The 'correct' way to deal with my boyfriend's breakdowns?

For issues specific to caring for someone with mental ill health.
Hi all!

I just joined and finally feel able to take on the 'carer' name (which has lifted a weight in itself), and feel like I could have also written half of these posts as the situations are often so similar.

My boyfriend whom I live with has severe depression, self harms A LOT and has very bad breakdowns/episodes of suicidal thoughts. The care he has received has been....frankly appalling. His breakdowns seem completely manic to me - shouting, slamming, punching, eyes wide, heavy breathing, somewhat imaginative/hallucinating - it's like a completely different person has kicked off. He has cut himself to the point now it's all down both legs, and he was worried he would bleed out the other day. He's even been arrested for self harming in public, and been up at a&e for suicide attempts and just sent home and placed on a CPN waiting list?! "He has a girlfriend who can look after him so...."

Anyway, when he is in these states I am losing hope and patience because I feel that I've tried every "tactic". I sit down, talk calmly, let him speak, apologise and see things from his point of view, encourage him to call for help but it still just results in all of the above and him slamming doors and running away. If I try a different tactic of getting 'angry' back at him, still not any better. Recently I've cracked and as soon as an episode is coming I find myself in floods of tears, begging and begging him to stop. So now I've started calmly explaining that I'll leave the house and stay at a friend's until the episode is over. But he has found this incredibly hurtful and unforgivable.

Does anyone have any other ways to deal with a partner when they are in this state? Is he right that it's unfair and selfish to leave him? What other things could I do?
HiBella
It's a bit late for most of us. Im just off to bed. Am sure others will be along to respond tomorrow.
Meanwhile heres advice from Mind that may help
https://www.mind.org.uk/information-sup ... eone-else/

Kr MrsA
Thanks,

Still really hoping for a reply... feeling very very alone. If something’s not clear in my post I can try to explain further :(
I have considerable experience of mental health caring so will try my best to help, is there any reason for these episodes-typical reason might be abuse in the past? In which case councelling would be the answer.

Has he actually seen the crisis team, if you attend A&E then they should call the mental health crisis team who should be arranging apropriate help, either help at home or voluntary stay at hospital.

If your boyfriend keeps harming, it may end up in sectioning, where you are kept in hospital sometimes for weeks or months.

Is the GP involved, has he or you contacted the GP , your boyfriend should be seeing the local community mental health team, these deal with the issues and should provide support to loved ones/family.
You really need to contact the GP and express your boyfriend gets help quickly, bunging someone on a waiting list does not resolve issues.

Have you tried PALS for your local mental Health service, all trusts have to have a PALS-Patient advice and liason i think its called, they should be able to help advise the best way forward.

Are there any triggers for these episodes, do they happen randomly, why are these episodes happening? do you know.

I am sorry i am unsure what you can do when he has an episode, you say you have tried everything, all you can do is encourage him to seek help to reduce the upset that these are causing you.

I have dealt with self harm a lot, it's often the only way of expressing themselves, anger frustration boils over, cutting relieves the pressure/bad feelings but isn't the answer.

Mental health services should be teaching coping techniques.

There are Mind Guides on the Mind website and there is NICE guidance on the treatment of severe depression that the mental health services should be following.

Unfortunatly A&E often isn't the best place to go for Mental Health issues, have you a specialist mental unit in your town? Try looking on the internet or contact Pals.

"The Crisis Centre is open 24 hours a day 365 days of the year and provides community based, emotional and practical support at times of crisis."

The crisis centre will be able to deal with the issues a lot better than you can.

I hope all this helps, I have gone through this with carees but really have not had much luck with the NHS, one caree is getting private therapy and is coming on leaps and bounds.

There are also charitys that provide councelling, also look on the internet or the GP/Pals should be able to give you details, these are often free, provided from a national Lottery grant.

Sorry is this reply is a bit disjointed replying at 4.30 in morning but i hope the above does help, post again if you need to and i will reply.
Hi Bella
Are you reading Emmas threads which is similar to yours?
https://www.carersuk.org/forum/specific ... ions-35056

Also some interesting comments from Jane_1609 You can read all her posts by clicking the number that comes up by her username on the right of any of her posts
"Is he right that it's unfair and selfish to leave him? "

No, of course it isn't!!!

Look, let me 'warn' you right from the start that I come to MH from the point of view of what I call 'firm love'. I start from the premise that 'something has gone wrong' in the patient's life, and that has led to 'appalling behaviour' now, that hurts and harms both themselves AND OTHERS (ie, you).

So, please take in what I say in that light. Others may well disagree with me vehemently, and I have no idea if I am 'right' or not (only that my views are probably influenced by having been raised by a mother with severe MH myself - at huge cost to herself AND her husband and children! - and a niece who has 'ruined her life' with MH since she was 15 twenty years ago....)

There are, to my mind, two things essentially to consider. The first is the most important, because it is about 'cause' (whereas the second is about 'effect')

So, to the best of your ability, do you have ANY idea what is the CAUSE of your BF's mental illness? WHY is he as he is?

Now, usually, it can be said that MH (or really, MI - as it's mental ILLNESS not 'health' isn't it!)(oh, that it were 'health', sigh) has two likely causes - one is 'genetic' the other is 'environmental' (ie, nature or nurture).

So, yes, there COULD be a 'genetic predisposition' for him to be mentally ill. We ALWAYS have to allow for that. It comes with HUGE consequences though, as in, if they are 'genetically ill' then is there ANY hope of change, let alone cure?????

I would say that IF we say that it is 'genetic only' then all we can do is 'treat the symptoms', just as we do with other genetic illness such as muscular dystrophy, type one diabetes, cystic fibrosis, etc etc. We can only 'patch them up' - maybe well enough so they can function 'more or less OK' (think diabetcs on lifelong insulin etc).

However, IF we allow that mental illness can be caused by 'nurture' (ironically, nearly always 'lack' of nurture!) (ie, crap childhoods etc etc), then there is a LOT more hope for 'healing' to be achievable.

(In terms of cause it could be that BOTH nature and nurture play a role - eg, one can have a genetic disposition to MI that is then grossly exacerbated or triggered into actuality by adverse environmental situations - which maybe means that some healing is possible and some 'symtom management' is possible) (the former most likely from talking therapy, the latter most likely from pharmaceutical 'rebalencing' of adverse chemis in the brain etc etc)
Another very important question to my mind is the following -

Do you think his MI is 'affective' (ie, about his FEELINGS) or 'cognitive' (ie, about his PERCEPTION of the world?)

I would say (entirely off my own bat I warn you!), that the latter encompasses primarily COGNITIVE disorders such as schizophrenia, paranoia, where the sufferer 'imagines' or 'mis-perceives' WHAT IS OR IS NOT THERE.

Of course that can impact their FEELINGS and emotions, but the root cause is an inability to 'correctly' perceive the world and the way it works, His KNOWLEDGE is flawed.

However, if his MI is fundamentally 'affective' it is about his emotions - how he FEELS about his own existence, his sense of happiness or unhappiness, his depression or cheerfulness, and, of course, of his relationships with others.
If you think, or have been told by him, his doctors, that he has COGNITIVE mental illness (such as schizophrenia), then you need to consult all the experts in that field, for how best to cope with him. There will be behaviours that do help, and that don't, and you simply have to learn what they are, what his brain can cope with.

However, if he has some form of 'affective' (emotional) MI, then I think you can have far more 'room to manouvre'.

Which is where 'firm love' finally comes in.

So, having SOME idea of WHY he is mentally ill (eg, some form of trauma, unloving parents, whatever whatever)(it's REALLY important to explore what these causative factors are, or you are working in the dark!) (again, consult all the self-harming forums - I'm sure you are already - huge amounts of help and advice up there!), then you can start to work out what YOU need to do.

Irrespective of the shameful funding inadequacies of the NHS for mental health.....is he having (a) any talking therapy and (b) is he on any kind of meds?

This needs to happen to attempt to provide some form of 'stability' (from the mood-stabilising meds) and potential for 'understanding and cure' (from the therapy).

The thing is, there is just SO MUCH that could be going on here, that you have to pick your way carefully.

For example, (and I'm inventing here until you tell us more!), let's say his self-harming comes from a deeply-ingrained sense of 'worthlessness' instilled into him by a cold, critical, rejecting, judgemental and hostile unloving parent who has told him all his life he's an unwanted failure......then it COULD be that his 'accusations' to you that you are being selfish in 'abandoning' him is his attempt to make 'you' into the 'horrible parent' and so is transferring the 'blame' he rightly feels for the parent (but has never been 'allowed' to express to the parent directly) 'wrongly' on to you (who is actually there to HELP - he blames you BECAUSE he feels 'safe' blaming YOU, but UNSAFE blaming his unloving parent etc etc)

The FIRMNESS of your love comes from negotiating the boundaries between sympathy and indulgence of him and his behaviouirs.

The key question is, and it is for all those with affective MI, to what extend are they responsible for their behaviour to others?

And, to what extend SHOULD they 'make an effort' for others?

If you feel he DOES 'make an effort' not to negatively impact on you, then you 'cut him slack' - but, if you feel he is making no effort whatsoever, and simply conveniently 'blaming you' for any stand you take to 'not indulge' him, then that is NOT ok.

One thing is essential - YOU cannot become the 'whipping girl' for whatever has 'gone wrong' in his life, or whatever caused it.

Does he talk to you about WHY he is so, so, so desperately unhappy?
Thank you so so much for your detailed answers, i really appreciate just having a response so I don’t feel so alone!

He has “always been like this” due to extensive childhood abuse and then I think the more failed relationships he has as a result of his outbursts, the more he is afraid of being abandoned etc.

We honestly both actually have wanted him to have inpatient help, and he’s been screaming asking for this, but still a&e just sent him home as he was already on the waiting list for a CPN, and yes the GP is still just “we’ve already referred you, you just need to wait to get to the top of the list”. I feel he is being horribly mistreated :(.

He’s on medication but that’s been a nightmare - it seems to have made him worse but no professional wants to touch it because “I don’t want to change the dosage, that’s so-and-sos job” but then so-and-so says it’s the other ones job and so on. Basically bickering between the CPN (he got one initial appointment recently but still back on the waiting list for anything more) team and the GP, leaving him on potentially harmful medication we don’t want to reduce ourselves because it’s in one dose...

Certainly the boys crying out for Counselling but we are struggling to make ends meet - he doesn’t get paid for all the days off sick he has to take for his MH.
It's really bad that there are so many people who are damaged from childhood abuse, why wasn't this dealt with in his childhood?
I know quite a few who are suffering just the way your boyfriend is, they just aren't getting the support either.

There is a massive shortage of Mental Health beds, the government has cut hundreds in the past few years, Only the VERY WORST get a bed.

NHS Mental Health is truly appalling, just shortages of staff, waiting lists and a general lack of care.

Have you tried HAVOAC Help For Adult Victims Of Child Abuse, might be worth a try?

NAPAC National Association for People Abused in Childhood, there is a telephone helpline

Is there any support group in your area, not the full answer but a bit of support while you are waiting.

I suggest writing to your MP, there clearly is a need for specialist services for people abused as a child but it just seems to be dealt with by mental health services.