Individuals living with a mental illness may feel that they are not in control of their lives and are not able to make choices for themselves. As an individual with a mental illness is empowered to participate in their recovery, their mental health is more likely to improve. The idea of empowering individuals with a mental illness to direct their own treatment and make their own decisions is considered self-determination.  

Self-determination promotes recovery
As a caregiver, it may be stressful or worrisome to foster independence. Remember that the ultimate goal of being a caregiver is to help your loved one experience recovery. The more involvement an individual has in their treatment, the more likely it will be effective.

Self-determination promotes recovery whereas making choices for your loved one merely provides maintenance from crisis to crisis. Find a balance that works for you and the individual you care for when it comes to decisions regarding their health care.  

Decisions regarding the safety of the individual with a mental illness and other people should always be given great attention. If your loved one has a history of suicidal thoughts, discuss with them and a professional, like a therapist, psychiatrist or social worker, how to best balance self-determination and the risk of suicide or other harm to themselves or others. If you or someone you know are in a crisis, visit your local Emergency Room, call 911 or call the national Suicide & Crisis Lifeline at 988.

Talk with your loved one while they are in a stable mental state about developing a Psychiatric advanced directive. This is a legal form that describes an individual’s wishes in regards to treatment during a crisis.  

Fostering Self-Control
Self-determination starts with little choices which build the foundation for larger decisions. As a person starts small with choosing what to eat, what to wear, what hobbies to pursue, and what friends to have they will be better prepared to make big decisions such as where to live, who to live with, where to work, whether or not to obtain a higher education, what treatment to receive, etc. This builds their strength to live with their mental illness and have a higher quality of life.

Support Self-determination
As your loved one becomes more self-determined support them in their decisions. Feel free to provide guidance, but allow the decision to be their own. Naturally, if the decision jeopardizes the health and safety of your loved one or others, you should intervene. Depending on the person you care for, it may be helpful to list options for them to choose from. For example, if your child who has a mental illness is choosing where to live but you and their medical team agrees they should not live by themselves, discuss your concerns and give suggestions. As long as their decision does not endanger them or others, support them. Giving an individual the ability to choose and supporting their choices can empower them, boost their confidence, and help them feel proactive in their recovery.  

Employment
By law, employers are not allowed to discriminate due to health status. As a caregiver, encourage your loved one to work if they are capable. Having a job, part-time or full-time, is a great way for an individual to learn self-determination and to help them return to recovery. Some individuals are not able to work due to current health conditions or the possibility of losing disability benefits; if your loved one is in this position, consider talking with them about volunteer work or other alternatives which foster self-determination. Click here for more guidance on work and recovery. 

If your loved one is currently working and it is taking a toll on them, discuss what changes could be made to ensure their employment is not hindering their mental health. For help understanding how healthy your loved one's job is, encourage them to take a work health survey.  

View Mental Health America's Related Position Statements on Self-determination and Employment.

Reprinted with permission from National Mental Health America.