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You Cannot Pour from an Empty Cup

Supporting Yourself While Looking After Someone Struggling from Mental Illness

“Rest and self-care are so important. When you take time to replenish your spirit, it allows you to serve others from the overflow. You cannot serve from an empty vessel.”

Eleanor Brownn

In our co-relational model at The Calgary Therapy Institute, we recognize the mental and physical impact of caring for a loved one with a mental and/ or physical health condition. It is crucial to acknowledge this role that many of us must take, and the impact of his role individually, and as a community. Today, our blog is focused on this role, and what it means to look after yourself when you’re faced with the unexpected.

Supporting someone with a mental health condition is probably a responsibility that you didn’t expect to deal with; however, you may have landed in this position anyways. Whether the individual in need of your support is a child, parent, partner, sibling, or friend, this can, and likely will be, taxing on your own mental and emotional resilience. According to Shah et al. (2010), the majority of responsibility for the care of an individual suffering from mental illness lies in the hands of the family, and carers are more likely to develop higher rates of poor mental health as a direct consequence of their role as a care giver.

Shah at al. (2010) found that a carer for mood disorders will often experience “significant distress, marked difficulties in maintaining social and leisure activities, decrease in total family income, considerable strains in marital relationships, … poorer physical health, limited activity, and greater health service utilization than non-caregivers” (Table 1).

Walinga (2014) teaches us that stress and coping is approached through the following steps: stressor, primary appraisal, secondary appraisal, and then coping response. (See Figure 1 below).

Figure 1: [The Transactional Theory of Stress and Coping]. (2014). Walinga. Retrieved May 18, 2023, from

Walinga (2014) notes when a stressor is presented to an individual, they will take a primary appraisal of the stressor in which they assess whether this is a threatening or non-threatening situation. Upon second appraisal, the individual decides whether they already have the tools to deal with this stressor. If the individual feels they have the tools to deal with the stressor, they are more likely to resort to a “problem focused coping response.” Alternatively, if they do not feel like they have the tools to deal with the stressor, they are more likely to resort to an “emotion based coping response.”

“When you perceive you have control, it can improve your overall well-being. And, when you lack perceived control, depression and learned helplessness can develop.” (Moore, 2022)

Dr. Miller has found in her practice, that when clients experience a sense of not being able to control the outcome of the health situation, they can feel helpless. She encourages people to find small ways that they can have control within medical or health crisis situations. Finding smaller goals such as making sure to eat a healthy breakfast, call a friend for support, attend an on-line talk that explores the living-with health topic, listen to a podcast, engage some mindfulness and breathing practices. These small actions of doing and caring for self can provide a sense of empowerment and resiliency, during times of stress.

When you’re looking after someone who is suffering from a mental illness, it is very important to take time to make sure that your needs are also being looked after.

Derived from Maslow’s Hierarchy of Needs (his theory originally proposed in 1945), SamSara Gear (2018) proposed a Hierarchy of Mental Health Needs (see Figure 2). SamSara Gear is a unique clothing company ran by a father, Frank, who lost his daughter to suicide in 2016 after a 20-year battle with an eating disorder.

Figure 2: [The Hierarchy of Mental Health Needs]. (2018). SamSara Gear. Retrieved May 18, 2023, from

The Hierarchy of Mental Health Needs was an image that spoke to Frank in terms of the individual’s primary mental-health needs, starting at the bottom of the triangle and working our way up, like building blocks upon one another. The idea is that when every one of these needs are met, one can “serve others from the overflow” (Brownn) and are able to show up for themselves, for their partner, child, family member, and/or friend in need.

Why is this important?

I’m not sure that everyone’s Hierarchy of Mental Health Needs is the same. I think that, perhaps, they follow similar patterns, but we are all individual people, and we all have different needs, we all handle stressors and crises different.

Let’s dissect Frank’s hierarchy:

  1. Support – While you are busy supporting someone in need; its important to recognize that you may also need support. If you’re putting on a strong face for your child, or loved one, it is okay, and perhaps necessary, to lean on another loved one for their support. It is what family and friends are for, and they should be used as a part of your mental health safety plan.

  2. Treatment – I think treatment and support can go together. Perhaps, support would include friends, family, etc. whereas treatment might be services such as a psychologist, social worker, general practitioner, a mentor? Maybe, it just means a plan… or the commitment to yourself to plan.

  3. Sleep – Sleep is a basic need and is a requirement of our primary health and wellness needs. We cannot function without sleep for more than a couple of days. This is a non-negotiable need that can have significant impact on our longer-term well-being. According to the National Heart, Lung, and Blood Institute (2022) sleep is vital for supporting healthy brain functions and maintaining physical health. Sleep regulates your heart a circulatory system, respiratory and immune systems, hormones, metabolism, and helps with proper learning and long-term memory function.

  4. Coping Strategies – This can range from internal to external coping strategies. Internal being things you can do yourself, to help take your mind off what is going on (walking, listening to music, cooking dinner, watching your favorite TV show, taking a bath). External coping strategies may include things outside of yourself, or your physical space that may help you take your mind off things (hanging out with your friends, playing a sport, getting a coffee at your favorite cafe). We don’t all have the luxury of knowing what our *healthy* coping strategies are… it may be worthwhile to put it somewhere on your hierarchy of mental health needs and spend some time thinking about what it is that can help you take your mind somewhere else when you need a bit of a distraction or cool down.

  5. Healthy Relationships – Ongoing support – maybe Frank was solidifying the importance of other people in the equation. When you’re looking after a loved one, you cannot put all the responsibility, and stress, on yourself. It’s okay to reach out to those around you.

  6. Self Compassion – This is a big one. And I think one that perhaps a lot of us struggle with. Are we doing enough? Did I say the wrong thing? Am I enabling them by helping too much? What if I had done this, or said this instead? Should I show more, or less empathy? Self-compassion is the ability to be kind, loving, and accepting of ourselves even in the face of failure (Moore, 2019).

  7. Self Transcendence – “the expansion of the individual self… going towards something greater, more complex, and infinite…” (“Self-Transcendence…”, 2019). This is one that I think could fluctuate on the Hierarchy for different people. For me, when things are going really bad, I have to believe that there’s a silver lining, there’s a lesson, an opportunity for growth… an “everything happens for a reason…”

  8. Self – Care – yes, of course. That is what the Hierarchy is all about!

  9. Humor – Ahh, humor. Yes. Life is so serious, being a carer is so serious… it’s important to find the time to allow yourself the space to relax. According to Li (2014), when we smile, this fires a signal to the brain that stimulates our reward system, which increases our “happy hormones”. This, among lots of research has shown that the term “fake it till you make it” actually does work.

  10. Empathy – Having empathy, perhaps for those around you, and for yourself. Empathy means putting yourself in the shoes of others and walking with them. Being able to see from other perspectives is an important part of your own healing process as it can provide you with insight into why an individual may be acting in a certain way (maybe even towards you).

  11. Rest – Not just sleep but allowing yourself to relax. Calm your nervous system.

  12. Hope – Never give up hope. I believe this goes with self-transcendence. Even at the grimmest hour, you must remember that you are not alone. Life ebbs and flows, and one way or another, if you want it, and you look after your hierarchy of mental health needs, you will be okay.

This was my interpretation of Frank’s hierarchy. Yours may be different.

What does you’re Hierarchy of Mental Health Needs Look Like?

While these times can be incredibly testing; remember, you’re not alone, and you do have control over your mental health needs. Small steps, and actions that validate that you are worth it, you cannot give what you have not received - a reciprocity of energy that the person providing needs to be provided to.

I know, even as the writer of this blog, that sometimes words on a screen can seem like just that, words. “Thanks for the science background… but it’s just so overwhelming.” One-step-at-a time. And remember, when you’re looking after yourself properly, you’re better equipped to look after your loved ones. And the good news is, you can take control of whether you try to focus in on you, and what you need too. Small actions - say a lot in the world of self-compassion and self-care.

The Calgary Therapy Institute


Li, D. (2014). What’s the science behind a smile? British Council.

Moore, C. (2019). How to Practice Self-Compassion: 8 Techniques and Tips.

Moore, M. (2022). Stress and the Perception of Control. PsychCentral.

(May 28, 2018). The Hierarchy of Mental Health Needs. SamSara Gear. Retrieved May 19, 2023, from

Peláez, M.W., (2011). Plan Your Way to Less Stress, More Happiness. Time.

Self-Transcendence: The Value of Going Beyond Your Individual Self (June 29, 2020). Exploring Your Mind.

Shah, A. J., Wadoo, O., & Latoo, J. (2010). Psychological Distress in Carers of People with Mental Disorders. British Journal of Medical Practitioners, 3(3), 327-335

Stangor, C., & Walinga, J. (2014). Introduction to Psychology (1st Canadian ed.). BCcampus.

(2022, March 24). How Sleep Works. Why Is Sleep Important?. National Heart, Lung, and Blood Institute.

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