How to Persuade Your Loved One to Seek Professional Help

By MARGARITA TARTAKOVSKY, M.S.

Associate Editor


Research has shown that mental illness tends to disrupt people’s lives even more than physical conditions, said Dr. Mark S. Komrad, MD, a psychiatrist and author of the excellent book You Need Help! A Step-by-Step Plan to Convince a Loved One to Get Counseling

“On average, a person with depression is at least 50 percent more disabled than someone with angina, arthritis, asthma or diabetes,” according to this report by The Centre for Economic Performance’s Mental Health Policy Group.

The good news is that treatments for mental illness are highly effective. The bad news is that only one out of three people might actually seek help. And some research suggests that the people who need help the most are typically the least likely to get it.

People understand that you can’t treat a lump in your breast on your own, Dr. Komrad said. But that same understanding doesn’t extend to mental illness.


Self-reliance is deeply imbedded in our society’s psyche, he said. That becomes problematic when anything that’s the opposite of self-reliance — such as dependency — is viewed as weakness and something to be ashamed of, he said.

People might worry about appearing weak if they seek counseling — and they might turn that stigma inward and see themselves as weak, Komrad said.

Another big deterrent is lack of insight, he said. Many people with mental illness simply don’t think they’re sick.

That’s why it’s critical for families and friends to step in and help their loved one realize they need to seek counseling. Don’t worry about “meddling” in their lives, Komrad said. Rather, you have the opportunity and power to improve – and in some cases, save — their lives.

Warning Signs

In You Need Help! Komrad lists the specific signs — along with real-life examples — that signal an individual needs help. These are some of the signs:

  1. Behavior that scares you, such as a significant temper.

  2. Problems taking care of themselves or regulating their behavior, such as ignoring basic hygiene, engaging in reckless acts or drinking and acting aggressively.

  3. Problems with thinking, such as becoming disoriented, seeing or hearing things that no one else does or forgetting important facts.

  4. Intense feelings, such as profound anxiety about leaving the house.

  5. Problems interacting with others, such as withdrawing from the people they love.

  6. Inability to work, such as not holding down a job or diminishing grades or effort in school.

  7. Experiencing trauma, such as abuse or the death of a child.

Ultimately, the key is to look for what Komrad calls “a change in baseline.” In other words, is your loved one acting differently in any area of their life, including work or home? Komrad said that it’s not unusual to see a person unraveling at home first.

Approaching Your Loved One in the Early Stages

Komrad suggested the following ways to approach your loved one about seeking help in the early stages of mental illness.

  1. Let your loved one know that you need to have an important conversation with them. According to Komrad, this helps to focus their attention and implies they should take it seriously.

  2. Pick a good time and place. For instance, avoid talking during family gatherings or when you’re fighting.

  3. Approach them with empathy. You might say something like “I know this is really hard for you, but I’m talking to you because I love you. If I didn’t care, we wouldn’t be having this talk.”

  4. Be prepared for the person to be upset – and try not to get defensive.

  5. Use “I” statements, such as “I’m concerned about you.”

  6. Ask for a gift – literally. Ask your loved one to give you the gift of seeking help, whether it’s for your anniversary, a holiday or your kids’ birthdays. Here’s an example from Komrad’s book:
    “Getting a consultation with a psychiatrist about your mood swings would be the best thing you could do for our little girl’s birthday. It’s better than anything else that you could possibly give her. Please, do it for her. She, more than anyone, needs you to get some direction and proper help, more help than I know how to give you.”

  7. Facilitate the process by finding a professional and scheduling an appointment. Even if they refuse to go, see the practitioner anyway. Talk to them about helping your loved one. Komrad said that 15 percent of his practice is meeting with clients about their loved ones.

  8. Offer to pay for the appointment, if possible. A common excuse is that therapy is too pricey.

  9. Don’t use words like “crazy” or “abnormal.”

Taking Stronger Measures

When your loved one has little insight into their illness – their “rationality is diminished” – or refuses to get help, you’ll need to take stronger measures. Komrad calls these strategies “therapeutic coercion,” which is akin to tough love.

An especially powerful tool, he said, is to explain to your loved one that families come with certain privileges – and responsibilities. For instance, if you’re a parent who’s financially supporting your adult child, leverage these privileges to get them to seek a professional evaluation.

If that doesn’t work and your loved one is a danger to themselves or someone else or is very ill, contact the authorities, Komrad said. Research your city’s laws on involuntary evaluation. And show up at every step of the process, he said.

“Don’t just call the authorities and wait.” Show up to the ER and the court hearing. “When you do show up, tell the story.” In fact, tell the ugliest parts, he said. Talk about the facts that substantiate the seriousness of the situation.

If you’re feeling unsafe for any reason, articulate that to the authorities. If you’re uneasy about bringing your loved one home, communicate that as well. As Komrad said, you don’t want to give the system an easy way out. You want to make sure they grasp the gravity.

Supporting Your Loved One Long-Term

Supporting your loved one through treatment is “a long-term project,” Komrad said. Check in with them regularly about their treatment and how you can help.

Also, realize that “a change in them is a change in you,” he said. In other words, as they’re making changes in their life, you might want to seek professional help as well. You might even realize that your relationship is part of the problem. As Komrad said, “Sometimes relationships can be sick, too.”

As a family member or close friend, you have a lot of power in helping your loved one. Use it.

 

Learn more about Dr. Mark Komrad at his website and about his must-read book at youneedhelpbook.com.



Margarita Tartakovsky, M.S. is an Associate Editor at Psych Central and blogs regularly about eating and self-image issues on her own blog, Weightless.



APA Reference
Tartakovsky, M. (2012). How to Persuade Your Loved One to Seek Professional Help. Psych Central. Retrieved on October 1, 2012, from http://psychcentral.com/blog/archives/2012/10/01/how-to-persuade-your-loved-one-to-seek-professional-help

 

“Getting people in the door is sometimes the greatest challenge,” Komrad says.  That’s the goal of my book:  to get that initial evaluation.”

“To get help sooner,

rather than later,

really pays off. . .”

“I have a family member/friend having problems far beyond my ability to help them.  How do I begin to talk to them about getting some professional help?”





                                                                                                                                               


Sep. 13, 2012 

by Haley Goldberg


Persuading a loved one to seek mental health treatment can be difficult. But with one in five Americans experiencing some form of mental illness in 2010, you may find yourself having that very conversation.

“You can call upon that established relationship and all the feelings and history and the caring that’s in it,” says psychiatrist Mark Komrad, author of You Need Help! “Mental illness is often an afterthought...until a major tragedy comes, and unfortunately we end up living from crisis to crisis.”

After recognizing that a person needs counseling, set a time and place to talk, he says. Tell the person ahead of time that you want to discuss a difficult topic. “Creating a little bit of anticipation is not a bad thing,” Komrad says. “It actually allows them to be a little more receptive.”

Focus on your concern instead of pointing a finger at the problem, he adds. Discuss how worried or anxious you are. When you reveal your own helplessness, a person can be more responsive to the “do it for me” approach.

If a one-on-one approach doesn’t work, gather allies to show their compassion for the person in need. Allies can be family members, or trusted figures.

In some cases, the task may demand outside help. If a person is dangerous, Komrad advises relying on law enforcement to aid in getting your loved one the right help.




September 21, 2012


You Need Help!:

A Book Review by Lloyd I. Sederer, M.D.


Mark Komrad, M.D., had a radio show in the 1990s called Komrad on Call, a call-in program about mental health. He starts this book by telling us the single most common question he received was. "My relative [sister/brother/wife/child/parent/friend] is clearly experiencing some real emotional problems. I think she needs psychiatric help. How can I broach the subject?"


You Need Help is his answer to that question. Since it is one of the most vexing of questions for families and friends, it needs answering. Dr. Komrad describes his book as "a step-by-step plan to convince a loved one to get counseling" -- that is, how to convince someone to get help (treatment) for a mental (or addictive) disorder.

Much of the book readies the reader for his "how to" advice: There are chapters on getting involved, understanding mental health problems, and why mental illness goes untreated before he discusses what he regards the goal of help, namely, getting an evaluation. Then his chapters address tactics, such as time, place, and allies, and offer clear advice illustrated by many dialogues that exemplify his points. He appreciates that people with serious mental illness may not yield to persuasion, which has him discuss moving from "persuasion to coercion" and discussing "how to play hardball." Dr. Komrad writes that benevolence often underlies coercion, which he calls "compassionate paternalism," and he gives examples of its success.. . . .

For readers in a hurry, the appendix "Seven Steps for Convincing a Loved One to Get Help" is a good coaching tool, and it summarizes the chapters that precede it.

Families and friends face extraordinary challenges helping a loved one enter and remain in mental health treatment. They also will face a bewildering mental health system and terribly uneven quality of care. They need information, support and coaching. Dr. Komrad's book can help.

Dr. Sederer's book for families who have a member with a mental illness, The Family Guide to Mental Health Care, will be published by WW Norton in the spring of 2013.

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The Metrosource Magazine, Dec-Jan 2013






Getting help for the mentally ill

Hopkins psychiatrist says we are too slow to intervene when loved ones show signs of mental illness

December 18, 2012|


By Mark S. Komrad


THE BALTIMORE SUN



Though none of us yet knows much of Adam Lanza's backstory, it doesn't take a mental health professional to suspect that a man who killed his mother before killing so many children and adults was likely suffering from a severe mental disorder. Although mental illness very rarely results in violence, let alone such heinous behavior, the fact is that so many of those who could benefit from state-of-the-art treatment do not receive it, for a variety of reasons. For example, some fear the implications of facing a condition that might limit the power of will to control thoughts, feelings or behaviors. Some are intimidated by the stigma of mental illness. Or, as with other medical conditions, financial limitations might make treatment difficult to obtain.




However, the possibility of preventing the rare violence that comes from mental illness starts with getting people in the door of treatment first. That can be the hardest part. I have spent 25 years as a psychiatrist brainstorming with people who consult me about how to get a loved one into treatment. It is close family and friends who are often in the best position to urge a troubled person to get professional help. Yet that opportunity is commonly missed. We can feel that it is impolite or insulting to approach this awkward topic. We are too easily put off or intimidated by the resistance and rejection we may encounter (e.g., "I'm not crazy!"). We give up far too easily.

Persuading a loved one to get needed treatment may take more than one approach. It might start with delicately and strategically discussing your own pain that the troubled person may be causing and your sense of helplessness in the face of his behavior or mood. This effort to persuade requires overcoming the fear of being rebuffed and bravely persisting in the message.

Many people have succeeded in creative ways, like the woman who asked her husband for a unique Christmas gift. She told him, "There is a gift I want that would be more precious to me than anything you could buy in a store: your seeing a psychiatrist — just one time — to talk about your depression. I only want to know if it's possible for you to feel better." It worked. He gave her the gift she wanted and was persuaded at that appointment to give treatment a try.

Serious conversations need to be pursued at the right time, a special time: not in a sudden, aggressive way; not when the troubled other is drinking; not at family gatherings when people want to appear at their best. If private and personal conversations are not fruitful, you might need to call on key allies for help, such as the person's primary care provider, clergy, coach or influential family members.

The problems may appear dire enough that it becomes necessary to push harder, using the power of your relationship. In counseling families about a troubled relative who has been refusing to get needed help, I have found that the greatest resource is often untapped: the power of family to steer, even to coerce, family members toward entering treatment. Sometimes the situation becomes more acute and dire. Perhaps the person is threatening suicide, or has said or written things that sound like he is contemplating violence, or she has behaved in overtly violent ways that seem to be caused by emotional illness of some sort. Then, systems to mobilize psychiatric evaluation on an involuntary basis are available. The police can explain the procedures if you call.


When you see someone in emotional trouble that goes beyond the ability of your attention and kindness to help, when you feel that more professional expertise is needed, do not remain silent. Do not avoid the subject, or let it go for fear that you might be meddling. Alone, or with the help of others, you need to say to him or her: "You need help."

Dr. Mark S. Komrad, a psychiatrist on the teaching faculty of Sheppard Pratt and Johns Hopkins hospitals, is the author of "You Need Help: A Step-by-Step Guide to Convince a Loved One to Get Counseling." Website:  www.youneedhelpbook.com 



 

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New book Provides Tools to Find Loved Ones The Help They Need

by Simone Ellin,   December 28, 2012

This article was not supposed to begin this way. But after the massacre in Newtown, Conn., last Friday, its opening paragraphs screamed for revision.

The subject of Dr. Mark S. Komrad’s new book, “You Need Help: A Step-by-Step Plan to Convince a Loved One to Get Counseling” (Hazelden, 2012), was important before Friday’s tragedies, but its message has never felt more chillingly relevant than it does now, as all of America is reeling with disbelief, horror and grief over the senseless murders of 20 young children and six adults at an elementary school in a quiet New England town. 

The murderer, a 20-year-old male who first killed his mother in their home and then proceeded to Sandy Hook Elementary School, where he killed students and teachers before turning a gun on himself, was clearly in need of psychiatric help. Treatment might have saved his victims, as well as his life.

Why didn’t he receive it?

How do you tell a person you love he or she needs psychiatric help?

Almost all of us have been in this situation at one time or another, and many of us have been clueless about how to approach it. But we no longer can afford to hide behind our uncertainty to avoid confronting the mental illness we recognize in our friends and relatives. In “You Need Help,” Komrad, a Towson psychiatrist, provides readers with the tools and information to deal with this common, yet critical, dilemma.

In the 1990s, Komrad hosted a popular call-in radio show called “Komrad on Call.” On the program, which was nationally broadcast for four years, he answered callers’ questions about mental health issues.
“My most frequent call was the one that went, ‘My mother/spouse/adult child is having emotional troubles, and they are way beyond my ability to help. How do I talk to them?’” he said.

But it was not only the callers to his radio program who alerted Komrad that this was a common concern, he also noticed it among patients in his private practice and even in social situations.

“In a nutshell,” said Komrad, “I wrote the book to tap into the unused power of people’s relationships to both support and maneuver people to get into treatment.”

“You Need Help” begins by helping friends and family members (“allies”) recognize when a mental health situation has become unmanageable and requires the intervention of a professional. When an individual’s emotional problems begin to affect his everyday functioning, and certainly if he becomes a danger to himself or others, it is time to get professional help, the book explains.

There are many reasons why psychologically troubled individuals may require support, persuasion and even coercion to accept help, Komrad said. Some of these include our American culture and its emphasis on self-reliance and self-determination, denial and its more serious cousin agnosognosia (the absence of insight). Despite the strides that have been made in recent years, mental illness still carries a societal stigma. Widespread misunderstandings about how mental health professionals work — often absorbed through the media — contribute to the reluctance to seek professional intervention. Additionally, said Komrad, our society’s civil rights tradition sometimes works against family members trying to secure help (in the form of inpatient hospitalization or mandated treatment) for their loved ones. Finally, Komrad said, “We are a Maalox culture. We want relief in a moment. In fact, the trajectory of recovery is long. People don’t want to invest time in therapy.”

In “You Need Help” Komrad addresses the obstacles that prevent friends and family members from discussing treatment. The most common obstacle is the fear that confronting the problem will anger him or her and result in the loss of a relationship. Although Komrad acknowledged that a loved one’s mental illness is a “delicate topic,” he urged allies to pursue the conversation anyway. And if the conversation goes poorly the first time, keep at it.

“Don’t give up. There are many different approaches to try,” he said.

Among the approaches Komrad has recommended is coercion. The doctor has come to believe that harnessing the power of a relationship to force a loved one into treatment, especially as a last resort, is fair game. He provides various techniques of “applying leverage,” which he contends is ultimately in the disturbed individual’s best interest. 

“You Need Help” also provides vital information on how allies can locate the resources they need. By providing step-by-step instructions on how to handle almost every situation that may arise, Komrad prepares allies to manage the interpersonal, as well as the bureaucratic, struggles they likely will encounter.

With a frankly personal forward by Rosalyn Carter and heartfelt quotations by Bruce Springsteen, Carrie Fisher, Patrick J. Kennedy and James Baldwin, readers confronting the issue of mental illness in themselves or their family members will find they are in good company.

For more information or to order “You Need Help,” visit http://www.youneedhelpbook.com.

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How to Help A Family Member Deal With Addiction

Cutting back on alcohol and quitting any illegal substances is a must for HIVers. But what if a loved one can’t do the same?

BY NEAL BROVERMAN

MARCH 20 2013



If the thought of confronting a loved one’s alcohol or drug use conjures up images of the A&E reality show Intervention, with its tears, fights, and relapses, take a breath. Talking to a friend, spouse, or family member about their substance abuse is never easy, but it doesn’t have to be as dramatic and scary as it’s usually depicted on TV.

“The first thing you should do if you suspect that someone is abusing drugs is open a dialogue with them, presenting them with the facts of what you’ve observed and trying to withhold judgment,” says Wesley Boyd, an assistant clinical professor of psychiatry at Harvard Medical School and the author of Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?

“This reduces the likelihood of pushback and denial.”

Mark Komrad, a psychiatrist at Johns Hopkins University and the author of You Need Help! A Step-by-Step Plan to Convince a Loved One to Get Counseling, also stresses a light touch when addressing the problem. The key is to make the problem about you and your worries, so you don’t reprimand and heap accusations on your loved one.

“Talk about your concerns,” Komrad says. “Frame your approach by discussing your feelings, worries, and concerns in the face of the specific behavioral or emotional problems you are observing and how they are affecting you. This is far easier for the other person to hear than scoldings. So keep the focus on your own distress and concern.”

It’s OK to suggest, rather than demand, that your loved one make an appointment with a mental health professional  “just to see” if there really is a problem with drugs or alcohol, Komrad says. If he or she doesn’t take you up on the offer, don’t give up; just continue to gently suggest this as an option.  

Both Boyd and Komrad recommend immediately seeking out your local Al-Anon or Nar-Anon group for help.

“Al-Anon, an international group with lots of meetings in many cities, is specifically for individuals who have a loved one abusing [alcohol],” Boyd says. “Al-Anon offers support to such people and sage advice about what to do and not do.” The group was founded in 1951 by the wife of an alcoholic who realized it wasn’t just the addict who needed support and treatment; spouses and children do as well. It’s given rise to a network of groups, including Nar-Anon, for families of drug addicts.

Other people you could turn to, says Boyd, might include a primary care physician, a therapist knowledgeable about drug abuse, or a clergy member.

A drug or alcohol addiction isn’t always obvious. Here’s what to look for if you’re having suspicions about someone’s use, according to Komrad and Boyd.
- Altered sleep patterns
- Trouble waking in the morning
- Daytime sleepiness
- Increased irritability or moodiness
- Missed workdays
- Clumsiness
- Unexplained weight loss or gain
- Other physical complaints, without clear explanations
- Money that’s spent without an explanation
- Disheveled appearance
- Deterioration of personal hygiene
- Slurred speech 

 

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Esperanza Magazine

(Fall 2012)



REVIEW






J Am Acad Psychiatry Law 42:1:126-126 (March 2014)

Copyright © 2014 by the American Academy of Psychiatry and the Law.

You Need Help! A Step-By-Step Plan to Convince a Loved One to Get Counseling

By Mark S. Komrad, MD. Center City, MN: Hazelden Publishing, 2012. 280 pp. $14.95 (soft cover).

Leah J. Dickstein, MD, MA

+


You Need Help! A Step-By-Step Plan to Convince a Loved One to Get Counseling by psychiatrist Mark S. Komrad should be read by anyone concerned about a person who may be exhibiting changes in behavior, excessive or prolonged sadness, anxiety, or thoughts of suicide. The book provides the steps one should follow to convince the troubled person to see a mental health professional for an evaluation.

Komrad's easy-to-read book is informed by his experience of more than two decades of medical practice in evaluating and treating people with mental illness. The book's style and format also reflect his extensive activity with his nationally syndicated call-in radio talk show about psychiatry, “Komrad on Call.” This radio program has enabled millions of listeners to gain a better understanding of mental health concerns and the steps to take to help others get the treatment they need, in the interest of improving and even saving lives, with proper diagnosis and treatment. Because of his nationally recognized expertise, he is a regular guest on National Public Radio and on television, and is a sought-after psychiatric consultant to Hollywood film directors, to help them portray mental disorders and psychiatrists more accurately.

In the book, Komrad explains that the time for a professional evaluation is when our caring efforts are not helping, and the person we care about is clearly getting worse. He guides us in lessening our hesitation to act, and he helps us to understand what mental illness is and the reasons that the person may be reluctant to get help. He guides us in finding the right mental health professional, and describes what happens in the initial professional evaluation. He clarifies the best timing and environment for speaking with the troubled other about seeking an evaluation and what to do, from the most minor to the most coercive measures, if the person refuses. The involuntary evaluation of a mentally ill person and the concerned person's safety are also addressed. This section of the book should be mandatory reading for all trainees, fellows, and medical and other health sciences students and professionals, as psychiatrically ill people more often see nonpsychiatric health professionals in an emergency because of their fear of being stigmatized. Komrad goes on to talk about how to be part of the support system and ongoing treatment plan for the individual who has been evaluated and received a diagnosis of mental illness. The appendix is packed with many helpful resources; it should be in every professional's arsenal and in every concerned other's, as well.

Komrad acknowledges the readers, most often caring, concerned, courageous others, willing to take the frightening steps to help someone they care about. He makes them feel that they are not alone with their fears and feelings. Throughout the book, he provides many case examples to help readers understand the process better. As Rosalynn Carter so wisely states in her foreword, “Helping someone to get a proper assessment by meeting with a mental health professional is vital….”

In this text, Komrad never quite explores thoroughly the potential forensic complexities of being a good neighbor to the individual who is in the midst of a psychological crisis. For example, one can well imagine that the individual in distress could have a negative experience once he comes in contact with the care system. Indeed, he could follow advice, seek care, and find himself being admitted against his will to a psychiatric service. In this newly discovered context, the patient may suddenly encounter new terms like patient's rights and autonomy while combating the reality that he is sicker than he thought. Such preoccupations, however, are an extension of Komrad's central notion of turning the Good Samaritan neighbor into a functional adjunctive caregiver and guide to specialized services.

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Wed Oct 22, 2014, OP-ED


Fiction does a disservice to psychiatry


by Mark Komrad M.D.








I just saw Center Stage's production of "Next to Normal," a play portraying a family grappling with the wife/mother's bipolar disorder. I am not a theater critic. I am however, a psychiatrist on the teaching staff of Sheppard Pratt, University of Maryland and Johns Hopkins, and I speak around the country about how movies and plays present mental illness, its treatments and its treaters.

Though accurately portraying a family's anguish about mental illness, sadly, "Next to Normal" incorporates some of the common distorted tropes that so often appear in entertainment. For example, a common dramatic tool, as seen in this play, is two psychiatrists with opposing methods — the uncaring, weird (or sometimes evil) one who prescribes medications and the good, trustable, normal guy who treats patients without medications, through caring talk therapy alone. Yet, psychiatrists are trained to do both, and many still offer both therapy and meds, which can be mutually complementary, each with benefits and risks.



Another trope that appears here is portraying the side effects of modern psychiatric medication as vastly outweighing the benefits. Yet state-of-the-art treatment for most people is generally tolerable, effective and often life-saving. Electro-convulsive therapy, one of the most remarkably effective treatments in psychiatry, is a favorite whipping post; it's typically mis-portrayed, as in this play, to have exaggerated effects on memory and no lasting value, making things worse. In "Next to Normal," the ill character concludes that the best approach to recovery is to distance herself from her family, particularly her remarkably supportive and devoted husband. Yet, research has shown that those who can sustain supportive family connections have the best outcomes.

Having consulted to some Hollywood filmmakers about the portrayal of mental illness and psychiatrists, I have learned that the needs for dramatic tension and box office sales sometimes call for exaggerations, stereotypes and oversimplifications. So many people who need psychiatric treatment are not getting it, often due to the misunderstanding of many aspects of mental health treatment. The Centers for Disease Control notes that one in four Americans has a clinically significant mental health problem severe enough to need clinical intervention. Yet, the National Comorbidity Survey showed that only 30 to 40 percent of people who could benefit from state-of-the-art treatment are accessing any kind of mental health care. There have also been a number of research studies documenting the negative effects of TV and film portrayals of mental illness and mental health professionals, which measurably discourage viewers from seeking treatment and diminish confidence in treaters. Even cartoons have been studied and found to contain distorted stereotypes of mental illness and treatment to children.


Most people have not consulted a psychiatrist or any mental health professional, nor have they even informally known a psychiatrist socially to neutralize the stereotypes commonly seen in entertainment. This leaves movies, TV and stage productions as the primary educators about mental illness, psychiatrists and treatments. Even when we know that these portrayals are fiction or "just one example," we carry away residual impressions and feelings from them, on top of potential misinformation. If we do not have other experience, powerful fictions become our educators. I myself think I know a thing or two about the life of cowboys, or what it's like to experience war. But my education about such matters really is strictly from movies. I have tried to be very mindful of this in my consultations to Hollywood productions, attempting to make portrayals of mental illnesses and those who treat them as accurate as possible, within the demands of the dramatic necessities.

That is why, as good as a performance might be, I cringe when I think of the residual off-putting lessons that plays like "Next to Normal" and a whole host of movies and TV shows leave in the minds of audiences about the world of mental illness, its treatment and its treaters. Treatment is not perfect, but it's typically far more effective than Hollywood and Broadway would lead you to believe. That's why we need to help ourselves and our loved ones to access it more often and more easily.


Dr. Mark Komrad is author of, "You Need Help: A Step-by-Step Plan to Convince a Loved One to Get Counseling" (YouNeedHelpBook.com). His email is mkomrad@aol.com.

Copyright © 2014, The Baltimore Sun

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                    Mental health fair presents options for help










KINGSTOWN — Mental illness carries a stigma, and local activists want to change that.

On Saturday, the Kent and Queen Anne’s counties Mental Health Town Meeting and Resource Fair was held at the Presbyterian Church in Chestertown.


“The stigma of having a mental illness is huge, so we are trying to get the word out there that there is help,” said Kate Farinholt, a member of the National Alliance of Mental Illness, or NAMI. Farinnholt said she is trying to get a local chapter started in Chestertown and hopes the resource fair will help.


“People need to know that there is help out there, and we are showing that by having this resource fair,” Farinholt said. In addition to having several booths set up with information displayed by local mental health care providers, the event also featured a guest speaker and a panel discussion.


Keynote speaker for the event was Dr. Mark S. Komrad, who is on the clinical and teaching staff at Sheppard Pratt and Johns Hopkins University.


Komrad has published a book to help families and their loved ones better cope with someone with a mental illness, especially a family member. Komrad, who has had various radio shows that have reached in upwards of 40 million people, said getting them through the door is the first step to treatment.


“Once they come through the door and are willing to get help, the treatment process begins,” Komrad said. He said reluctance to seek treatment is not uncommon, mainly because people don’t think they have a problem or don’t want the stigma mental illness carries with it.


“We want people to be agreeable to treatment because many people don’t think they have a problem,” Komrad said. “However, the reality is they do have a problem.”

Komrad presented a slide show that took several excerpts from his book, and showed ways to get loved ones and friends to get the treatment they need.


“Oftentimes, people don’t acknowledge they have an illness, and reluctant to get treatment,” he said. “What we want to do is lt people know ways if a family member or loved one suspects a mental illness, this is what they can do.”


Komrad spoke about a patient of his whose father used a reward system to make sure his son went to therapy. The patient was obsessive about the Internet, Komrad said. Every day, the father would change the password until his son went to therapy. Then, his son was let back on the Internet went they got home, Komrad said.


While this may seem like an extreme measure, it was effective, Komrad said.

“This is just one way to assure that a person who may need treatment will get in the door,” he said.  Because mental illness is still largely misunderstood, Farinholt said meetings such as this are very important. “Twenty years ago, you’d never see something like this town meeting,” she said. “Now, mental illness is becoming a bit more understood, and things are changing.”

Want to Suggest Treatment to a Loved One? Read This First
http://www.dualdiagnosis.org/want-to-suggest-treatment-to-a-loved-one-read-this-first/

Written by Tamarra Kemsley

Society’s self-imposed gag order on the subject of mental health means opening up to loved ones about one’s own struggles can often have a coming-out-of-the-closet feel to it. But what about the reverse? What happens when the one struggling isn’t you—it’s someone you care about? Suggesting that someone else seek help isn’t easy, with fears of offending fueled by the same stigma that silences so many sufferers. With an estimated one in five Americans1 over the age of 18 suffering from a diagnosable disorder and fewer than one in three 2 receiving the treatment they need, odds are we all know someone who stands to gain from seeking help. Not sure how to encourage a loved one along that path? Here are a few points to keep in mind.

Know the Signs

A difficult boss, problems at home—it’s easy to get weighed down with the concerns that all of us experience from time to time. How then do you know when a loved one is merely in need of a listening ear versus when professional help is required? According to the American Psychiatric Association,3 a few indications that a serious condition is taking root include:
Social withdrawal
A decrease in functioning, be it failing at school or missing deadlines at work
Apathy
Problems concentrating
Increased sensitivity to sights, sounds, smells or touch
Dramatic mood swings
Sudden changes in sleep patterns or appetite
Fear or distrust of others
As Baltimore-based psychiatrist Dr. Mark Komrad notes in his book You Need Help! A Step-by-Step Plan to Convince a Loved One to Get Counseling, “It’s one thing to be down in the dumps… It’s altogether different, however, if you are so distressed or out of control that your functioning begins to shut down, or you are hurting those around you, or are destroying your relationships by slow degrees.”
Once you’ve established that something is wrong, it’s a good idea to do a little research on your own before approaching the person, says Ashley Groesbeck, a licensed clinical social worker practicing in New York City. Groesbeck, who has worked with veterans and traumatized youth and families for seven years, suggests the Mayo Clinic and the National Alliance on Mental Illness for basic information to help guide your conversation.

It is not your job to make the actual diagnosis. 

But as Komrad adds in an interview, it is not your job to make the actual diagnosis. Rather, “you know that something is wrong with your loved one’s thoughts, feelings, or behaviors. You aren’t sure how to understand it, what to call it. But you do know that the problem needs more help and more evaluation than you as a caring supporter can provide.”

Approach with Love
So you’ve established that professional help is needed. What’s next? According to Groesbeck, making the conversation a dialogue is more likely to result in a positive outcome than launching into a lecture. She suggests starting with a statement of how much you care about the person before noting that something seems different about him or her. “’You’re my sister, and I love you. I’ve noticed things have been really off lately’ is more helpful than ‘Hey, you keep canceling on me. What’s your problem?'” Grosebeck explains.
This is something M.* experienced firsthand when her boyfriend of three years and her boss of five stepped in to express their concerns (*her full name is being hidden to protect her privacy). The 26-year-old Utah native was already coming to terms with a lifetime of sexual abuse at the hands of her grandfather when her 19-year-old brother drowned himself during a schizophrenic episode. She admits she was stubbornly against the “foreign” idea of meeting with someone at first and credits the way her boss and boyfriend approached her as part of the reason she finally was able to open up to the idea of getting help.

Making the conversation a dialogue is more likely to result in a positive outcome than launching into a lecture. 

In the case of her boss, the conversation was one of concern, not criticism. “He pulled me aside and said, ‘We can see it behind your eyes. What can we do to help?'” Her boyfriend, meanwhile, suggested it “organically” after an especially bad day. “We were in bed and I was crying and he was holding me when he said, ‘We need to find somebody.’ It was a very soft suggestion. He just said, ‘Maybe if you find someone to talk to, you won’t be this sad,'” M. remembers.
Still, the decision wasn’t an easy one. “I felt defeated. You want to be a strong person who can get through anything and to admit you need help is a big step,” M. says. In the end, it was knowing there were people in her life who were anxious to see her take that step that gave M. the motivation to move forward with getting treatment.

When They Say “No”

Of course, not everyone will respond to the suggestion of professional help as quickly and openly as M. did. “Don’t push it,” Groesbeck recommends. “If they don’t want to talk about it, the conversation isn’t going to be very productive.” That doesn’t mean dropping it permanently. Rather, leave the door open by asking if there is a better time to talk. If they say no, let them know you may bring it up again. “The risk here is the person might start avoiding you, but you’ve set yourself up to be available,” she explains.

Leave the door open by asking if there is a better time to talk. If they say no, let them know you may bring it up again.


In his book You Need Help!, Komrad warns readers to “be prepared to put the relationship at stake” as a last resort should all other approaches fail. “Obviously that is an end-stage measure,” he tells DualDiagnosis.org. “Nor is that going to be a successful maneuver in many cases,” with one possible outcome resulting in any problematic behavior being merely pushed underground as much as possible. “Sometimes, however, this needs to be done to give the helper some respite, to recharge, gather new allies, get the oxygen mask on and try a different angle,” he says.

A Risk to Themselves or Others

R. was in her junior year of college when she received a late-night phone call from a friend who had seen another friend’s car abandoned at the side of a road in a forest. Together they searched the woods, where they found him alone, speaking incoherently. Taking him back to R.’s apartment, they sat through the night with him. By morning, R. and her friend decided to take him in to the school clinic. “He wasn’t trying to harm himself but he was definitely talking about self-harm,” she says. Though he didn’t feel safe going—he was still in the middle of the episode at the time—he eventually gave in. “He trusted us; we were his friends.”
According to Komrad, other indications a loved one is a danger to himself and/or others include:
Explicit threats to hurt self or others
Expressed fantasies or plans of hurting others or a suicide plan
Escalation of violence from verbal to physical
Lack of self-care leading to medical risk
Lack of self-care or care of environment leading to physical risk
Obvious impairment in coordination, motor skills or judgment in a person who continues to drive a car or has a driving/piloting profession
Obtaining a firearm or ammunition for a preexisting firearm in a person already having problematic changes in thoughts, feelings or behaviors
Escalation of reckless behaviors
Extreme social withdrawal, such as locking oneself in a room
Growing paranoia with increasing expressions of intention for violent self-protection or revenge
“I don’t think that the helper needs to sort out whether a behavior meets the threshold for being serious enough for involuntary treatment,” Komrad adds. “If you are worried, mobilize the authorities,” and “don’t hold back” on what you tell them.

Don’t Forget About You

Any time a loved one is struggling, it’s easy to let concern for him or her override concern for oneself. “Make sure you get the support you need and don’t get totally sucked in,” Groesbeck cautions. Establishing boundaries is essential, especially when you are living with the person, as is making time for self-care, be that going for a run or out to the movies with friends.
“Yes, you want to get them help. Yes, you want to support them in the recovery process,” Groesbeck adds. “But at the end of the day, you also have to realize it’s not your responsibility to fix the person.”

1 National Institute of Health, “Information about Mental Illness and the Brain” (2007), accessed Sept. 5, 2015 <http://www.ncbi.nlm.nih.gov/books/NBK20369/>
2 Messias E, Eaton W, Nestadt G, Bienvenu OJ, Samuels J., “Psychiatrists’ ascertained treatment needs for mental disorders in a population-based sample” in PubMed.org (2007).
3 American Psychiatric Association, “Warning Signs of Major Mental Illnesses,” in pamphlet Healthy Minds, Healthy Lives (2009).
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