Caring for a family member with mental illness without losing yourself

This page is not medical or legal advice. Do Not Lose Hope is not a clinic or a crisis line.

You are not alone in this

Caring for a son, daughter or spouse with serious mental illness is one of the hardest things a family can face. You may feel love, fear, anger, guilt and grief in the same hour. You may feel that if you rest, something bad will happen.

Here is the truth. Your loved one needs you for the long run, not just this week. That means you have to last. Taking care of yourself is not selfish. It is part of taking care of him.

On this page we say "he" and "him" for the person you care for. Everything applies to a daughter, a spouse or anyone you love.

How can I help him day to day?

These are our practical suggestions, not medical rules. Ask his care team which ones fit him.

1. Learn about the illness. Knowing what schizophrenia, bipolar disorder or severe depression does to thinking helps you take things less personally. Free family classes are below.
2. Talk simply and calmly. Short sentences. One topic at a time. Do not argue about beliefs that come from the illness, like voices or suspicion; NAMI notes that pushing a different view can frustrate or anger a person (NAMI). You can say, "I do not hear that, but I can see it is scary for you."
3. Focus on his goals, not yours. He may not want "treatment." He may want to sleep better, keep a job, or stop feeling watched. Start there.
4. Support the basics. Sleep, meals, a regular routine, taking medicine as prescribed, and going to appointments.
5. Notice early warning signs. Many families learn the pattern: less sleep, pulling away, odd talk, stopping medicine. Write them down and act early.
6. Keep alcohol and drugs out of the picture as much as you can, and lock up medicines and any guns.
7. Celebrate small wins. A shower, a good day, a kept appointment. Recovery is built from small days.

Will the doctors talk to me?

Often families hear, "I cannot talk to you because of privacy." Here is what federal law actually says.

• You can always tell them what you know. HIPAA does not stop a provider from listening to family members. Call or write to the care team. Share his history, his warning signs, his medicines and what you are seeing at home. They can use it in his care.
• You can ask that your call be kept confidential. If he later asks for his records, information a family member gave under a promise of confidentiality may be held back if sharing it would reveal who said it.
• They can share back if he agrees. The easiest path is to ask your loved one, on a good day, to sign a release letting the team talk with you.
• If he objects, an adult patient's wishes generally win. The exception is a serious and imminent threat to his safety or someone else's, when a provider may share with family who can help.

If he has a substance use problem too, special federal rules protect those treatment records even more strictly. A signed consent still opens the door.

How do I get him into care?

Start with the county. Your county runs specialty mental health care for people with Medi-Cal and for many without insurance. You can call about someone else.

• San Mateo County ACCESS Call Center: (800) 686-0101. Staff speak English, Spanish and Chinese, with free interpreters.
• Santa Clara County Behavioral Health Services: (800) 704-0900, then press 1.

Ask about the right level of care. If weekly visits are not enough, ask about more. San Mateo County offers Full Service Partnership (FSP), a team based program that works with the person and, when appropriate, the family. It is for adults with serious mental illness who are, for example, homeless or at risk of it, involved with the justice system, or using hospitals and emergency rooms often. The county decides who qualifies. Ask the ACCESS line or your loved one's clinician whether FSP fits.

Medi-Cal and immigration status. Since January 1, 2026, most adults 19 and older without a qualifying immigration status cannot newly enroll in full Medi-Cal. People who already have it can keep it if they renew on time. Specialty mental health care is run by county plans. See Medi-Cal for adults in 2026 and Mental health care without fear. If he is denied care, see How to complain or appeal.

Privacy and immigration. In California, if a clinic learns a patient's immigration status, the law treats it as private medical information. See Will my therapist share my information with immigration?

What if he refuses treatment?

This is common, and it is painful. Some people with serious mental illness truly cannot see that they are sick. NAMI notes early studies suggesting about 30 percent of people with schizophrenia and 20 percent with bipolar disorder have a severe lack of awareness. That is a symptom, not stubbornness. Arguing about it often makes a person angry or pull away.

• Keep the relationship. You are more likely to help if he still trusts you. Listen more than you push.
• Find a reason he cares about. "Would you see a doctor about sleep?" can open a door that "you need a psychiatrist" closes.
• Use peer and family support. Family classes teach ways to talk that lower conflict.

CARE Court is a California civil court process that connects adults 18 and older who have schizophrenia spectrum or other psychotic disorders, or bipolar I with psychotic features, to a care plan with housing and services. It is for people who are not stable in voluntary treatment and are getting worse. A parent, spouse, sibling, adult child, grandparent, or a person he lives with may file a petition (form CARE-100). In San Mateo County, the BHRS CARE team is at 650-372-6125 or CAREBHRS@smcgov.org. It is not a crisis service. San Mateo County says services require willingness from the person.

Involuntary holds are for a crisis. Under California law, a person can be held for up to 72 hours when, because of a mental health disorder, he is a danger to himself or others, or is "gravely disabled." Gravely disabled now means unable to provide for basic needs like food, clothing, shelter, personal safety or necessary medical care, and it can include a severe substance use disorder. San Mateo County began using the newer rules on January 1, 2026. Longer holds and conservatorship are possible. This is a serious step that takes away a person's freedom, so talk with the county about it.

What should be in our crisis plan?

Make the plan on a calm day, ideally with your loved one.

For when to call which line and what happens on a 988 call, see Calling or texting 988 and Where an adult can go in a mental health crisis besides the ER.

Can I get paid time off or help at home?

Paid Family Leave (PFL). If you work in California and pay into State Disability Insurance (shown as "CASDI" on your pay stub), you may get up to 8 weeks of partial pay in a 12 month period to care for a seriously ill family member. That includes a child, parent, parent in law, grandparent, grandchild, sibling, spouse or registered domestic partner. A friend or chosen family member is not covered yet; a 2025 law (SB 590) adds a "designated person" starting July 1, 2028. A serious health condition can be a mental condition. His doctor or psychologist must sign a medical certificate.

• You can apply even if you are undocumented and have no Social Security number. Use the paper application and leave the Social Security number question blank.
• PFL pays benefits but does not protect your job by itself. Other laws, like the California Family Rights Act, may. Ask your employer or a worker center. See Your rights at work.

In Home Supportive Services (IHSS). If your loved one has a disability, lives at home, and has a Medi-Cal eligibility determination, the county may pay for help with daily tasks. The person who needs care hires the provider, and a family member can be the paid provider. Apply through your county IHSS office. The state's IHSS page says the person needs a Medi-Cal eligibility determination. It does not say whether restricted scope (emergency only) Medi-Cal counts. Ask the county IHSS office before you count on it, and ask how the 2026 Medi-Cal changes affect your family.

Other help. For food, rent and other needs, see 211.

How do I take care of myself?

Caregivers burn out. The 988 Lifeline reminds people who support someone else to take care of themselves too (988). Signs we suggest watching for: not sleeping, getting sick often, losing your temper, feeling numb, drinking more, or feeling hopeless. If you see these in yourself, it is time to get support, not time to try harder.

• Join a family class. NAMI Family to Family is a free 8 session class for relatives, partners and friends, taught by trained family members who have lived it. The Spanish version is De Familia a Familia. NAMI also runs free, confidential family support groups, including in Spanish.
• Talk to someone for you. Your own doctor, a counselor, your pastor. You can call or text 988 for yourself when you are the one at the end of your rope.
• Share the load. Make a list of who can do what: rides, meals, a night off. Let people help.
• Keep one thing that is yours. Church, a walk, a friend, music. Protect it.
• Set limits with love. You can say, "I will not give you money for alcohol," or "You cannot stay here if you hurt someone." Limits keep the home safe for everyone.
• Let go of guilt. You did not cause his illness. You cannot cure it alone. You can love him and get help.

Questions people ask

Is this my fault? Serious mental illness is a health condition, and guilt will not help him. Your steady support will.

He is 25. Can I make his appointments? You can help, remind and drive. As an adult, he decides about his own care unless a court says otherwise. Ask him to sign a release so you can be part of it.

Will calling 911 get him deported or arrested? In California, local police may not ask about immigration status for immigration enforcement, with some exceptions. A crisis line or mobile team is often a better first call when no one is in immediate danger. If a life is in danger, call 911.

Can our church help? Yes, with meals, rides, prayer and company. A pastor can walk beside medical care, not replace it. See When to talk to your pastor and when to see a counselor.

Who can help

These are public programs, nonprofits and free lines. Contact them to confirm hours, languages and openings. Being listed here is not a referral or a promise of service.

• NAMI San Mateo County: family support groups and classes. Office (650) 638-0800. 350 Twin Dolphin Drive, Suite 115, Redwood City. namisanmateo.org
• NAMI Santa Clara County: free classes including De Familia a Familia, and family support groups. HelpLine (408) 453-0400, ext. 1, Monday to Friday 10 a.m. to 6 p.m. 1150 S. Bascom Ave., Suite 24, San Jose. namisantaclara.org
• NAMI HelpLine: 800-950-6264, text "NAMI" to 62640, Monday to Friday 10 a.m. to 10 p.m. Eastern, with a Spanish line. nami.org
• San Mateo County BHRS ACCESS Call Center: (800) 686-0101, 24 hours, TTY 711. smchealth.org
• San Mateo County BHRS Office of Consumer and Family Affairs: help for families finding services and resolving complaints. (800) 388-5189. smchealth.org
• San Mateo County CARE team: 650-372-6125. Not a crisis line. smchealth.org
• San Mateo County Crisis Line (StarVista), for San Mateo County residents: (650) 579-0350, 24 hours. County crisis resources
• Santa Clara County Behavioral Health Services: (800) 704-0900, then press 1, 24 hours. bhsd.santaclaracounty.gov
• EDD Paid Family Leave: edd.ca.gov
• 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org. Free and confidential, available 24/7/365.

You are carrying something heavy because you love deeply. You do not have to carry it alone.