By Emalee Gillis, NAMI Spokane Blog Editor.

Participants in NAMI’s Family to Family eight-session course learn about many dimensions of supporting a loved one who has a mental health condition. One topic covered in those sessions is the predictable stages of emotional responses* of family members when a loved one experiences a mental illness. Knowledge of these stages can help families cope with the situations as they arise.

The first stage in the cycle is a mental health crisis. A crisis can take many forms. The event could be the first signs or symptoms of a mental health condition, getting a mental health diagnosis, change in diagnosis, self-harm, suicide attempt, law enforcement involvement, arrest, incarceration, unsafe housing, experiencing homelessness, relapse, hospitalization, other illnesses, etc.

Responses from family members to a crisis can include shock, confusion, and denial. At the crisis stage, the needs of family members include support, empathy, intervention, comfort, help finding resources, and prognosis. During the crisis stage, NAMI Spokane’s Resource Navigator, Robert Lang, can be particularly helpful. He can be reached at

The second stage is coping. Coping can involve many different actions including seeking information, trying new approaches, reflecting on relationships, building a support system, finding mental health services, changing living situations, adjusting to change, attending a class/support program, etc.

During the coping stage, family members may experience anger, guilt, resentment, grief, exhaustion, and numbness. The needs of family members during the coping stage include expressing emotion, accessing mental health information like treatment options, connecting with others, exploring self-care strategies (like nutrition, sleep, exercise, identifying stressors, and time management), learning skills, and family and peer support.  NAMI Support Groups like the monthly group for family members or the monthly group for people with a mental health condition can help at this phase.

The third stage is advocacy. This is where family members reach out and help others who are in similar situations. Actions family members might take in this phase is joining social networks, volunteering, advocating for policy, partnering with loved ones, collaborating with or changing mental health service providers, developing a wellness plan, emergency planning including psychiatric advance directives, and consistently practicing self-care. At this stage, family members may become more active in NAMI, even becoming leaders.

The emotional responses family members may feel during the advocacy phase include empathy, acceptance, energy, motivation, and determination. The needs of family members in this phase include opportunities for participation and leadership, activities, larger purpose, doing enjoyable things, creative outlets, and activism.

It is important to note that this is a cycle. Family members can experience a new crisis of their loved at any time including when the advocacy stage is well underway. The journey with mental health can be long. Sometimes family members may experience responses in all three areas at the same time. They may experience responses in a different order from other family members, friends or others at any point. Family members must take care of themselves no matter what stage they are in for their own mental health and so they can be a support for others.

For more information or to sign up for a Family-to-Family 8-session course, contact Amanda Kaplan of NAMI Spokane at

Emalee Gillis is a writer and blog editor. She is the author of the memoir Adventures on the Path to Living Well with a Mental Illness and has a related TEDx Talk.

*Adaptation of Stages of Emotional Response chart developed by Joyce Burland, PhD, 1991. Additional source: Material included in NAMI Family-to-Family course materials.