This is a huge question. It depends on the mental illness that they’re having – I find that if they haven’t had an active mental illness diagnosis, they are likely to have anxiety or depression induced by the situation. When that happens, I often might ask them something that will bring up good memories so they can relax in their body. Typically, they love telling stories and remembering good things that happened in their life. If the dementia is not so overwhelming that they can no longer remember those things, these questions can bring joy and distraction.  

That said, medication for either anxiety or depression or any other mental illness when a person is struggling with dementia would only mitigate the problems that come with dementia. That said, when someone’s in an assisted living facility, I will get the staff to learn a little bit about their history so that when they’re having a difficult time, they can use distraction by asking them to talk about their children, a sport they loved, a great story that they’d like to tell etc.  

Again, it’s hard to answer the question without knowing exactly the mental illness they are struggling with and how far along they are with dementia; nonetheless, this strategy above is something that has helped staff to shift people from a place of feeling angry and violent to happier and jovial within moments. Depression occurs when they are lucid and recognize they can’t remember things. Often, with dementia, when those memories go, they don’t come back, so keeping up with where they are developmentally in their progression of losing memory is helpful. 

1. Denial is also challenging as I don’t know the diagnosis or what the diagnosis means to this person. Additionally, if you are the caregiver and the words bring up a physiological response or a threat response, it means your ability to control her response can be very difficult.  

So, I would ask if the threat response was based on not feeling heard, which can lead to a physiological trauma response. If so, with cumulative interactions where words are repeated over time, her body can start to have threat responses, which means cortisol gets pushed to the part of the brain, the hippocampus, that controls our emotional centre and doesn’t allow us access to our executive functions (which helps us to think her way-out situations). It kicks in the fight-flight-freeze or Fawn response and then becomes angry, or if she’s forgetting, she’s possibly disassociating, i.e. the freeze response – which is why she may not remember some things. 

What I’m saying is that when a person feels that way repeatedly due to how they feel they are being treated, their body begins to produce a reaction meant to protect them. As a result, they may sometimes not remember those problematic situations even though they may have participated in the discussion or argument. If this is occurring, it may also be essential to figure out if previous traumas may have occurred and gone unreported or perhaps not remembered.  

Depending on the person’s age and developmental capacity, negotiating with them about what the diagnosis means to them is one of the many ways to start to chip away at the denial. Additionally, offering hope and information about how normal a person can live with any mental illness. 

I am researching this model - It has been a while since I have worked with this, so I will take a little while to read so when I get the answers, I’ll send them over.  

When fearful many young people fall back on “I don’t know.” You add into that equation someone who may be struggling with mental illness and it can become much more frustrating for both parties.  Oftentimes, they want to be told what needs to happen, and they’ll fight it until they get the answer they want.  So, one of the ways that I deal with that is by contracting with the young person around the “I don’t know comment.” This also means being patient and ensuring you have that conversation on the day you are grounded in a good place. “I don’t know” typically means I’m scared, and I want help but don’t know how to ask for it.  

You could say something like: 

I don’t know either, but if I worked with you on this, we could figure out the answer. So, I will ask you to get involved with the problem-solving process, and we can figure it out together—or at least try! And instead of “I don’t know,” could you say this is tough, or what else might be helpful for you to say instead of going to “I don’t know?” (Additionally, young people often depend on us getting frustrated and dropping it when they say “I don’t know.”  

Or else: 

Are we at "I don’t know" again?  

• “So, what would you say you wanted if you were talking to a friend?”  

• “I don’t know.”   

• “I think you do know, and that’s difficult to say because it may not be the answer you want. And that likely sucks, doesn’t it?”  

• “I’m going to ask you, as your caregiver/parent/healthcare professional, what answer you think I want and how far off the two are.” 

Quite often, over time, we acquiesce to the statement, “I don’t know,” and the young person learns that this is how they get their needs met. The more we allow that to occur, the more we promote it. 

Using your curiosity, I would check in with the young person to understand what having depression would mean to them. Additionally, I’d also want to know if they understood what different treatments are for depression and what some of the outcomes are for receiving treatment. 

Supporting them with the stigma of that – reflecting on who, if anyone, in the house has talked negatively about anybody who has a mental illness.  

This is a tough one as it quite often points back to the system being exceptionally expensive; things like psychoeducational testing for learning disabilities such as ADHD are quite often unaffordable. When I’m working with people who live in remote communities where there are only walk-ins, or even if they live in Toronto, I typically invite them to do a self-assessment that would help any doctor understand that it was more than not having enough sleep (so you know, lack of sleep is one of the significant symptoms of ADHD).  

ADHD is also often accompanied by processing issues, short-term memory issues, anger management, and anxiety (not always at the threshold of a diagnosis for anxiety). That said, when untreated, ADHD can perpetuate the likelihood of a situational anxiety diagnosis. I’ve attached two self-assessment ADHD questionnaires that you could use to bring to a clinic. Oftentimes, they take you much more seriously and may be more likely to help you find treatment or offer a prescription - with the caveat that they will monitor how that goes. If you want to connect with a clinic that does assessments virtually, I can find that resource for you. Note that it is costly!