Self-help Articles

by Michael J. Orlosky, MD, MMM, CPE

Nearly all mental illnesses carry with them an increased risk of poor health, although proper treatment can dramatically reduce those risks. For those with a mental illness, knowing your risks can help you to anticipate possible problems and improve your overall care. In this article I will highlight some of the steps that you can take to reduce risks, and also how you can add healthy components to your life.

First, to define the terms, here are the risky conditions that I am writing about:

• Intentional self-injury
• Attempted suicide
• Excessive use of alcohol
• Recreational use of narcotics
• Sexual behaviors without protection
• Driving while mentally impaired
• Putting oneself into dangerous situations

Let’s make a distinction between risky behaviors that are part of the mental illness versus risky behaviors that are a consequence of the mental illness. Here is the difference.

Many people with mental illness have impaired judgment during the symptomatic phase of the illness. Those with schizophrenia may have delusions and hallucinations that lead them to act in dangerous ways. Similarly, during an acute phase of substance abuse the judgment and behaviors during intoxication can put the person at serious risk. People with bipolar disorder usually demonstrate risky behaviors while in the manic phase of the illness. Those behaviors may include excessive use of alcohol and drugs, reckless spending of money, unprotected intercourse with multiple partners, aggressiveness leading to physical altercations, and traffic accidents due to distraction. When the manic phase has been stabilized, the risk of those behaviors goes down significantly. These are all examples of risky behaviors that are a component of the mental illness.

People with serious depression may experience trouble concentrating, extreme lethargy, insomnia, agitation, and loss of appetite. As the depression deepens, the psychological pain increases to the point where the person may begin to contemplate suicide. In this instance, the suicidal ideation is a consequence of the prolonged depressed mood coupled with a sense of despair that the feeling will never end. In many other mental illnesses the exhaustion associated with unrelenting symptoms can produce suicidal feelings. Finally, this process is not unique to mental illness. People with chronic medical problems, such as intractable pain, often become hopeless and suicidal.

In the first case when the risky behaviors are part of the mental illness, direct treatment of the illness will bring the most effect. The person with schizophrenia needs to be taking an effective antipsychotic medication, the substance abuser needs to stop using drugs, and the bipolar person will see that taking a mood stabilizer will quell the manic urges and bring an improvement.

Once they are in a state of recovery, it is important for those in this category to also know what triggers may bring on another episode of illness. Serious personal stress (loss of job or divorce), use of alcohol and other intoxicants, and even periods of sleep-deprivation can trigger relapses in susceptible people. Knowing your triggers and managing them are a key part of keeping yourself in good health.

For those whose risky behaviors are a consequence of their mental illness, a different approach seems to help. That approach is often simply called emotional support, but the term belies how important it is to feel supported by others. In part, the benefit of peer support has lead to the creation of support groups. Once the support groups were physically based, but many of them now exist through the internet and social network sites on the internet.

What is common to support is the way it removes stigma, isolation, and a sense of personal flaws that can be devastating when left unchecked in your mental thoughts. Understanding and being aware of how many others suffer from the same condition brings a sense of affiliation instead of alienation, of shared experiences instead of aloneness, and hope instead of despair.

Another form of help for those with mental illness includes the many self-help books available. Virtually every condition has a great selection of titles and information that can help. Research has convincingly shown that self-help is beneficial for a number of conditions.

Some years ago a research study found a key factor that outweighed all others as protective for mental health. That factor was the number and quality of your personal relationships. Having many good friends turns out to be strong protection against many forms of mental illness.

Some risk factors cannot be changed. For example, if there is a family history of mental illness, this is not a risk factor you can change. Likewise, age can be a risk factor for such things as dementia. You cannot change your age. So when considering risk factors, you need to think about the ones that you can change, and put your efforts there.

About the Author:

Dr. Orloskyis Executive Vice President and Chief Operating Officer at Human Capital Specialists, Inc., a management consulting firm that specializes in the healthcare industry and advocates for improvements within the system. He serves as Instructor in the Department of Psychiatry at Yale University School of Medicine. He can be reached at morlosky@hcspecialists.com or at www.hcspecialists.com.