Boundary-setting and mental illness

Boundary setting is an important, albeit difficult, part of self-care when a loved one is living with a mental illness. This may be harder and more complex for some than others. By setting boundaries, you are taking responsibility for how others treat you and your own needs seriously.

It’s okay to expect basic rules of conduct and cooperation. We all require these to get along. It is not uncommon for feelings of guilt to prevent people from effectively setting limits and realistic expectations for their loved one.

Relationship dynamics

Wanting to help your loved one as much as possible is common. But sometimes this can be to your detriment. Understanding relationship dynamics may help provide insight into helpful boundaries.

Are you being taken advantage of?

Do you feel overextended, or your needs are on the back burner? It is important to learn to say ‘no’ to unreasonable or unmanageable demands.

Are you inadvertently enabling?

For example, parents of adult children with a mental illness feel obliged to provide care, or fear hurting the person, even though they are capable of caring for themselves. Setting boundaries compels the person to take responsibility for their actions and teaches independence.

Are you unwittingly accepting being abused mentally, verbally, financially and physically?

Even though you love the person, this behaviour, related to mental illness or not, is never acceptable under any circumstance. Never compromise your own or others’ safety for fear of hurting your loved one’s feelings. Make sure you are safe first and contact emergency services.

Deciding your limits

Establishing boundaries is a process. Take your time and look for small ways to begin. Where to set your limits to is a personal decision.

Level of support

Decide what level of support and care you and others involved are realistically able to provide, including limits to protect yourself (or the family) from unacceptable behaviour.

Family conversation

These conversations may be about current, emerging or foreseeable issues. For instance, if your family member may drink alcohol or use drugs while socializing, establish that borrowing the car is never an option under these circumstances. Or, staying up late may be tolerated, but alcohol use is not.

Conversation with your loved one

Discuss and establish basic rules for behaviour and co-operation, limitation and expectations. A clear understanding about what everybody needs, wants, or expects is important. Record these rules and keep them in an accessible location. Boundaries may need to be set without the input of your loved one if they are uncooperative, or redefined over time.

Boundary rules and expectations

Some rules and expectations you, your loved one and family members may want to discuss and decide upon include:

How much financial support you are able and willing to provide
Whether or not you are willing to co-sign papers (a lease, loan or credit card)
How much practical help you can provide (meals, budgeting, grocery shopping, transportation)
Your loved one’s ability to live in your home by agreed rules and consequences
What household chores you expect your family member to do
Personal hygiene requirements
Disruptive behaviours such as refusing to follow house rules, playing music too loudly, neglecting to show up for family meals, being argumentative
Use of tobacco, alcohol and/or street drugs in your home
Gambling
Attending medical appointments
Taking prescribed medications

Following through with a boundary

Boundary setting can almost be the easy part, with the follow through being most difficult. When setting a limit, ensure you are able to implement and live with it. Limits are likely to be tested and, if broken, the person is making a choice, leading to consequences.

Do not excuse them, change your mind, or feel guilty for enforcing a consequence. Giving in sends the message you aren’t committed to the boundary, allowing their behaviour to continue unchanged.

Possible responses could include:

Taking time to choose your response
Saying the agreed boundary has been broken
Explaining how you feel
Giving an ‘action-response-outcome’ statement such as ‘when you come home drunk, I feel very angry with your behaviour. I’m going to ask again that you honour our agreement’
Renegotiating the boundary — restating your wants and needs.
Implementing consequences of the broken boundary
Being a ‘broken record’, repeating what you want, not letting yourself be deflected from this boundary
Commenting how the behaviour was different from that agreed upon, for example: ‘Every time this happens, you say sorry and carry on as if we had not made an agreement’
Being consistent.

Communicating positive feedback

Providing positive feedback to your loved one is as important as communicating concerns. People are more likely to continue positively when provided with positive feedback.

Responding in difficult situations

When a loved one is unwell, unable to think clearly, aggressive or under the influence of drugs or alcohol, discussing broken boundaries can be difficult. Sometimes consider waiting until the person has improved before discussing negative consequences and future prevention.

If you experience fear in these situations, if physical aggression has occurred previously, plan for it to occur again. Do not hesitate to contact emergency services. You will not get your loved one in trouble. Suggestions include:

Irritable or critical behaviour

Remind yourself the person is ill
Don’t argue logically if the person is not thinking rationally
Address specific comments or behaviour (like shouting) that are unacceptable, without criticizing or blaming the person as an individual
Set limits with the person’s verbal abuse by saying ‘I understand you’re upset but I’m not going to tolerate being spoken to in this way’ and walk away.

Aggressive behaviour

Recognise the warning signs of impending aggression
Take casual threats of violence seriously
Plan to ensure your safety (have locks on rooms, leave the house and get help)
Remove objects like knives that could be used as weapons

If risky or aggressive behaviour has occurred, the person, yourself or other family members may need urgent medical help. It is common to feel traumatized by physical and emotional abuse and professional counselling can be helpful. There is a useful list of services at the end of the article to assist you.

Conclusion

Boundary setting is not easy and doesn’t occur overnight. But its implementation is for the benefit of you, your family and your loved one. Your mental and physical health should be nurtured equally with those you love. This can take practice.

Many carers face the dilemma and difficulty of boundary setting, so you are not alone. Please reach out for assistance with the services below if you need support.

Further support . . .

Mental Health Carers Australia (formerly ARAFMI National) 1300 554 660

Carers Australia 1800 242 636

Relationships Australia 1300 364 277