Helping a close friend or a spouse cope with their depression is difficult enough when they are cooperative. However most depressed people do not cooperate, are in denial, and therefore make the options available much more challenging and very limited. Many people suffering from depression very likely may have additional problems occurring concurrently such as Bipolar, Schizophrenia, and Dementia. In an earlier blog post – Depression Part II – Understanding the Signs, we provided a summary of the symptoms that you should be aware of that may cause you to conclude that this special person in your life may have a problem.
Once you determine that something very serious appears to be wrong, these are some of the steps that you can consider:
- Get a proper diagnosis – You are not a mental health professional. So at best, your observation and conclusions are an educated guess. However, since you know this person better than most everyone else in their life, and have observed a radical change in their behavior, the chances are that what you are observing that is causing your concern is real. Ideally, you would make an appointment with a mental health professional and insist on accompanying this person on their initial office visits to make sure that the information being provided to the health professional is accurate and is true. These patients generally are unable to describe and are know to lie about their condition. They need you there to be their advocate and support.
- Psychiatrists – Up until approx. 20 years ago, these doctors were trained to perform proper evaluations and would spend adequate time with their new patients to get to know them and try to understand their conditions. A few good ones still practice the old way — listening and evaluationg. Most do not — see Surviving Depression – Part III – Why Psychiatry has Failed. Most will give you 10 minute quickie consultations to evaluate their condition or progress, and then prescribe more drugs. However, whether you find one of the good ones or just a glorified pill-pusher, this is a medical problem and it is the psychiatrist that controls the prescription pads. Some of the latest pharmaceuticals can help control this condition. Many of the older medicines just worked at numbing the person’s mind. Either way, prescription meds will not cure depression. At best, they will move that person closer to a condition of stability and functionality in their life.
- Psychologists – These doctors (PhDs) are better trained in evaluating the person’s condition. They also will provide longer sessions, 45 minute to one hour. Most likely they will set up weekly sessions with this person and dig deeply into the person to try and make a proper real diagnosis. The psychologist might refer the person back to a psychiatrist for drugs if they think there is immediate need for help with medication. However, if there is no obvious immediate danger (ie. suicide thoughts, bipolar activity, or extreme manic behavior) the psychologist will most likely try and treat the patient with talk therapy and help them to verbalize and better understand their problems. Hopefully this will eventually lead to solving the problems, or at least keeping them under control. If possible and the person is willing, this can be a much more effective alternative to psychiatric care. Also, given the time these psychologists will be spending with the patient, they are much more likely to make a correct diagnosis and set up a program of treatment.
- Peer support and self-help – This is almost like an AA session. The person goes to weekly or monthly meetings participating in a group of people with a leader. They talk anonymously and offer each other support. This can be a viable method for those that are in denial with their close friends and relatives, but who still understand that there is a problem that they would like to address in a more anonymous fashion.
- Social Work – This includes crisis intervention hotlines and social workers who even make house calls to visit people who may need intervention, but do not have either the resources or mobility to go outside their home to seek help.
- Involuntary detention – If the person is deemed to be a danger to themselves or to others, depending upon your State’s laws, you might be able to get a temporary Court Order to have them detained for evaluation and stabilization in a facility such as a psychiatric hospital. Usually this initial detention may only last for 72 hours. The courts are very careful to not violate a person’s rights to care for themselves. However if the initial evaluation is serious enough, further court proceedings may follow that would result in an order for long-term commitment to a psychiatric facility. This is very difficult to achieve and also does little to solve the problem of depression. It is essentially a psychiatric jail, where the person is force-fed drugs to numb their mind.
- Close friends and relatives (spouses) – Sometimes this may be the best and most effective option. Having a caring person show the depressed their support, love, hugs and prayers can be the strongest medicine available. The danger here is that the person trying to give the support and intervention may be so close to that person that they are perceived as the cause of their depression and most every other problem in the depressed person’s life. Due to society’s stigma for people with mental illness causing them to deny it and withdraw, this method of dealing with the problem can be the most difficult one to accomplish, but also the most effective one if you have the skills, determination to succeed, and the thick skin to absorb a good degree of abuse from the depressed friend or relative.
- Psychiatric Conservatorship -In the case where the mentally ill person is no longer able or willing to follow their treatments or therapy and you can get their doctor to testify that this is occurring, a court case can be initiated that will give another responsible adult, family member, or organization the control over that person’s medical or mental treatment. While this can theoretically be a good solution to an uncooperative depressed adult to cause them to get proper treatment, it is very difficult to convince a court to take away a person’s right to have control over their own decisions. In places like California, involuntary psychiatric conservatorships are rare.
Most likely, if you are reading this article, you are a person trying to find a way to get help for someone that is close to you who has radically changed their behavior and is apparently suffering from some sort of illness. You are not a doctor. So you cannot diagnose them to be sure what it is exactly that has occurred Unfortunately, there is no one single good solution. There is also no cure for this sort of disease. You will likely be fighting the patient as well as dedicating a good portion of your life and energy to get them care. If you are successful, the best that you can hope for is controlling the problem so that the person you are helping returns to some degree of happiness and stability. We wish you well.
Another possibility to consider – if they can swim and are in decent shape, is to have them learn how to dive and take them to visit the wonders that are hidden beneath the sea. There is no better therapy for sadness than diving on a tropical reef surrounded by colorful fish and enjoying the experience with another special person. If you have noticed the other 4 postings on this topic, this ends up to be the suggestion of last resort … because we are out of options.