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.

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?

Last Friday’s post discussed how stigma is–unfortunately–still a major force in mental health.

Today, I want to share with you something you can do about it. Many positive things in the world have happened because someone has had a loved one go through a negative experience, and decided to instigate change. The National Alliance on Mental Illness (NAMI) has just the thing: Become a StigmaBuster!

Having a partner with a mental illness can feel very lonely. You may feel as if it’s not right to burden others with your problems and concerns, but also wish there was someone who understands what you are going through. Maybe, for whatever reason, going to therapy or in-person support groups yourself is not an option, or not enough. What else is there?

Technology to the rescue!

Online support groups–sometimes called online discussion groups or Internet self-help groups–are one way of finding others who are having the same experiences you are as the partner of someone with a mental illness. These online support groups generally are welcoming environments which users often find helpful. People who use online support groups get emotional support and suggestions, as well as accurate information, since other users will quickly chime in to make a correction if someone posts something erroneous.

In a perfect world, recovery from a psychiatric illness would be like getting over a cold: once it is gone, it’s gone. Our bodies would build immunity to that illness, and we’d never be sick in the same way again.

Unfortunately, it doesn’t work that way with mental illness. It can come back, and when it does, it is often stronger than it was before.

When I release clients from my care because they have recovered to a place where we have decided therapy is no longer necessary, one of the questions I ask them in our final session is, “How will you know if you need to check in with me? What are some of the red flags that will tell you that perhaps you are relapsing?”

This information is good to share with partners, because the person who has the illness may not notice the red flags at their earliest stages. The person may also be in denial, or frustrated that they are ill again, and resisting returning to treatment. As the supportive partner, you have an important role in making sure your partner gets the help they need, whether it’s the first time, or the 57th time, or somewhere in between.

“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.