Recently, I had the opportunity to take a Mental Health First Aid class. If you’ve never heard of them, I highly suggest you look into them. And if you have time and resources, I definitely suggest taking one. Now going in, I really wondered if I was going to learn anything new. Afterall, I have a childhood of dealing with trauma, a lifetime of struggling with mental illness, a masters degree in the mental health field, and a handful of years working in the mental health industry. I had to wonder if a one-day course could really teach me something I didn’t already know. Well let me tell you, it did!

The class material was definitely designed for a normative population with little to no knowledge of mental illness or psychological struggles. But, if you are someone like me who has spent much of their life dealing with mental illness professionally, educationally, or personally, this is a truly unique view. This was the first time I was truly able to see this struggle from the other side. From the perspective of someone who does not have experience or even understanding of what is happening.

While logically, I understand that there is a lot of stigma around mental illness and mental health struggles, I often emotionally forget this. These types of conversations were my bread and butter nearly from infancy. I grew up surrounded by mental illness, I experienced mental illness first hand, and I jumped right into an education and profession that dealt with it. So I frequently forget that for the majority of society, mental illness isn’t simply a fact of life that needs to be dealt with, like eating or finding transportation to work. For many people in society, mental illness, whether it is yours or someone else’s is this big, scary, taboo thing that you keep hidden in dark corners and hope no one notices it. It’s the elephant in the room that everyone has been taught to politely ignore.

Taking the Mental Health First Aid class really drove this home for me. There was so much information on how to even broach the subject with someone who might be struggling. And this is the topic I want to dive into deeper today: How to have a conversation about mental illness with someone who you worry is struggling. While some of the information I will be covering today is based on knowledge offered in the class, not all of it is. What you’ll be reading here is simply my suggestions, based on a variety of resources I have encountered.

Set The Mood

Remember, for many people, mental illness or mental health struggles are a sensitive and embarrassing topic. It’s not something they want broadcast to everyone and it is not something to be fumbled about with inelegantly. I mean, imagine standing in the very busy check-out line at a department store with your friend, and she suddenly and loudly brings up the subject of your hemorrhoids or your chlamydia. Most of us would be horrified. While some people are definitely open to having these types of conversations and don’t mind who hears, many more people do not feel this way.

So my very first tip for starting this kind of conversation is to set the mood. Find someplace quiet and private where you won’t be overheard. Where the individual can feel comfortable talking. Also, make sure there are few distractions and enough time. If the person actually wants to talk, this is typically not the kind of conversation that can be done in a few minutes, over cubicle walls or when being bustled about in a busy bar. The conversation has the potential to bring a lot of heavy, personal issues up. You need to make sure the environment is right and comfortable for that person.

Some people prefer having all your attention when they speak. Other’s though, prefer something else to focus on. Ask yourself, what would make this conversation easiest for this individual? Would it be best to be working on a project (such as performing car maintenance or a pedicure) while you speak, or would it be better to have full and complete focus on one another.

If you can never find the right time, create the right time. This might mean asking the person to meet up later or to speak privately for a few minutes. And remember, do your best to keep it informal. Unless it actually is an intervention, don’t treat it like one. No one likes being grilled or aggressively interviewed. Keep it casual with little pressure

Open Your Mouth

Once the environment is right, you now have to face the biggest hurdle: opening your mouth and making meaningful words come out. For many, this is the most stressful moment. The moment where you are poised to crumble beneath your boots all the taboos of our culture, to piss all over the parade of stigma. You are asking someone to open up to you an intimate and personal way. It can be scary, especially if you don’t know the person well. What do you even say?

What words you use will, of course, be fully dependent on the situation and the person. There is no right one-size-fits-all conversation starter for this topic. You need to think about why you are worried. And why you care enough to ask the person to speak in the first place. Below are some suggestions of basic phrases that you might be able to use or adapt. If the idea of asking these questions makes you feel uncomfortable, try practicing saying them out loud to yourself or with a close friend you trust until they feel no different than any other phrase you might say.

Identify Why You’re Concerned

Sometimes it can help to tell the person exactly why you are worried. I know when I am struggling, I don’t always realize right away that I am. There is so much going on that I just don’t have the capacity or time to stop and realize that I’m acting differently. Having someone identify specific reasons let’s me know they’ve been paying attention. It also helps me realize the extent to which I am struggling.

If possible, it’s also helpful to stick to objective changes you’ve noticed. This can be things like changes in going out and socializing, or maybe in work behavior, or possibly even an increase in alcohol use. Sometimes, though, you don’t have anything objective to point out. It just seems the person is off or not feeling well. In these cases, try your best not to put your feelings in the other person’s mouth. Use qualifiers such as “it seems like: . . . or “I feel like. . .”. For example, “You seem a little off lately.” Or “I feel like you’ve been dealing with a lot lately.” Sometimes our perceptions are more about us, then they are about the person we are perceiving. Remember this and keep an open-mind.

When pointing things out, definitely remember not to be accusatory or judgmental. This is where non-verbal messages can be extremely important. Think about the phrase “You’ve been missing a lot of work lately.” This phrase can be punishing and judgmental or it can be matter of fact or it can be laced with concern and worry about the person. And follow up your observations with your concern. Just pointing out things about other people is kinda creepy, like you’re stalking them or something. So follow it up with why you’re pointing it out. Phrases such as “I’m worried about these changes.” Or “I’m concerned about you.”

Let them Talk

Once you have started the conversation, remember this conversation is supposed to be about the other person: their feelings, their experiences, and their perceptions. So you need to give them space to share. There is a popular quote by Stephen Covey: “Most people do not listen with the intent to understand; they listen with the intent to reply.” These conversations are all about listening wit the intent to understand. Pretend the person is giving you directions or teaching you something you need to know. They have the information, and you don’t. The only way you are going to get this information is you provide the space, time, and opportunity to let them give it to you.

A great tool that can be used in these conversations is silence. Our society is not big on silence. Often, when there is a lag in conversation, we feel uncomfortable and we want to fill it. Try your best to refrains from doing this. Pauses give the person time to think and encourage the other person to talk. Remember, our society often doesn’t teach us how to think about, let alone communicate, our feelings. The other person needs time to work through what is happening and find the words to frame it. Let them have this time. Additionally, the societal concern over awkward pauses can work to your advantage. If you don’t jump to fill in the silence, the other person likely will. Since you want to hear what the other person has to say, this helps you to hear it.

Focus on Listening

Your main job in the conversation is listening. Remember, you are listening with the intent to understand. Many of us aren’t quite sure how to do this or how to convey our interest without words. This is where non-verbal cues work greatly. Show you are listening by focusing on the person, nodding, or making “go on” noises such as “mmm hmm” or “yeah.” If possible, face the person, and use open body language. Don’t cross your arms or frown at them. Instead leave your body open to them, turned toward them, make your facial expression one that reflects the content they are sharing. The active listening technique of rephrasing what the person has said also works well. This technique can sometimes help the person better clarify what they are trying to say.

If the other person seems to stall out or seems to need help knowing where to go with the conversation, try repeating key phrases in a leading way. If they just said something about their father, and it sounds like there is more that could be said, say something like “your father. . .” in a manner that makes it sound like a question with an inquisitive look on your face. It can also be helpful to use open ended questions when needed. I always think of open-ended questions as being similar to essay questions on a test. They require the person to explain and extrapolate. They are not asking for confirmation of an answer or lead down a conversational dead-end street. Instead they are open to interpretation and encourage the person to provide more data.

Another big part of listening is adapting to the other person. Be aware of the other person’s reactions: emotionally, physically, mentally. See how their words are effecting them. See how your words are effecting them. And then respond accordingly. Maybe the person is about to cry and you need to offer them a tissue or a shoulder. Maybe the person is feeling uncomfortable sharing something with you and you need to respect their privacy. Or maybe the person is finding relief in just talking abut the issue and you need to keep going. Use your listening skills to pay attention to the whole message, verbal and non-verbal, so you can really help the person.

Basic Don’ts of the Conversation

When having the conversation there are a few basic things you should avoid doing. Don’t use derogatory language. This can be things such as “crazy” or “off your rocker”. The person likely feels vulnerable enough, throwing round weighted words like these isn’t going to help. Don’t attempt to diagnose the person. Unless you have degree and licensure to do this, and the necessity to bill insurance to pay for said degree and licensure, this is not your job. Don’t judge, condescend, or belittle the other person. Telling the other person their feelings are wrong, or they are acting stupidly is not going to help. At best it will make the other person feel defensive and at worst it will make them feel even worse about themselves compounding their already existing problems.

Don’t attempt to fix the person’s problem. This can be very hard for many of us who want to make everything better. But ultimately this is not going to help anyone. It is the person’s responsibility to fix their own problems. They may require professional help to do so, but it is still ultimately their responsibility. The point of the conversation is NOT to fix the person’s problems, it is only to allow the person a safe place to be open and honest, to take the first step in beginning their journey to healing or stability.

Above all, do your best to not invalidate the other person. Saying things such as, “I’ve been through worse” or “but you have so much to live for” isn’t helpful. If a person is hurting or struggling, this pain or struggle is big to them. It may be life or death for them. It consumes their whole world. When you step in with invalidating statements what you are actually saying is that you refuse to hear what the person is saying or are incapable of empathy. You are also, essentially, asking them to “prove it.” Asking someone that is in severe pain or severely struggling to prove how bad it is never a good idea. This proof often comes in the form of life-altering or destroying behaviors such as drug use, risky sexual behavior, self-harm, or even suicide.

Basic Do’s of Conversation

While knowing what not do during the conversation is important, it is equally important to know what to do. These are things you should be aiming to do during the conversation. Try to understand. You don’t necessarily have to agree with the other person’s beliefs, feelings, or thoughts,. But do your best to put yourself in their shoes, and see if you can understand where they are coming from or why they would, think, feel, believe this way. Sometimes what the other person is experiencing is far beyond what you can even comprehend. It’s ok to say something like “I can’t even imagine how hard this has been for you.” Admitting this can also be very validating for the other person.

And you want to do your best to validate the other person. Again, you don’t have to agree to validate. You can say things such as “That sounds like it was really difficult for you.” Or “ It sounds like you are going through a really difficult time.” These phrases say to the other person that you hear them, that you see their struggle/pain, and you acknowledge that the struggle/pain is causing them issues.

When you do talk, make sure you speak a language the other person understands. Maybe you have a lot of education or experience with mental illness. Now is not the time to show off the awesome words you know. Instead, use words the other person will understand. Part of this is also being very clear in your language. Don’t avoid the topic or sugar coat the ugly. Instead of saying “are you thinking about doing something to yourself” come right our and ask “have you thought about killing yourself.” If you are going to have the conversation, commit to having it and be willing to say the words our society finds taboo.

It’s also important to follow-through. If you agreed to do anything in the conversation, make sure you do it. The whole reason you started this conversation was to help the person. Leaving them hanging is going to make things worse. Which means, also, only commit to those things you can actually follow-through on.

The reality is, talking to you may not be enough. If it looks like the person needs more help then a simple conversation, see if you can help them find this help. This may come in the form of suggesting they find other resources such as support groups, doctors, or therapists. If you suggest these things, remember to be careful about how you say them to ensure you don’t come across as judgmental or like you are trying to foist them off on someone else. It may also be helpful to offer to help the person find help. This may mean telling them about 211 or NAMI, joining them on the call to the suicide hotline, or, if the relationship is a close one, possibly even accompanying them to their first appointment.

Lastly, do take care of yourself. Having these kinds of conversations can be extremely stressful for both parties. When you stop to help someone share their load for even a moment, you have to remember that weight will take a toll on you. Make sure you are practicing the necessary self-care to keep yourself safe and stable. Also, sometimes you start conversations such as these and you realize the other person is not only willing to talk but is now demanding that you give them more than you are capable or comfortable with. Remember, it is not your responsibility to fix the other person’s problems. If the other person starts to act as though it is your responsibility, it is totally acceptable and necessary to set boundaries. Do your best to help the person find someone who actually can help them, but do not put yourself in danger (physically or psychologically).

Refusing to talk

One last thing to consider with these types of conversations is what happens when you attempt to have these conversations and the other person refuses to have them? It may be you do everything right and say all the right words, but the other person just isn’t willing. When this happens, the first thing you should do is make sure it’s not you. By this, I mean, maybe the person just doesn’t feel comfortable wit you. Maybe your relationship isn’t close enough for the other person to open up or maybe they have a crush on you and are afraid of embarrassing themselves. The reason is irrelevant, but if the person is unwilling to talk to you, ask if there is someone they would be comfortable talking to. Say something like “It’s cool you don’t want to talk to me. Is there someone else you might be comfortable talking to?”

Whether they talk to you, someone else, or no one, remember to keep being present. Be available in case they change their mind in the future. And simply be present and supportive from afar. This may mean an encouraging smile, continued interest, or just a cup of coffee. I also recommend using the Eeyore principal. As long as the person is not presenting a harm to you or others, include them. Winnie the Pooh and the gang included Eeyore even though he was always depressed. They didn’t ask him to be happy or ask him to change, they just asked him to come along. Let the person know it’s ok if they are sad, or stressed, or anxious you still want to be part of their life.

It’s ok to make mistakes

I know, this all seems like a lot to remember. But remember, it’s ok to make mistakes. None of us are perfect, and these can be difficult conversations to have. No one expects you to be an expert. If you do make mistakes, though, own them. Be willing to say “That was insensitive of me, I’m sorry I said that.” Or “I can’t believe I just did/said that. I had no right.” You are asking the person to “be real” with you, so make sure you “be real” with them. And if you’re scared to have this conversation, ask yourself would it be better to try and have things be a little awkward for a while? Or would it be better to not even try, have the person take a turn for the worse, and live your life regretting what you could have done?

References & Resources

Mental Health First Aid a great site to get information about Mental health First Aid and where to take a class.

Having a Conversation with Someone You are Worried About from Beyond Blue and Australian Mental Health Support Service

Supporting Other’s Mental Health: How to Start the Conversation from Think Mental Health a Western Australian Education Campaign for Mental Illness

Supporting a Friend or Family Member with Mental health Problems from mentalhealth.gov a U.S. government education and guidance service

Talking About Other’s Mental Health

Talking About Your Own Mental Health

Cages vs. Colonies: How Culture and Environment Impact Mental Illness and Addiction