership between Alberta Health Services and Justice and Solicitor General of Alberta, the PMHDP, provides an alternative to traditional court prosecution for individuals who have come into conflict with the law primarily due to a mental health disorder.

Finding Housing in Edmonton

Finding appropriate housing for a loved one with mental illness can be a daunting task. Numerous agencies offer a variety of services for those living with mental illness, addiction or both. Some feature supportive living in a group setting, others offer more independent living. Despite the number of agencies offering housing, there’s a limited amount of housing and most programs have a waiting list – sometimes quite lengthy.

On this page we have housing information from Alberta Health Services (AHS), Canadian Mental Health Association Edmonton (CMHA-ER), and Homeward Trust Edmonton. This is not an exhaustive list; other options may be available but this should provide a good starting point. Keep in mind that no housing sites will keep a client against his or her will – all require at least a minimal level of cooperation.

Alberta Health Services – Cross Level Housing

AHS prepared a Cross Level Housing Guide which they presented at a FAMI workshop on June 18, 2019.  The document includes information about both transitional and permanent housing, and most are collaborations with other organizations. Here’s a summary of housing sites; those marked with * offer services that are non-prohibitive towards substance use (harm reduction, managed alcohol, etc.). The others are considered “sober sites” for those not living with addiction. For more information about each site, download the Cross Level Housing Guide.

Transitional housing sites, listed in order from more supportive to more independent, are:

  • *WISH In-Motion Homes: Two-year group homes with onsite HCA support.
  • *Inner Ways, Buffalo Home: Harm-reduction, transitional supportive housing for self-identifying women.
  • *Inner Ways, Bear & Beaver Den: Harm reduction, transitional supportive housing.
  • Journey Home: Forensic focused, skill-building group home for transitioning to independent living.
  • House Next Door, Houses 2 & 4: Forensic focused, skill-building group homes for ongoing community reintegration.
  • House Next Door, Houses 1 & 3: Skill-building group homes for transitioning to independent living.
  • *Donnelly House: Three-month group home for individuals with a transition plan and community supports in place.
  • Cornerstone: Apartment-style, sober housing program for self-identifying women.
  • *Anderson Hall: Apartment-style, housing program for young adults (18-30).
  • *DiverseCity: Assertive Community Treatment (ACT) Housing First program.

Permanent housing sites, also listed from more supportive to more independent, are:

  • *Ambrose Place: Indigenous focused, harm reduction assisted living site.
  • Stepping Stones: Mental health assisted living site.
  • Edmonton People in Need Shelter Society: Inner-city, supported housing.
  • *e4c Harm Reduction Lodge: Lodge-style supported housing for people with mental health and concurrent disorders.
  • Support Homes: Various group homes with 24/7 Health Care Aide support.
  • *Cloverleaf Manor: Harm-reduction, lodge-style living in Warburg for people age 24 to 64.
  • Belvedere Apartments: Apartment-style housing with 24/7 HCA support.
  • *Iris Court: Lodge-style living for people age 18 to 55.
  • Ottewell Manor: Lodge-style living for people age 55 to 64.
  • *Our Place: Long-term, supportive group home for 10 women.
  • *Meadows Place: Four group homes and one satellite house for men.
  • *Balwin Place: Harm-reduction, permanent supportive housing in an apartment.
  • Approved Homes: Supportive home environment in family or couple’s homes.

Each location in the document has a phone number. As you read through it and find a type of housing that seems appropriate, give them a call to discuss your situation and learn more about the facility. They may invite more involvement or recommend a different location to better suit your loved one’s needs. If you can’t determine the most suitable option, go to the Strata Health Pathways section on page 10 and call the Housing Consultant or Intake Coordinator.

Canadian Mental Health Association-Edmonton Region

The goal of CMHA-ER’s housing program is to provide quality secure and affordable housing for people with mental illness and/or low income. The program works with tenants and their supports to maintain long-term housing. It’s available to adults with a history of mental illness or low income who are capable of independent community living.

Their current locations are:

  • Wood Manor – 8 one bedroom and 1 bachelor single occupancy suites
  • Citrus Court – 26 one bedroom single occupancy suites
  • Edward Street – 27 bachelor, single occupancy suites
  • Santa Rosa A & B – 38 one and two bedroom suites
  • Place 103 – 30 one bedroom suites
  • Northern Arms – 15 bachelor, one bedroom, and two bedroom suites

To learn more, go to the CMHA-ER’s Housing Program page.

Homeward Trust Edmonton – Housing First Program

Housing First is a recovery-oriented approach to homelessness that involves moving people who experience homelessness into independent and permanent housing as quickly as possible, with no preconditions, and then providing them with additional supports and services as needed. If your loved one is currently experiencing homelessness and you’d like further information on housing programs call 780-702-5267 or leave a message to get a call back.

There are weekly housing workshops at various locations. The workshops offer information about affordable housing and resources, help with online housing searches and a list of available rentals, updated weekly. The workshop schedule as of June 2019 is:

Mondays 9-11 am Bissell Centre, 10527 96 Street
Mondays 3-5 pm The Neighbour Centre, 10050 81 Avenue
Wednesdays* 1-3 pm Edmonton Public Library (Enterprise Square), 10212 Jasper Avenue      * not held first Wednesday of the month
Thursdays 9:30-11:30 am Mosaic Centre, 12758 Fort Road

 

It could also help to talk with other families in a similar situation. Find a support group on our resources page or post questions on the FAMI Facebook group.

If you find any information on this page is outdated or incorrect, please let us know.

 

Helping in the Long Term

Those in the mental health field often talk about recovery. This doesn’t mean that someone will be “cured” but the symptoms may subside over time with treatment. Your loved one will likely be permanently affected in some way. You may have to change expectations for the future. But, for many, it may be possible to manage and create a fulfilled and happy life for your loved one and yourself.

Some things you may want to consider are housing, setting up a trust fund, trusteeship or guardianship. These all take time and patience. Check our resources and links pages for agencies that can help.