Your spouse has seemed especially unhappy lately. Your friend is drinking too much. You spot your co-worker crying in the bathroom on several occasions. You want to reach out and offer help. But it’s not easy.
Mental health is a touchy topic to broach. Most of us aren’t trained or experienced in dealing with mental distress, and we don’t want to appear nosy or step over someone’s privacy borders. Yet, seeing a friend or loved one in obvious distress is impossible to ignore. It is also dangerous, because the person’s anguish could lead to harming himself or herself.
So what is the right way to begin the conversation? “The place to start is, delicately,” says Dr. Philip R. Muskin, a professor of psychiatry at Columbia University and secretary of the American Psychiatric Association. “In wood shop, for those who remember wood shop, they used to teach you, ‘measure twice, cut once.’ I think it’s the same thing here,” he says. “If you’re concerned about a loved one, think it through carefully before you bring it up.”
[See: Am I Just Sad — or Actually Depressed?]
Setting Goals and Making Plans
It’s critical to have a goal in mind before you start the conversation, Muskin says. “People don’t always hear this with the kind of compassion it is meant to be,” he says. “They can hear it in a stigmatizing way. It can be very disconcerting to people — ‘You think I’m nuts?’ That gets you nowhere. You have to understand what you are hoping to accomplish.”
Those goals can run the gamut from, “I just want to check in and see how you are” to “I’ve seen some things that concern me and suggest you consider treatment” to “I’m worried for your safety, and I am calling an ambulance to get you to an emergency room.” Whatever your goal is, be clear about it, Muskin says. “If it’s fuzzy, the risk is that the person’s pushback negates the intervention.”
Prepare for the possibility that the initial reaction may be defensive or resistant. “This will help you remain calm, patient and understanding of their fears and concerns rather than becoming angry or frustrated by their unwillingness to acknowledge the problems they’re having or doing something about them,” says Alison Ross, a clinical psychologist in New York City. Another possibility is that the person may insist that his or her troubles remain a secret between the two of you. “You have to be ready to say, ‘That can’t be. We can’t do nothing. We have to come up with a plan,'” Muskin says.
Before approaching the person, he suggests talking to another friend or family member, to compare observations and concerns. “Do you agree and see this in same way? That is important,” Muskin says. “Also, sometimes we don’t know everything. Another family member may say, ‘Did you know about …?’ That changes things.”
And give some thought to where and when you want to have this conversation. “In their home or yours? One-on-one or with other family members present? That could also make a difference in how the conversation goes,” Ross says.
Finally, have a detailed, perhaps written list of examples of what you have seen that concerns you. Whether it is seeing the person crying all day or having five drinks instead of one or arguing with people all the time, come with facts and express that these incidents worry you. “Expect the person to refute what you are saying,” Muskin says. “That may not happen, they may say, ‘Yes, I am suffering terribly, I think of killing myself every day.’ Then you can say, ‘I am so glad you are sharing that. Let’s get you the help you deserve.'”
[Read: 7 Things You Should Never Say to Someone With Depression.]
Starting the Conversation
In terms of the conversation itself, Ross thinks it’s helpful to prepare the person for what you’re about to discuss with them. “Offer a two- or three-sentence preface before launching into the topic so that they don’t feel attacked or ambushed or blindsided by it,” she says. There are many ways to do this; she offers this: “I wanted to talk to you about something that’s been on my mind. I’m hesitant to bring it up because it’s a tough subject, and I don’t want to upset you, but I’ve noticed that you’ve been having a hard time lately, and I wanted to talk to you about it to see if there’s anything I can do to help.”
Choose the words you use carefully. “Use words like ‘deserve’ or ‘entitled to,'” Muskin says. “Saying ‘You need help’ is not the same as ‘You deserve help.’ That simple change of wording changes the emotional meaning of the sentence. ‘What’s wrong with you?’ is very different than ‘I am worried about you.'”
Navigating the Conversation
Once the conversation has started, it can go in any number of directions depending on the person and the severity of his or her issues. If you believe the person needs more help than you can give, suggest talking to someone with more experience in these matters. “It can be clergy. Many are trained in these situations,” Muskin says. “It may be an internist. That’s fine.” He suggests, however, that seriously depressed people should be assessed by a well-trained provider to determine if suicide is a real concern or not.
“One thing to think about are the reasons why the loved one has not sought treatment on their own,” Ross adds. “Do they view having mental health problems and seeking treatment for them as a sign of weakness or shame? Are they afraid of what a doctor’s diagnosis might mean? Are they adamantly opposed to taking psychiatric medication and/or seeing a therapist? Appreciating and anticipating your loved one’s mindset will be helpful in addressing their concerns, and in helping them work through them when talking with them.”
[See: How to Find the Best Mental Health Professional for You.]
Whatever path this conversation takes, be prepared to continue to walk it with your friend or loved on. “Once you make the commitment to talk to someone, you should include the notion that you will help them get help they deserve,” Muskin says. “If they are depressed, they may not be able to handle that. Say ‘I will make the appointment for you, and I will take you to it.’ We are supposed to care about each other, but psychiatric illness and substance abuse pushes us away from one another. Reaching out in a compassionate way can change a great deal, but it has to come from an internal place of, ‘I care enough about you to enter into this mess. Now let’s find a way to help you.'”
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How to Start the Conversation About a Loved One’s Mental Health originally appeared on usnews.com
