NAMI HelpLine Learnings: How to get through to someone when they’re seriously mentally ill

The National Alliance on Mental Illness has so many resources & I wanted to highlight those most relevant and necessary to every person.

A NAMI HelpLine specialist is a volunteer position. Once a week for the past 6 months I spent 4 hours taking calls and navigating people to mental health resources. Think of it as the mental health yellow pages.

I’ll make this short. (As short as I can.)

Anosognosia. It’s a symptom in which a person with mental illness doesn’t realize it. And about half of people with serious mental illness (SMI) have it.

Imagine your doctor writing you a prescription for a broken leg when you are certain you never broke it. Why would you take that medication? It would be unnecessary.

Now take an invisible illness, like schizophrenia. About half of those patients have anosognosia. They are not in denial about their disease. Denial is emotional, it’s about not coming to terms with a diagnosis. Anosognosia is biological.

Researchers scanned the brains of patients with anosognosia. They looked at the brain regions associated with self-awareness and perception, and what did they find? Nothing. No brain activity. Or limited brain activity.

A snippet of the side-by-side brain scans. (Left) “Low insight”: anosognosia patient showing limited brain activity (i.e. no red spots). (Right) “High insight”: study participant with substantial brain activity (i.e. red spots).

So how do you convince someone they need to take medication for an illness that isn’t real to them? LEAP.

LEAP is a framework developed out of the Henry Amador Center. Henry had schizophrenia and anosognosia. His brother, Xavier, a clinical psychologist developed the LEAP framework in working with his brother to manage his disease.

LEAP stands for Listen, Empathize, Agree, Partner.

Here’s an example: Someone tells you, “I’m not going to the doctor, they’re already spying on me. They already know everything.”

You listen. Let them speak a little longer than you might like. Let them air their grievances. You hear that they’re paranoid and distrustful.

Respond: “I’m sorry your relationship with your doctor is not in a good place. That sounds really awful.”

Now, you may be wondering, How can I agree with them? Wouldn’t that reinforce their delusions?

You can agree with their sentiment. For example, “I agree. Privacy is really important for building trust and respecting others. And you deserve respect.”

At this point, something normally clicks. They may respond with something like, “Yes! That’s what I’ve been saying all along!!” They finally feel heard. This is your moment of opportunity. While the person is optimistic, put the ball in their court. Partner with them. In this example, you can ask them, “What’s an example of a trusting relationship you have?” You can suggest applying those aspects to the current situation.

Personally, I’ve found that focusing on the person’s positive experiences is the most effective approach. It affords them the opportunity to re-frame the situation. With optimism comes flexibility and greater receptivity.

When Xavier Amador developed LEAP, he emphasized that it was about the strength of your relationship, not the strength of your argument. I personally feel that the LEAP method could apply to conversations beyond anosognosia. Any time we need to bridge understanding across people with opposing views, I think the LEAP method could prove useful.

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Big fat disclaimer: This article I wrote is not endorsed by NAMI. I volunteered on the NAMI HelpLine, but I do not represent the official views of the organization.