Prioritising caregiver mental health to improve healthcare outcomes

Andleeb Abbas is a seasoned social activist and former Chairperson of the National Task Force for Mental Health (2021–2022) under the Ministry of National Health Services, Regulations, and Coordination, Government of Pakistan. With personal experience as a caregiver to her late mother, she brings a profound understanding of the challenges surrounding mental health and caregiving. Over the past two decades, she has played a leading role in public health advocacy, notably raising awareness about Thalassemia and contributing to its inclusion in national health policy.

It is mind over body. When the mind begins to crumble, even the strongest physique becomes weak. It can turn a vibrant, full-of-life person into someone lifeless. It transforms the most energetic soul into a zombie. It creates distance in the closest relationships. It hurts. It wounds. It injures—emotions, feelings, thoughts, actions, and reactions. It makes you do things you would never do and say things you would never say. When the mind loses control, the loss is unimaginable—except for those who witness it. More than the patient, whose mind’s eye becomes so clouded that they lose self-awareness, it is the loved ones who experience the pain of watching a human being fade away.

Being a caregiver to my mother, who battled mental illness for decades, has been a deeply personal and emotional journey. She suffered from bipolar disorder, a condition that causes extreme mood swings and unpredictable behaviour. All mothers are special, but mine was extraordinary. She had a towering personality and could accomplish anything. With no prior experience, she co-managed an export business with my father, won over the most difficult international clients, and sealed impossible deals. Within the family, she was a central force. All her siblings and relatives adored her. She helped everyone in every way. She was also the most beloved neighbour in our community—people would often come to her with problems, and she would pick up the car keys and drive to the most remote places to assist them. To us, she was a devoted mother who would do anything to educate and empower her daughters. She was unstoppable—until her mind stopped.

Unlike heart attacks, mental attacks go unnoticed. We attribute them to bad days, bad omens, or bad moods. But they can be as damaging—or even more so—than heart attacks. They significantly impair the brain's ability to think rationally and regulate emotions. The resulting symptoms, such as extreme low moods and manic depression, often go undetected. Then one day, a suicide attempt occurs, and the family is left shocked and traumatised. Caregivers are overcome with guilt, shame, and depression. Families fall into a cycle of blame, and siblings find themselves embroiled in conflict, reacting with fight, flight, or freeze responses.

An article published on February 7, 2022, in Psychiatric Times, titled “Taking Care of Caregivers”, revealed that 53% of caregivers report a decline in their own health. Furthermore, 70% struggle with their own mental health issues, and about 33% have seriously considered suicide in the last 30 days. Among caregivers aged 24 to 43, this rate increases to nearly 45%.

For the primary caregiver, it is a constant battle—to continue caring for their loved one while preserving their own sanity. Watching someone so vibrant and revered become someone who accuses, hallucinates, and blames you for unimaginable things is heart-wrenching. And it happens every day. The shift from a quiet, subdued personality to an aggressive, loud one is a hallmark of bipolar disorder. Even when you intellectually understand it, emotionally, it's nearly impossible to accept. Witnessing the psychological, mental, and even spiritual decline of someone you once idolised is agonising. That is why training for caregivers is crucial. Nearly all research confirms that depression can be contagious, and caregivers often develop varying degrees of psychological morbidity. The health and stability of the caregiver are vital; without it, more people in the household will fall mentally ill, and there will be no one left to care for them.

Here are some essential tips for preventing caregiver stress and burnout:

1. Get educated and stay updated

Mental health is a complex subject. Learn the early warning signs. Consult psychologists and psychiatrists. Understand the specific patterns and symptoms of the illness your loved one has—whether it's bipolar disorder or another condition. This knowledge helps you separate personal hurt from the illness. It’s painful when someone you care for lashes out at you despite your support, but being informed helps you brace for those moments.

2. Involve the family

Don’t try to do it all alone. Share the responsibility. Even if family members live far away, involve them in the process. A single caregiver cannot bear the brunt of a patient’s erratic behaviour indefinitely. Create a shared schedule of support and stick to it.

3. Strengthen your body and mind

Grief and guilt can weaken your immune system. Engage in regular physical exercise—it releases dopamine, the feel-good hormone. Light jogging can significantly stimulate brain health. Incorporate yoga, mindfulness, or spiritual practices into your daily routine. Even 10 minutes of deep breathing or prayer can offer relief and restore inner balance.

4. Maintain social connections

Caregiving can consume all your time, often at the cost of work and friendships. Social interaction is essential for mental relief, emotional sharing, and maintaining perspective. Make time—at least once a week—to meet friends. Even an hour can renew your energy for days to come.

The mind holds memories that make it difficult to erase the pain of watching a loved one suffer. It takes commitment, care, and compassion—not just for those with mental illness, but for those who care for them. One message cannot be repeated enough: the quality of your life is directly linked to the quality of your mental health. Take care of your mind, and help others care for theirs.