Communicating with a Loved One Experiencing Serious Mental Illness

By Karen Stanley-Kime, Ph.D., LP, ABPP

Many individuals experience serious mental illnesses, including Schizophrenia, Schizoaffective Disorder, and other psychological disorders in which symptoms are severe, persistent, and life impairing. Having a serious mental illness, or SMI, can negatively affect a person’s ability to communicate. For example, a person experiencing a depressive episode can have trouble concentrating on a conversation. Instead, his or her mind might wander during the conversation. Additionally, he or she might have trouble remembering important details of the conversation later. This does not necessarily reflect disinterest in the conversation or intentional disrespect toward the conversation partner. Rather, difficulty concentrating and memory impairment are common symptoms associated with major depressive episodes, which can occur during the course of some SMI diagnoses. Other symptoms that can arise during the course of SMI can also hinder communication. For example, a person with SMI may withdraw or isolate him/herself from others, have difficulty expressing his/her emotions, or display particularly intense emotions.

Effective communication can be challenging, but it is an important skill for people with SMI and those in their support networks to continuously develop. Effective communication can reduce frustration and stress for both a person with SMI and supportive others, which is important as increased stress can increase psychological symptoms in a person with SMI and burnout in a supportive other. Effective communication can also strengthen bonds between a person with SMI and a supportive other, which is crucial as the consistent support of others can positively influence a person’s mental health recovery.

Here are some tips to improve communication:

1. Eliminate or minimize distractions when having a conversation. Concentration difficulties occur in many psychological diagnoses, but concentration can often be improved if fewer distractions are present. If a person is engaging in an activity, be sure to ask if this is a good time for a conversation. If it is a good time for a conversation, turn off the television, put aside the smart phone, find a quiet place, and devote your attention fully to the conversation for the duration of the conversation.

2. Pay attention to both verbal and non-verbal forms of communication. One symptom of some SMI diagnoses is called flat affect, which means that a person might not show emotions in facial expressions. Alternatively, he/she might display an emotion that is different from the emotion that he/she is describing. For example, a person with Schizophrenia might say that she is very sad, but smile or laugh as she speaks about what is triggering her sadness. After your conversation partner finishes expressing his/her thoughts, summarize what you believe was the message and give your partner a chance to correct any misunderstandings. For example, you might say, “I want to be sure that I understand what you’re saying. You said that you’re sad because you just heard that a friend passed away. Did I understand you correctly?”

3. If a person is experiencing psychological symptoms, keep communication simple, clear, and brief. If you are asking questions, ask them one at a time and give your partner a chance to respond before asking another question. If you are providing directions or instructions, provide them one step at a time, if possible. If you are making a request, make one request at a time and allow the person to complete the request. Be prepared to break a large request into more manageable steps. For example, a request to complete a chore like cleaning the kitchen requires many steps. You might break that large request into smaller steps by saying, “I would really appreciate your help cleaning the kitchen. Let’s start with the cabinets. Could you dust the cabinets, please?”

4. Allow for pauses in the conversation to give your conversation partner a chance to process what you have said and ask questions or respond to you. Sometimes a person with SMI may need a little extra time to collect his/her thoughts or to find the words to express a message. Prior to engaging in the conversation, be sure you have time to spend in the conversation without rushing it.

5. Be polite and respectful during the conversation. For example, do not interrupt, assume you know what your partner will say and therefore finish your conversation partner’s sentences, or talk down to your partner. Instead, demonstrate your care and support for your conversation partner by making eye contact, showing interest with your body posture (e.g., sitting forward attentively with your arms open in your lap rather than reclining with crossed arms), and listening to what your partner is saying rather than planning what you want to say next.

Using good communication skills on a regular basis with a conversation partner with SMI increases the likelihood that both you and your conversation partner will feel understood and that your partner will incorporate the skills you demonstrate into his/her own communications. If you are making requests using good skills, it is also more likely that the conversation partner will complete the request. Sometimes, however, communication with a person with SMI who is experiencing active psychological symptoms can be very difficult, as in the instance of trying to understand a person experiencing mania who is speaking very quickly about many different topics. If you notice that communication with a loved one with SMI is consistently difficult, bring your concern to the attention of your loved one and work together to determine if extra support is needed. Sometimes communication difficulties can signal that a person’s mental health is declining. For example, increasingly hostile or irritable interactions with a loved one with SMI might indicate that he/she is experiencing increased mood symptoms, which is important information for the treatment team. Members of your loved one’s treatment team, such as a case manager or therapist, can help you troubleshoot and might be able to offer personalized communication skills to practice.