Rebecca Woolis, Program Director for Berkeley Creative Living Center and author of “When Someone You Love Has a Mental Illness”, spoke at the February FAMI meeting on the recovery processes for both families and for persons with mental illness.

Stages of Family Recovery Process
The recovery process for the family of someone with mental illness is a grieving process. A loved one is no longer the person we have known them to be. The grief process is not linear; we move back and forth in the stages. Each person goes through at a different pace, so family members often have different opinions about how to handle the situations they face. In spite of this, families need to be as united as possible to best help the person with mental illness.
1st Stage: Shock, disbelief, sense of security and predictability is lost. There is enormous stress, manifesting in different ways (i.e. sleeplessness, headaches). During this stage, families need to be surrounded with compassionate people who understand mental illness.
2nd Stage: Families begin to deal with the reality and take action. Deciding where to draw lines and set limits is a challenge. They will feel just about every emotion, including wishing the mentally ill person were gone (a normal reaction). A network of support and obtaining education helps families move forward.
3rd Stage: Families begin to feel a sense of basic competence, but also frustration with the system and with stigma. They begin to think of the future. Families need to learn to balance caregiving with taking care of themselves and having their own lives.
4th Stage: Families are coming to terms with the illness, adapting, using more sophisticated interventions and developing long term plans and strategies. Many look for avenues for advocacy to make a difference.

Stages for Recovery from Mental Illness
Rebecca presented a framework for helping someone move into change, using as a model the Stages of Change and noting appropriate interventions the family can use at each stage. The range of possible recovery for persons with mental illness is very wide. Some move through all the stages of recovery, while others never recognize that they are ill. “Lack of insight” into the illness, called anosognosia, is the largest barrier to recovery.
Precontemplation Stage: Persons with mental illness first experience a sense of powerlessness, feel desperate for control, and are preoccupied with their symptoms. In this stage, the person lacks insight that there is a problemor is unable to recognize it as a mental illness. Beginning to understand what is really happening is key to moving forward. Unfortunately, some people never move beyond this stage.
Family Strategy: Engagement. Families/caregivers should not press the person to accept their illness. Focus on maintaining a relationship, establishing a working alliance. Meet the person wherever they're at. It's critical to understand and accept that someone who doesn't believe he/she is ill will not submit to treatment. Trying to convince the person they're ill now only discredits you. Preserving the relationship means a chance to help when they eventually do develop insight.
Contemplation Stage: The person begins to accept and cope with the idea of having a mental illness. Ideally, they are able to get education and develop basic coping skills and behavioral strategies. A combination of medication and psychosocial treatments is most effective.
Family Strategy: Persuasion. Help them recognize the benefits of treatment and the negative effects of certain behaviors. Don't tell them or weigh in with your opinion - instead, ask them what they think are the pros/cons. Understand that they may change their mind from one day to the next. Motivational Interviewing, following the GRACE strategy, is a useful tool:
G - Generate recognition of the gap between their current life and their goals.
R - Roll with resistance to the ideas. Don't push!
A - Avoid arguments. It's still critical to retain relationship and trust.
C - Control of one's life. Help them feel some level of empowement. Encourage using skills no longer in use (i.e. playing piano, artwork)
E - Express sympathy, be warm and compassionate.
Action Stage: They begin strengthening a sense of self, regaining social and vocational roles. They are better able to manage the illness. Stigma is a big hurdle in this stage.
Family Strategy: Active Treatment. Encourage them to sustain changes in behavior that they've already begun (i.e. limiting drug use, managing symptoms). Help them identify the early warning signs in order to intervene and minimize intensity and duration of episodes (i.e. have this conversation after a manic episode). Often family members see the warning signs first. WRAP (Wellness Recovery Action Planning) is a good tool, putting the plan in writing.
Maintenance Stage: The person grows beyond the illness, and develops ways to express his/her talents and abilities.
Family Strategy: Relapse Prevention. Help them develop plans for resisting the pull to return to old behaviors and to continue to expand new behaviors. Some people are able to remain stable without medications after developing appropriate symptom management abilities, so they may try reducing or eliminating the medications, but this should only be done under the Doctor's supervision.

A deep thanks to Rebecca Woolis for her very helpful and informative presentation. Note that her book, “When Someone You Love Has a Mental Illness”, offers additional invaluable and practical advice for families on managing life through the throes of mental illness.

Two Great Magazines to consider
If you want to read about the latest research in an easy-to-read format, get advice from experienced consumers and families, keep current with political and social aspects on mental illness, and hear others' stories of their recovery journey, BP Magazine or Schizophrenia Digest may be just what you're looking for. These two journals are top-quality productions, covering just about any topic relevant to the illness. The most recent issue of BP Magazine featured articles with Patty Duke, on the ECT controversy and "Straight talk about suicide". Schizophrenia Digest's cover story was on Susan Smiley's documentary of her mother's life. Both magazines are only $19.95/year (4 issues each). For more information, go to http://www.bipolarmagazine.com or http://www.schizophreniadigest.com or call MHAAC's Family and Caregiver Advocate, Carrole Johnson, at 510-835-0188.