Caregivers often take on a range of responsibilities, which can be physically and mentally taxing. This can include helping a loved one with activities of daily living (ADLs), such as getting dressed, using the bathroom, going to medical appointments and more. At the same time, they may provide emotional support and ensure that the patient takes medication as prescribed.
Responsibility often weighs heavily on caregivers, especially when they must step in during a crisis involving the person they care for. Balancing this duty with work, family, personal health, and other commitments adds to their stress.
A 2018 study by researchers from IMH found that over 90 per cent of caregivers supporting those with mental health conditions also experience affiliate stigma when a relative develops mental illness. Affiliate stigma is the negative feeling that comes from being linked to someone who is stigmatised. These feelings can include shame, low self-esteem and embarrassment. Over time, this emotional strain can adversely affect the caregiver's mental wellbeing.
Other common challenges include having to take time off work for appointments or unforeseen situations, managing conflict or misunderstandings at home, adjusting routines to accomodate care needs, and financial burdens.
Because caregiving often happens "out of sight" and quietly behind the scenes, many who manage on their own can feel a great sense of isolation.
Over time, the ongoing emotional and physical strain of caring for a loved one can lead to burnout, a state of physical, mental and emotional exhaustion. Once caregivers get to the point of burnout, both the caregiver and the person they are caring for may suffer, said Dr Bhanu Gupta, Senior Consultant, Dept of Emergency & Crisis Care at IMH.
Studies have shown that when caregivers are overwhelmed or unsupported, they may struggle to provide consistent emotional and practical care. When this happens, there may be tension in relationships and lapses in care that can exacerbate the individual's condition.
Over time, caregivers themselves are also at higher risk of developing mental health conditions, such as depression and anxiety disorders, said Dr Bhanu. This in turn increases the risk for other physical health problems such as high blood pressure and heart disease.
Some common signs of burnout include:
- Prolonged periods of low mood, irritability and resentment towards the person being cared for
- Feeling tired all the time
- Difficulty sleeping and concentrating
- Cutting back on leisure activities
- Withdrawing from friends and family members
- Unhealthy coping methods such as excessive alcohol use and smoking
Here's a self-check list to gain insight into how you're coping. Pause for a moment and think about how you've been feeling recently. In the past two weeks, have you been:
- More easily irritable than usual?
- More resentful about looking after your loved one?
- Having less energy to complete usual tasks?
- Having less interest in participating in social events?
- Feeling less enjoyment from your favourite activities?
- Getting angry very quickly?
- Feeling tired most of the time?
- Spending less time on yourself?
- Feeling less motivated to get up the morning?
If many of these are true, it might be time to slow down and reach out for support. This could mean talking to a trust friend, taking short breaks, or getting advice from a professional.
You might also think about talking to the mental health professionals caring for your loved one. A medical social worker may be able to help you explore other care options. Ultimately, remember that experiencing burnout can happen to anyone and does not reflect a failure in your role as a caregiver.
"Self-care is a necessity, not a luxury. Caregivers must take care of themselves physically and emotionally, and not feel guilty doing so," said Dr Bhanu.
Self-care tips include:
- Set realistic expectations for what you can and cannot control. Share the load when caregiving is too much for you to handle as the main caregiver and remember to give yourself credit for what you are already doing.
- Balance practical needs with responsibilities and prioritise tasks based on urgency. Stay organised during stressful situations with a "care folder" containing your loved one's medical information, and take care of your basic needs like nutrition and rest.
- Acknowledge how you feel and speak to a professional or trusted friend. To unwind, do something joyful each week to help you recharge.
- Stay connected with your support system by having regular check-ins with family to update and plan for your loved one's needs. Joining a caregiver support group can also help you feel less alone as you learn new coping techniques.
Sometimes, help can unintentionally make things worse. This is called enabling, where a caregiver's actions reinforce or sustain a problematic behaviour. For example, a caregiver may give in to unreasonable demands just to keep the peace, step in too quickly to cover up mistakes, or in extreme cases, give money to a drug addict so that they do not "go hungry" - inadvertently enabling the drug addiction.
"When caregivers step in to solve the person's issues, they can sometimes take away motivation for the person to take responsibility for their own actions," Dr Bhanu explained. "Not dealing with consequences also gives the impression that the behaviour is acceptable, escalating with an expectation that the caregiver continues to give in," he said.
Ask yourself:
- Am I doing this because I'm afraid that the person will leave or get upset?
- Am I lying, making excuses, or blaming others to cover up their behaviour?
- Do I continue to help even when it's not appreciated or worsens the issues?
If answers lean towards "yes", it may be time to take a step back.
A relapse can occur when symptoms return or worsen after a period of stability. While they cannot always be prevented, there are steps to take to minimise the risk:
- Help your loved one keep a regular daily routine.
- Watch for early warning signs, such as changes in behaviour, mood or habits.
- Ensure medication is taken as prescribed.
- Keep communication open and calm.
- If worrying changes are noticed, contact your loved one's mental health team.
- Prepare a simple crisis plan with emergency contacts and discuss who can help with symptoms return.
When you think a relapse is happening, stay calm and speak gently. Ask about your loved one's concerns and listen with empathy. Avoid arguing or correcting them. Give them space if they feel overwhelmed and offer to go with them to seek help.
In a crisis situation:
- Stay calm and do not panic.
- Maintain a safe distance if the person shows agitation.
- Speak in a calm and soothing voice and ask how they prefer to be helped.
- Call the national mindline (24 hours) at 1771 to speak to a trained counsellor for mental health support, or an ambulance at 1777 if transport is required.
For more caregiver resources and support, visit the Agency For Integrated Care's website.
