How do we establish behavioral guidelines for a grown child who suffers from mental illness? Should our boundaries be the same as those we'd set up with any other child? Or do special considerations apply in a situation like this?
A great deal depends on the kind of mental illness you are talking about. A wide variety of conditions get lumped together under that general heading, including everything from mild depression to schizophrenia. Obviously, an individual who merely has trouble sleeping at night due to anxiety has to be handled in one way, and a person who suffers from delusions or dissociative personality disorder in quite another.
On the whole, it would be fair to say that someone who struggles with mental disease in any form needs more boundaries, not less, than the average person. By definition, a mental disability distorts an individual's perception of reality in some way. Since this is true, it stands to reason that he will require extra guidance, very specific limitations, and a lot more structure than most young adults. Because of this, those who live with or interact with him on a regular basis should expect to spend a significant amount of time and energy communicating those guidelines and boundaries in a way he can understand.
As you're probably aware, anybody who suffers from a serious mental illness – for example, schizophrenia or bipolar disorder – should be receiving treatment from qualified medical and psychiatric professionals. This will almost certainly involve some type of drug therapy. If that's the situation in your family, your first concern is to make sure that your adult child is taking his medication faithfully.
If he is unwilling to follow the regimen prescribed by his doctors, you will have to proceed with extreme caution. Sit down with the rest of the family, possibly in the presence of a professional counselor. Agree to govern your interactions with him by means of some strict boundaries and guidelines. For instance, you might tell your child, "If you refuse to take your medication, we can't permit you to spend time in our home," or "Until you decide to cooperate with the doctors, we won't be sending any more financial support." It may sound harsh, but it's a question of self-protection. Besides, there isn't much you can do for him if he isn't willing to go along with the program.
If he is receiving the treatment he needs, or if the illness from which he's suffering is less severe, go ahead and assess the situation with an eye to the best interests of everyone concerned. Then set your boundaries accordingly. The goal here is to preserve healthy relationships. If you want your interactions with your child to remain friendly, you need to be direct and diligent about protecting your time, your privacy, and your health from unjustified intrusions.
As you go through this process, remember that it's easy for parents in your position to blame themselves for their child's difficulties. If you allow yourself to feel guilty, you will quickly fall into the trap of enabling your adult child to manipulate your feelings. There isn't any reason in the world why a young adult struggling with depression, anxiety, neurosis, or even bipolar disorder should not be given responsibilities similar to others their age. Not doing so can prevent their progress toward healthy independence. Remember, each and every one of us has hurdles to overcome in one way or another, not just those who are labeled "mentally ill." We all need to learn how to trust in God and make our own way in the world despite our limitations. So in mapping out your strategy, make key decisions on the basis of prayer and careful, rational thought, not emotion.
If you'd like to discuss these ideas at greater length with a member of our staff, feel free to call Focus on the Family's Counseling department.
National Alliance on Mental Illness – 1-800-950-NAMI (6264)
Bipolar Disorder: A Brief Overview