How can I maintain a positive relationship with my loved one who lives with mental illness?

If your loved one lives with mental illness and you've had a tough time keeping a positive relationship with them, you are not alone. Remember that it is not your fault, and it is not your loved one’s fault, either.

There are many things about living with a mental illness that can negatively impact relationships, and these challenges can be difficult to move through. The good news is there are things you can do to maintain a positive relationship with your loved one as best as possible. We hope you’ll find the strategies below helpful.

Learn About Your Loved One’s Condition

Learning about your loved one’s condition can help you better understand their behavior. It’s likely you’ll learn that a lot of your loved one’s choices might be out of their conscious control right now.

Over time, understanding this can help you feel less frustrated about their actions and put you in a better headspace to interact with them. In turn, your loved one may feel less worried about judgement and more comfortable opening up to you.

Here are just a few resources you could use to learn more about your loved one’s condition:

NAMI Family-to-Family Classes are for families, significant others, and friends of people with mental health conditions. This program facilitates a better understanding of mental health conditions, increases coping skills, and empowers participants to become advocates for their family members. It is also available in Spanish as De Familia a Familia de NAMI. Find a Family-to-Family course class near you via your local NAMI Affiliate. 
NAMI Basics is a free 6-session education program designed to empower parents and caregivers of young people (ages 22 and younger) with the tools, knowledge, and support needed to navigate the challenges of youth mental health conditions. Find a NAMI Basics course class near you via your local NAMI Affiliate. You can also take the education course in a self-paced, virtual format as NAMI Basics OnDemand.
NAMI’s About Mental Illness webpages have information about different mental health conditions including their symptoms and relevant recovery strategies, concerns that are common with mental illness like substance use disorders, suicide, and self-harm, and information about different types of mental health treatment.
Schizophrenia & Psychosis Action Alliance (S&PAA) provides information, toolkits, videos and support groups for people living with schizophrenia or psychosis-related conditions and their families.
Depression & Bipolar Support Alliance (DBSA) provides information on treatment, resources, and support groups for individuals living with a mood disorder. They also have a DBSA Support Group Locator for individuals living with mood disorders and their families.
Other reputable mental health organizations including the American Psychological Association (APA), The American Psychiatric Association, the National Institute of Mental Health (NIMH), The Jed Foundation, and Mental Health America (MHA). Use these resources to learn more information about your loved one’s specific mental health condition.

Learn About Anosognosia & The LEAP Method

If your loved one is experiencing symptoms of a serious mental illness like schizophrenia or bipolar disorder, but they don’t seem to think they’re ill and aren’t willing to receive treatment, they may be experiencing anosognosia.

Anosognosia [Ann-knows-egg-NOSE-yuh] is a neurological condition that can accompany serious mental illness; it affects a person’s ability to recognize that they have a mental illness.

If someone doesn’t recognize that they have a mental illness, it makes sense that they wouldn't want to go through treatment. Learning about anosognosia might not make the circumstance any less difficult. However, it can encourage more focus on what is within your control, such as maintaining positive communication with your loved one, and less on what is outside of your control, such as whether your loved one chooses to pursue treatment.

The LEAP Method, created by Dr. Xavier Amador, is an evidenced-based communication program that has helped families improve their communication and overall relationship with a loved one who has serious mental illness. LEAP stands for Listen, Empathize, Agree, and Parter. Once the relationship has been strengthened, many people are able to use this communication strategy to encourage their loved one’s eventual participation in treatment.

To learn more about anosognosia and LEAP, check out the resources below.

“I Am Not Sick I Don’t Need Help” is a book by Dr. Xavier Amador that discusses how family members and allies of those with serious mental illness can use The LEAP Method to help partner in the person’s recovery. Portions of the book are accessible to the public on our website. The full book is available for purchase at online booksellers in English and Spanish. 
The LEAP Institute is a for-profit organization whose mission is to spread the word about the LEAP approach. Their website contains free LEAP videos where you can get an idea of how this communication strategy works in practice.
NAMI’s Ask the Expert Webinar: How To Help Someone With Mental Illness Accept Treatment - Dr. Amador describes anosognosia, how it can impact individuals with mental illness and their relationships with loved ones, and how to use LEAP to encourage a loved one’s participation in treatment.

Get Good at Validation and Reflective Listening

Supportive communication is the foundation of a positive relationship. You might find it challenging to make your loved one feel heard because you don’t want to enable perceptions or behaviors you see as wrong. Maybe you don’t want them to think an impulsive behavior is safe or a delusional belief is based in reality.

These concerns are understandable, but they make supportive communication tough. Validation and reflective listening can help.

Validation means communicating that someone’s feelings make sense given their own personal beliefs and experiences. Because validation has to do with someone’s personal feelings, it does not require agreeing or disagreeing with their behavior. It sounds like this:

“I hear that you’re upset. I think that anyone would be upset if they were being followed. How are you doing with all of this?”

“Even getting out of bed feels impossible for you right now. That must be so hard.”

Reflective listening means reflecting someone’s words or the meaning behind those words back to them. When speaking with someone who may be experiencing delusions or hallucinations, The LEAP Method encourages reflecting exactly what the individual has said.

For example: “You feel spiders crawling everywhere any time you close your eyes. Do I have that right?”

Reflective listening can also look like reflecting what someone has implied, what emotions lie under their words, or even a summary of the things they’ve shared. For example, if your loved one says, “You think I want to be like this?” you might say, “It’s exhausting to feel so out of control all the time. You don’t want it to be this way.”

Use validation and reflective listening to ensure that your loved one feels seen, understood, and believed -- to show that you’re listening and you care. Remember, you do not need to agree or disagree with your loved one’s personal feelings or beliefs in order to practice validation and reflective listening.

Be Curious

Many people avoid discussing topics that are uncomfortable, but uncomfortable thoughts, beliefs, and sensations are common with mental illness. By being curious and open, you communicate to your loved one that you are a safe person to talk to. They know they can share this part of themselves without upsetting you or making you uncomfortable.

You don’t have to be a mental health professional or know the perfect thing to say. Just saying something like, “Intrusive thoughts can feel scary. Would you like to talk about them?” can help your loved one feel supported.

If your loved one ever talks about things you don’t quite understand or things that make you fear for their safety, you can help them connect with their treatment team or a trained crisis counselor for professional support.

Practice Acceptance

In most circumstances, you cannot control your loved one’s actions and treatment decisions. Practicing acceptance of this fact can help you let go of the urge to control the situation and instead focus on partnering with your loved one to make the choices they feel are right for them.

Trying and failing is an important learning experience for all of us. It’s no less true for people with mental illness. If your loved one’s behavior will not lead to significant harm for themselves or someone else, try to suspend judgment about their choices and be a supportive presence in their life as they navigate their own successes and failures.

Of course, there are some things you can do to support your loved one in staying safe and pursuing recovery as much as possible, such as participating in their treatment or helping plan ahead for a crisis. For more information, check out NAMI’s Supporting Recovery webpage.

Maintain Your Own Boundaries

Part of maintaining a positive relationship with anyone involves communicating your own boundaries, limits, and needs. This can be tough when you’re caring for someone with a serious health condition, but it's important.

If you need to say “no,” take some time for yourself, or have a tough and honest conversation – it's OK to do so. Even if it upsets your loved one in the short-term, knowing what they can expect from you allows them the opportunity to plan responsibly for their own needs.

For more information on caring for your own needs, check out NAMI’s Taking Care of Yourself webpage.

Spend Time Together

Nothing strengthens relationships like spending meaningful time together. Try experimenting with new activities or show interest in a topic or activity your loved one already enjoys.

Fishing, walking, making music, gardening, or even watching TV together can help you take the focus off of your loved one’s mental health condition and just enjoy being with one another. Regular, everyday moments like these are often what sustains a positive relationship.

Express Care When and How You Can

Many people with mental illness don’t live at home or have close contact with family. They may be unhoused, in and out of jail, or in a long-term treatment facility. Their whereabouts may even be unknown right now.

You can maintain a positive relationship in these circumstances by expressing care when and how you can. Whether it’s sending a supportive text every few weeks, visiting your loved one in jail, or giving them a standing offer to go to a support group together when they’re ready, there are lots of ways you can express your support from afar.

These small acts of care help your loved one understand that you’re still a supportive presence in their life. When they reach a different point in their recovery journey, you may be able to focus more on strengthening that positive relationship, together.