by Jon Cue Publick

Created on: April 06, 2007   Last Updated: April 17, 2007

The best part of my job as a Public Defender is the clientele. While most PD clients just need a self-esteem boost and some social collateral, other clients are certifiably mentally ill. This is where the real fun begins. Here are some tips to make your experience with mentally ill clients genuinely more productive and enjoyable:

1. Mentally ill clients aren't mad at you. They are just mad!

Many mentally ill clients will approach everyone in your office (as well as the world) with undeserved hostility. They yell at your secretary, shout at the janitor, and leave rambling angry voice mails that fill your mailbox. Do not take it personally. To some mentally ill people, anger has prove to be the only effective way for them to communicate. Unfortunately, while it may get them heard, it often also gets them feared. Don't push the panic button unless you believe any threat to be credible. Most of them time they just think they are communicating effectively or are using your ear to let off some steam.

2. You can't win an argument with a crazy person.
If a mentally ill person argues with you, there is no point in debating the validity of their delusion. It is like arguing about the existence of God. One person will say it is there and the other will demand proof. Nobody wins and the believer ends up sighting fantastic events as "evidence." Your mentally ill client will not stop seeing what they believe is there simply because you explain to them that they are mistaken. They will instead feel defensive and, in turn more stressed out, which only leads to more symptoms.

3. You can and should set appropriate boundaries
If your mentally ill client shows up every day at your office with a fruitcake that you suspect is poisoned, you don't have to take it. In fact, every day visits are probably not acceptable to you so feel comfortable communicating that. Mentally ill individuals often have problems setting and recognizing what are appropriate boundaries. They may appreciate you assisting them in doing so. Tell your client you can't work on their case (or any case really) with them visiting you all the time. Set a maximum contact schedule- for example, one visit per week and one phone call. Enforce the boundaries. State consequences if they are violated. Hang up the phone on the second call, but first explain exactly how the mentally ill client has violated your boundary or rule.

4. Avoid all physical contact
Similar to literal boundaries, physical boundaries in terms of touch are important to distinguish. Do not touch your clients and do not permit them to touch you. To a mentally ill person, touch can be confused or misconstrued to have unintended meanings. Help you client develop appropriate social boundaries with those they share only a professional relationship by disallowing them to hug or touch you. Setting this rule early may prevent escalation down the road.

5. It is okay to laugh
The mentally ill client can make you feel mad too. While it's not okay to laugh at your client, it is okay to acknowledge to the client that you have a limit to how much interaction you can take. When things are tense, it is okay to laugh to relieve stress. You may also find that many mentally ill clients actually have terrific senses of humor and can recognize when their conduct may be perceived as bizarre or humorous. Some of my best material has come from a bipolar NOS client who once brought me a fruitcake.

In conclusion, no two mentally ill people are alike. Such clients require you to be flexible, communicative and honest. Since these skills are important to develop in all human relationships, why not practice them with your most difficult clients? You have nothing to lose but your fear of the unknown.

Learn more about this author, Jon Cue Publick.
Click here to send this author comments or questions.