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.

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?

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.

Every so often, I like to share with my readers resources that I have found elsewhere on the Internet. Today I’d like to introduce you to “Patient Voices,” a New York Times online resource that highlights multiple patient stories for myriad illnesses, including ADHD, bipolar disorder, eating disorders, OCD, PTSD, and schizophrenia. If your partner has one of these illnesses, or perhaps another type of physical illness, these interactive clips may give you new insight into your partner’s experience.

Let me know which ones you watched and what you thought. Also, what are some of your favorite resources for learning about mental illness? Post them in the comments below!

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?

“If you leave me, I will kill myself.”

“You don’t really care if I live or die. Why don’t I just kill myself–then everyone will be happy.”

“If you loved me, you would do what I tell you.”

If you are on the receiving end of threats like these, whether they come from your partner, your parent, your sibling, your child, or your friend, it can feel like a bucket of ice water has been poured over your head.

Mental illnesses come with the risk of suicide. Some diagnoses, such as borderline personality disorder, come with a 10% suicide completion rate, although there are often many attempts that are unsuccessful or are simply an exaggerated cry for help. Other disorders, including depression, eating disorders, and substance abuse, carry suicide risks as well.

If the person in your life truly wants to die and/or has a suicide plan and a means to carry out that plan, you need immediate assistance. Call 911 or your local emergency number for assistance. Alternatively, you can call the National Suicide Prevention Helpline at 1-800-273-TALK (8255).

Always take threats seriously and follow through with calling for help.

When your partner is not feeling well, it’s natural to become reactive, doing whatever it takes to get through the current crisis of the moment, and hoping this is the last time.

Taking a more proactive approach to managing the symptoms of your partner’s illness, however, is more effective and empowering, both for you and your partner as individuals, and for your relationship as a whole. Working together to identify a “What Works” list that can be referenced when the illness appears eliminates confusion, frustration, and the feeling of helplessness.

This technique works no matter what illness your partner has. Both of you should work together to create this list, and agree that when the illness appears, both of you will reference this list in order to figure out how to stop the cycle.

Today is Part 2 of my interview with Bridget C. Cantrell, PhD, expert on military PTSD and author of several books about military life (read part 1 here). More information about Dr. Cantrell and her work can be found on her website, Hearts Toward Home.

3) Many soldiers who come home from military service are afraid to seek mental health services at their VA, or to get mental health services at all. How can concerned partners encourage their soldiers to seek help?

Yes, this is very true that the stigmas of seeking help for the service member can interfere. However, with that being said, the help is available and things are changing to encourage our troops to reach out to address the issues they are experiencing. It is important for them to know that it is to be expected to have some challenges with sleep, irritability, relationships, etc. The military have providers on the bases, and there are organizations that provide services for our service members and their families. There are also community and veteran service organizations that have programs to explore. So one needs to be creative and determined to seek out what works best for them to get the help they need to move forward.