Active Bengaluru: Negotiating Conflicts as a Mental Health Caregiver – Part 1

This episode of Active Bengaluru features an interactive session that Dr. Deepak Jayakumar from NIMHANS had with the team of AMEND (Association For Mentally Disabled) on how to manage challenging issues while caregiving for PMIs (Persons with Mental Illness). 
Dr. Deepak’s specialisation is in the field of de-addiction. Following are a few of the questions and answers that were recorded at the session.

Case 1

A caregiver’s son has bipolar disorder and constantly asks for money. The maximum amount that has been demanded so far is Rs. 30,000. Dr. Deepak responds as follows:

When they are children, they tend to ask for smaller amounts of money. It becomes harder to curb this habit as they grow older. The main thing to look out for is whether the demand for money comes from the illness or not. A feature of the bipolar condition is a tendency to spend money.
One must make sure that the medication is being taken on time. Regular visits to the doctor are helpful, since visiting the psychiatrist will rule out the probability that the requests for money are due to the illness. As a caregiver, one’s duty is to provide for basic needs such as shelter and food. Money can be considered as a luxury provision. A suggestion could be to give this money as a contingency amount – indicating that the person has to do something in order to get the money or earn the money, especially by doing tasks that they have not been doing.

Negotiating with and keeping the person living with the illness informed about money should be a priority since as a caregiver it often becomes difficult to provide them with large amounts of money. If a one-on-one conversation is difficult, especially if the person concerned is likely o become violent or angry, bringing this topic up in front of the psychiatrist becomes a better method of approaching it. 

Since it is very difficult to force somebody to do something they don’t want to do, it has to come from within them or their own personal will. The conversation cannot be taken forward if violence is a possibility. The conversation should be moved to a time frame when both the parties are calm and can try to understand each other. Another thing that might help is showing them or explaining to them why as a caregiver it is difficult to provide them with the money. They will try and make an effort to understand and may even open up to the option of a part-time job. If the money is an issue, then the caregiver can cut off the supply completely.

Case 2

A caregiver’s wife has been suffering for the past 45 years. Unfortunately, she has not been able to take medicines without posing an argument or a fight. The doctor advises:

In this case, the goal has to established – which is more important, them taking the medicine or them accepting the fact that they have to take the medicine? Some persons may not be able to adjust to the fact that they need to take the medicine. But they may still take the medicine, which is a good enough outcome.

Any illness has three aspects – awareness, acceptance, and attribution. These indicate the following:- whether or not the person is aware that their behavior is different. – whether or not the person accepts their illness, – whether or not the person attributes their illness to their mental illness, or to other things such as black magic, etc. 

As long as they take the medication, their reactions shouldn’t be a problem. If it is felt that the person seems to be getting more violent, they can be switched to injectable medicines that may have their own side effects. When the patient argues, the feelings that they are expressing are very real. To constantly refute their point becomes pointless, since as a caregiver, there is nothing that can be done to diffuse their fear. This fear does not respond to logic, so it is best to not confront their belief or fear.Case 3
Another concern raised was why caregivers are always the target of a PMI’s anger. The doctor’s response:

A simple reason for this is the fact that the caregiver spends as much time as possible with them. They are usually caught up in their own delusions. Some of their anger is due to the illness. They feel that most of their environment is out to harm them, which could be one of the major reasons for their anger. 

How do you deal with the guilt that comes with the anger of caregiving for someone? Reduce face-to-face time. Give them activities to keep them occupied; when they engage with things other than the caregiver, the conflicts can go down.

NIMHANS also has a day-care facility that engages patients. Either the caregiver or the person living with an illness needs to spend time away from the house. This provides a break between them. 

Listen in!

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