How can you best support a loved one who has a mental illness?

"Mental illness directly impacts both the affected person and those around them, with the effect extending to all spheres of life," says Dr Noluthando Nematswerani, Head of the Centre for Clinical Excellence at Discovery Health. "Knowing how best to support a loved one in this situation can make a significant difference for everyone involved."

Recognise the warning signs of mental health problems

According to the American Psychiatric Association, mental illnesses are health conditions involving changes in emotion, thinking or behaviour - or a combination of these. And, major mental illnesses rarely appear unexpectedly.

Warning signs of possible mental illness include:

• Withdrawal from social interactions
• Loss of desire to participate in activities
• Feeling disconnected from oneself or one's surroundings
• Problems functioning at school, at work or in social contexts
• Changes in mood, sleep and appetite
• Difficulties with concentration, memory or logical thought
• Avoidance of over-stimulating situations

While warning signs alone cannot predict mental illness, they may indicate the need for further evaluation by a healthcare professional.

Moreover, people with suicidal thoughts or intent, or thoughts of harming others, need immediate attention. The South African Anxiety and Depression Group (SADAG) lists important warning signs of suicide in young people, which include experiencing bullying at school and depression.

Get the right professionals involved

Stigma around mental illness can make it hard for those affected to reach out for help. They often feel ashamed and mistakenly believe they should be able to overcome their illness with willpower alone. You can help your loved one realise that they have a medical condition, and not a personal flaw or weakness. Cassey Chambers, spokesperson for SADAG says: "Mental illness - whether depression, bipolar disorder, anxiety or otherwise - should be thought of as a disease, which has symptoms and progression, and can be treated. Loved ones should learn as much as they can about the illness to be able to help in the right way."

One of the most important steps you can take to help a loved one is to start the conversation. "You do not have to be an expert. Express your concern and willingness to listen and be there for your loved one. Then, a family physician can assist in arranging a referral to an appropriate healthcare professional, such as a psychiatrist and/or psychologist, or assistance can be sought from a community mental health centre in your area," says Dr Nematswerani. Supporting a loved one can better a relationship

Helping a loved one through stress or depression can help their future mental health, and foster a healthier relationship between you. These are findings from a 2017 study by University of Alberta researchers, who (annually, for six years) surveyed around 1 400 couples on their levels of depression, self-esteem and mutual support:

• Higher depressive symptoms in one partner were associated with higher levels of depression in the other partner, one year later.
• Men and women who received support from a partner during times of stress had lower symptoms of depression a year later, and into the future.
• Men who offered support to struggling partners also increased their own self-esteem; while for women, being able to provide support boosted a sense of self-worth.

Get active together

"Exercise is key to good mental health throughout life. A great way of supporting someone with a mental illness is to make sure they are physically active, as many studies show that physical activity has antidepressant effects. While finding the motivation to exercise may be tough for a person affected by a mental illness, you can encourage them to get physically active to whatever extent they are able - even if this means going for regular walks together," adds Dr Nematswerani.

Interestingly, a recent paper published in The Lancet Psychiatry found that different kinds of team-oriented sports, cycling, and aerobic exercise are the most beneficial to mental health.

Get some 'ecotherapy'

Research into so-called 'ecotherapy' has shown a strong connection between time spent in nature and reduced stress, anxiety, and depression. In a 2015 study, researchers compared the brain activity of healthy people after they walked for 90 minutes in either a natural setting or an urban one. They found that the group who walked in nature had lower activity in the prefrontal cortex. This area of the brain malfunctions in people who are depressed or under high levels of stress, causing a continuous loop of negative thoughts.

How much time in nature do you need? Research published in June 2019 reports that we need around 120 minutes each week.

Psychiatrist Dr Jonathan Moch runs Mindfulness in the Park events on Sundays afternoons at Huddle Park, Johannesburg. "We spend 90 minutes experiencing stillness and mindfulness," says Dr Moch. "No cell phones are allowed and we encourage people to remain silent as we mix up walking, standing, sitting, listening and looking. A regular mindfulness practice can be invaluable in helping to reduce the effects of depression and anxiety."

A recently published book titled The Three-Day Effect reports that the more exposure humans have to nature, the more we enhance our mental wellbeing. War veterans, sex trafficking survivors, and others go on a three‑day excursion into the wild wearing devices that measure brainwaves. Testing nature's direct effect on these people, the devices show that being outdoors can be highly effective in assisting those with mental health challenges.

Don't patronise or belittle

Chambers advises, "It's important to keep social and community conversations as normal as possible. Don't leave the person out of family discussions because you think that it would be less stressful for them if they're not involved. Ask the person what they hope for, fear, feel and need in the situation, as you would anyone else involved."

Help your loved one to follow a healthy diet

More and more, doctors are encouraged to discuss healthy eating with their patients alongside other clinical interventions. In fact, the growing field of nutritional psychiatry focuses on the impact of diet on mental illness. Founder and president of the International Society for Nutritional Psychiatry Research, Prof Felice Jacka, reports (in a 2017 paper) that the quality of one's diet is related to their risk for common mental disorders, such as depression. In addition, implementing dietary changes suggests promise for the prevention and treatment of depression. New studies focused on understanding the biological pathways that mediate the observed relationships between diet, nutrition and mental health also point to the immune system, oxidative biology, brain plasticity and the microbiome-gut-brain connection as key targets for nutritional interventions.

"If you share a home with someone who has a mental illness, you can work on ensuring that their diet is as healthy as possible. Help them to eat lean proteins, and fresh, whole foods, cooked at home in a healthy way, instead of highly processed foods, refined carbohydrates, excess sugar and salt and other foods that compromise mental and physical wellbeing," says Dr Nematswerani.

Ensure your loved one has support at work

Emma Atwell has bipolar disorder (read her remarkable story here. She says, "I found office jobs incredibly difficult as I had to devote an enormous amount of energy to proving myself at work and proving that I was more than my diagnosis."

Clinical psychologist Dr Colinde Linde adds, "The labels given to a person with a mental health diagnosis - a largely invisible problem that few understand - can quickly erode compassion or understanding of how this disorder affects the sufferer in the workplace and in society." Read Dr Linde's thoughts on dealing with workplace stigmas around mental health here.

Finally, remember to take care of yourself

"Depression is about more than just a chemical imbalance, genetics, and upbringing. It's also about taking the time to acknowledge one's present reality," says Dr Moch. "A loved one can provide a safe, trusting space for a person with depression to reflect on the past and consider the future. The powerful, life-changing insights gained with the support of people we trust are key in controlling our future selves and life choices."

However, caring for a sick person takes its toll. How can we prevent caregiver-stress and ensure good coping mechanisms? "While you're focusing on helping your loved one, it's also important to take care of yourself, physically and emotionally, so that you can better care for your loved one. Prioritise your own health through good nutrition, enough sleep, physical activity and making time to de-stress. Reach out for help when you need it and acknowledge your limits," says Dr Nematswerani.

Add these numbers to your contact list - who to call for help

• The South African Depression and Anxiety Group (SADAG) is Africa's largest mental health support and advocacy group. SADAG counsellors are available between 08:00 and 20:00, Monday to Sunday at 011 234 4837. The SADAG 24-hour helpline number is 0800 456 789. For a suicide emergency, contact SADAG on 0800 567 567. Teens can also SMS 31393 for help.

• Childline is an effective non-profit organisation that works to protect children from all forms of violence and to create a culture of protecting children's rights in South Africa. To speak to a Childline South Africa counsellor, call their national crisis line at 08000 55 555. 

• Contact the Discovery emergency line, 0860 999 911, and select option 4 to be put through to the Smart Health Choices medical advice line, to gain access to professional nurses or trauma counsellors who will assist you with any mental illness-related matters.