How to Support Siblings of Children with Mental Illness

First published May 2018
Updated March 2026

A child or teen going through mental illness is not the only one affected. Families and siblings also experience a secondary crisis. It is important that we not only support the impacted child but consider the wellbeing of siblings who are also struggling as the family attempts to cope.

When considering how to support the sibling of a child with mental illness, it is important to think about the ongoing nature of the behavioral health concerns the child is experiencing. Is this a recent change? Is this an ongoing and chronic situation? Was there an acute crisis event? These are important questions to ask when supporting siblings.

• Brand new or acute events are scary for families and lead to a great deal of confusion regarding the system and the “right” steps to take.
• Long-term and chronic problems can lead to families feeling discouraged.

Other factors to consider include:

• The nature of the symptoms the patient is experiencing. Is the child who is going through the behavioral health concern acting impulsively? Isolating? Harming themselves? The nature of these behaviors can have different impacts on the sibling.
• Parent reactions and the home environment. Younger children are much more likely to react strongly to adult emotion. Older children can be negatively influenced by changes to their routine and schedule.
• Other life stressors. Insecurity of resources or basic needs, community violence, or familial conflict can negatively affect the experience of the sibling.

Mental illness and its impact on a family can be difficult to navigate. The best approach is to keep open communication. Encourage the sibling to ask questions about their sibling’s conditions or ways to best support. Talk to the patient’s sibling in words they can understand. For example, “Your sister’s brain is making her mind and feelings get all tangled up. If she had the choice, she would not want to feel this way.” Providing space for open communication helps family members better understand mental health and can reduce potential feelings of guilt or confusion.

Consider using these techniques to encourage open communication:

1. Encourage the sibling to share their thoughts. For example, “Have you told your mom that you are worried about your sister?” or “Maybe we could tell your dad together that you miss getting to go to baseball practice during your brother’s appointments.”
2. Validate what the sibling is saying and feeling. Don’t try to minimize their feelings or change their mind. For example, “Wow, that must be scary” or “It must be hard being so mad all the time.”
3. Reflect back what they tell you. For example, “Your sister hasn’t acted happy in months, and you have felt very alone.”
4. Consider creating a plan. This way, if their sibling does something “scary” or “confusing” they know how to communicate:
   • What they are feeling
   • Who they will talk to about it
   • How they will say it
   • Things they will do to help themselves feel better
   • Things other trusted people can do to support them.
5. Encourage parents to schedule one-on-one times with the sibling. Talk with your patient’s parents about scheduling small moments, roughly 5–15 minutes daily, for individual time with the patient’s sibling to help them feel supported and valued. This could include engaging in their favorite game or art activity together, practicing a sport, baking or cooking together, or talking about their interests.

Remember that mental illness can be a life-long journey and there is no “magic pill.” Treatment is an ongoing process that can take time.

If you or caregivers are concerned about patient’s siblings’ safety, connect patient’s sibling and caregivers to crisis resources or encourage presenting to an emergency department.