It’s no secret that health insurance is expensive, and paying for mental health services can be outrageous as well. When you and your partner have a large pile of bills to pay, it can make a difficult decision to forgo mental health appointments and psychiatric medications appear–on the surface–to be easier.

No money = No care, no meds. Period. End of story. Right?

Unfortunately, you and your partner may have already discovered what happens when mental health treatment is stopped abruptly. Or if you are considering this possibility, you may be in for an unpleasant surprise.

The ramifications of not getting appropriate treatment go much further than just a depressed mood or anxious thoughts and feelings. It could result in an untimely death.

Postpartum Support International has declared May to be National Maternal Depression Awareness Month. Has your partner or other loved one struggled with depression, either during pregnancy and/or right after giving birth?

Estimates are that 15-20% of women–that’s 1 in 8–have depression either while pregnant or postpartum. Despite such high numbers, many women do not get treatment because they may feel guilty that they are not happy during what society says should be a joyful time.

They may also not realize the symptoms they are experiencing are in fact depression, or may be waiting to see if they feel better after the baby is born, or once the baby has settled into a routine, etc. because what new mom (and dad!) isn’t tired, cranky, and overwhelmed when caring for a newborn?

The problem is, maternal depression is serious, and there is help out there that can make a tremendous difference quickly. Left untreated, your partner is at risk of developing severe depression or postpartum psychosis, which are mental health emergencies.

As a supportive partner, what do you need to know and what can you do to help?

Nancy’s problems with spending began when her job stress increased. As she felt more anxious and depressed, she found herself turning to shopping as a way to make herself feel better.

At first, the “high” of a new purchase would help her forget her stress, but Nancy found herself spending more and shopping more often. As the bills piled up, she found herself hiding her purchases from her partner, and feeling guilty, too.

We all spend too much money from time to time, but there are some clear signs of compulsive spending:

• Being preoccupied with shopping or spending money
• Shopping when angry, sad, or anxious
• Buying things that are not needed or too expensive for the budget
• Experiencing a “high” after a purchase, but then having a mood crash afterwards
• Having relationship and/or legal problems because of the spending behaviors

Compulsive spending has the double-edged sword of both positive and negative reinforcement. Your partner experiences positive feelings from the purchase, and also relieves the negative feelings that led to the urge to spend in the first place. This can make breaking a spending habit really difficult…but not impossible.

Carl sat in his therapist’s office, a softball-sized wad of tissues in his hand, tears streaming down his cheeks. After telling his therapist that his week since his last visit had “been good,” he began to cry. He said that he was worried that he didn’t really have depression, but that how he felt was just part of who he was, and that his life would never get better.

He also said that he has an “anger management problem,” despite never getting in trouble at work or with the law for his behavior. He apologized for taking up the therapist’s time, saying that his therapist probably sees people “who have real problems,” minimizing his own very obvious distress.

Carl is a man struggling with depression.

While the DSM-IV-TR, the “bible” of psychiatric diagnoses, does not delineate between how depression shows up in men versus women, there can be differences that get overlooked or attributed to other factors in men.

One of my three cats, CJ, has a unique purr. Her purr can be heard across the house, or over the phone by unsuspecting callers, and her sound has been compared to a pigeon or turtle dove. It’s nearly impossible not to smile when she is purring (unless it is 3 a.m., because if she wakes up, she purrs then as well!) My other two kitties like to snuggle–often at inconvenient times, such as when I am trying to type a blog post!–but there is no doubt they love me. They tend to stick especially close when they sense I am unhappy or not feeling well.

One of my colleagues at Duke, Jennifer Strauss, was featured recently about volunteer work she, her husband, and their dog, Murphy, do at a camp for children who have lost a parent, sibling or other significant person in their lives within the past two years. In the article, Jennifer discusses the connections the children make with Murphy, and how his presence seems to allow them to express feelings that may not be so easy to share with adults.

The physical and mental health benefits of having pets are numerous. If you and your partner already have pets, are you getting the most benefit? If you don’t have pets, is it time to consider getting one?

If your partner has been taking medication and going to therapy, yet is still struggling with severe depression, there is hope. Sometimes, therapy and medication for depression is not enough. Treatment-resistant depression does not have to be the life sentence it sounds like, however: there are other options that are safe and effective.

Recently, The Dr. Oz Show did an episode on electroconvulsive therapy (ECT) for depression. My department chair at Duke, Dr. Sarah Lisanby, was one of the panel experts. Besides being an expert on ECT, she is also a leading researcher on another alternative treatment for depression, called transcranial magnetic stimulation, or TMS. A third option is vagus nerve stimulator therapy, or VNS. If your partner is not getting relief, one of these three other options might be worth considering.

Bringing up the topic of a partner’s mental illness with family and friends can feel tricky. In some cases, it might be obvious that there is something wrong, but many mental illnesses can’t be detected from the outside. However, that doesn’t mean you and your partner don’t need and deserve support from understanding family and friends.

Asking for that support can feel uncomfortable, though, given the stigma that still exists around mental illness, and cultural perceptions that we should keep personal problems to ourselves.

Jim’s drinking was clearly out of control…he had been up for over 24 hours, and the beer bottles lying around numbered over thirty. Yet he refuses to see a counselor, saying that he “doesn’t have a problem and doesn’t need help!”

Jane’s mother, Sally, age 76, can barely make her way through her own house because of the clutter and items she has accumulated. Jane is concerned for her mother’s safety, but Sally will not allow Jane to clean the house or throw anything away. The more Jane insists, the stronger Sally’s resistance. It’s gotten to the point where Sally has told Jane she is not welcome to visit anymore, and Jane cannot figure out how to help.

Josh has not been feeling like himself for a long time now: he lost his job six months ago and his girlfriend of two years broke up with him a few weeks ago. He’s finding himself sleeping through the day and staying up all night, gaming online and looking at porn. He knows he should be job hunting, but really, he doesn’t care anymore. He’s lost 20 pounds, and when he does see his friends, they are shocked at the changes. But when they ask questions, Josh blows them off and says, “I’m fine.”

All three of these people are great candidates for therapy, but none of them will go. Why?

The American Psychological Association released its annual Stress in America report earlier this month, and the findings were clear: those caring for people who are aging and/or chronically ill (including those having a mental illness) are under more stress than the average American. According to estimates from the National Alliance for Caregiving, 65.7 million Americans served as caregivers for an ill or disabled relative in the past year.

Not only that, caregivers reported that they are less successful in making changes that could improve their quality of life, such as eating well, exercising, managing stress, and getting enough sleep. If you read this blog regularly, you know that I often reinforce the importance of these strategies, but the results show this is still difficult to put into practice.

You may have told your partner during your time together that he or she is “one in a million,” but if they also have a mental illness, they are more like 1 in 5 Americans, according to a recent report from the Substance Abuse and Mental Health Services Administration (SAMSHA).

According to the report:

A new national report reveals that 45.9 million American adults aged 18 or older, or 20 percent of this age group, experienced mental illness in the past year. The rate of mental illness was more than twice as high among those aged 18 to 25 (29.9 percent) than among those aged 50 and older (14.3 percent). Adult women were also more likely than men to have experienced mental illness in the past year (23 percent versus 16.8 percent).

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health also shows that 11.4 million adults (5 percent of the adult population) suffered from serious mental illness in the past year. Serious mental illness is defined as one that resulted in serious functional impairment, which substantially interfered with or limited one or more major life activities.

As the well partner, what does this mean for you?