How to Talk to Someone About Mental Illness

The only thing worse than struggling with mental illness is the shame that often accompanies it.

“Most families are not prepared to cope with learning their loved one has a mental illness,” explains Mental Health America. “It can make us feel vulnerable to the opinions and judgments of others.”

The stigma that shrouds mental illness often prevents people from talking about it. Fewer still want to hear anyone talk about it.  

I began to experience dark periods of sadness and anxiety when I was in third grade.  

As I got older, the periods of depression and loneliness lengthened. I felt despondent and isolated. I felt guilt and shame because I couldn’t find my way out of the darkness. I had no vocabulary to describe what I was feeling. I had no communication skills and no personal boundaries. I was a target for bullying.

In my teens and twenties, depression was complicated with severe panic attacks. Anxiety exploded into full-blown agoraphobia. I was afraid to leave my home.

“Mental pain is less dramatic than physical pain, but it is more common and also more hard to bear,” wrote poet, C.S. Lewis.  “The frequent attempt to conceal mental pain increases the burden. It is easier to say ‘My tooth is aching’ than to say ‘My heart is broken.'”

The frequent attempt to conceal mental pain increases the burden. - C.S. Lewis

Conversations about mental illness may feel uncomfortable, but they are necessary. Honest conversations reduce the stigma that often manipulates people into silence.

• Approximately 18.5% (1 in 5 youth and adults) of the U.S. population experience mental illness.
• 11% of the population experienced depression.
• 18.1% of the population experienced an anxiety disorder.
• 50.5% of those with a substance abuse disorder also have a co-occurring mental illness.
• 50% of all chronic mental illness begins by the age of 14; 75% by the age of 24.
• 26% of the homeless population in the U.S. live with serious mental illness. 
• Nearly 60% of those struggling with mental illness were unable to receive mental health treatment.

It can be excruciatingly difficult for someone wrestling with mental illness to admit when they are struggling – to themselves or to anyone else. You may not want to approach the subject because you may fear upsetting the person you care about. Saying something with kindness and respect is much better than not saying anything at all.

If you suspect someone you care about is struggling with a mental health issue, try these following suggestions:

Do your mental health homework.  Contact NAMI, Mental Health USA, or mental health organizations in your area for information about support, services, and resources.  

Arrange time to talk when you and your loved one feel calm. If necessary, set appropriate boundaries by agreeing to listen to one another with respect. 

Start the conversation by sharing your feelings, such as “I really care about you.”

Identify the issue that concerns you.  Rather than confronting him or her with a diagnosis, be gentle. Share behaviors you see and hear. Say, “This is what I saw (or heard). Is everything okay?” or “Would you like to talk about it?”

For example say, “I am concerned because you spend so much time alone in your room,” not “I think you have bipolar disorder and you need to get help.”

Practice reflective listening.  Reflective listening involves respectful attention to another person’s feelings. Listen with empathy.  Do not offer your perspective or solutions until you’ve heard input from them.

Say, “It sounds like you feel sad about …. Is that what your saying?

Summarize and rephrase key points back to them. Make eye contact and ask clarifying questions such as “It must feel really lonely to believe no one cares about you.”

Ask questions and explore options.  Reflective listening can help the person you care about clarify his or her thoughts and decide on a course of action. In this way, he or she feels empowered about which steps to take next.

Say, for example, “It must feel overwhelming when … What are your choices?” ” or “What do you need?”

Refrain from offering suggestions unless the person you care about asks for advice. Invite deeper discussion by asking, “How can I help?”  If the person you care about is open to suggestions, be prepared to offer options such as making an appointment with your family doctor or contacting a mental health professional in your area.

Record your concerns and questions.  Be specific; list behaviors  (not assumptions) that you believe may be helpful for health care professionals. Track progress and celebrate successes.  

Remember those struggling with mental illness have privacy rights. Healthcare professionals are are bound by law not to share medical record information without a patient’s written consent. However, if someone wants you to be included in their recovery process and provides a doctor or therapist with consent, written documentation will be very helpful to monitoring their progress. 

Create a family or office plan that offers support for the person you care about. Set appropriate boundaries. Never allow mental illness to be an excuse for inexcusable behavior. D0 not tolerate verbal or physical abuse.

Here is a list of what NOT to say if someone you care about is struggling with a mental health issue:

• You look depressed.
• I think you need help.
• Snap out of it.
• It can’t be that bad.
• Stop feeling sorry for yourself.
• It’s all in your head.
• It could be worse.
• You should get out more.
• If you think you’ve got it bad, I …
• Nothing

You and your loved one need not suffer in silence. Talk to someone. Call a counselor, doctor, minister, a trusted friend or family member. There is help. There is hope. There are resources available in your community.

If you are worried someone you care about may hurt themselves, call the National Suicide Prevention Lifeline. Their phone number is 1-800-273-TALK (8225). Trained counselors are available to answer calls 24 hours every day.

Suicide feels like an option if someone believes there are no options left.  Consider these risk factors and warning signs from NAMI.

There is also a Crisis Text Line, a global not-for-profit organization that provides free crisis intervention via SMS messages. Enter 741741 and type “HOME” to send a text to a trained crisis counselor

If you believe someone you care about may be thinking about harming themselves, the National Suicide Prevention Lifeline suggests these five steps:

#BeThe1To Ask.  Ask the tough questions. Be direct. Ask, “Are you thinking about killing yourself?”  

#BeThe1To Keep Them Safe.  Ask, “Do you have a plan?”  A plan often indicates reveals how much time they’ve invested into thought about ending their lives.

If you can not physically intervene in someone’s attempt to hurt themselves, get help. Call a family member. Call 911. Or use Emergency SOS on your iPhone or Android device to request assistance.

#BeThe1To Be There.  Listen with compassion without dismissing or judging their words.

#BeThe1To Help Them Connect. Work together with someone you love to build a network that includes family, friends, doctor, therapist, and support group.

#BeThe1To Follow Up.  Continue to check in with them and ask how they are doing. Call. Text. Show support.

Caring for someone who is struggling with mental illness can be exhausting. NAMI reminds you to take good care of yourself.  By modeling good habits of self-care, you show others how to take good care of themselves.

If you are thinking about having a discussion about mental health with someone you care about, they may be waiting for someone with the courage to approach the subject. It is just as difficult for someone struggling with mental illness to acknowledge their fears and apprehensions as it is for you to begin the conversation. Perhaps more so.  

Be brave. 

Ask someone you care about, “How are you doing?”

Their lives may depend upon it.

Are you ready to share your concerns with someone you care about?

This SlideShare presentation offers specific links to information and resources if someone you care about is struggling with mental illness.

How to Talk to Someone About Mental Illness from Julie Connor, Ed.D.

Use these suggestions from Mental Illness at Work: Tips for Employers and Employees if you have concerns about someone at work.

I speak to youth and adult throughout the country about mental illness.  Contact me or visit www.DrJulieConnor.com if you would like me to speak to your audience.

In this keynote presentation I delivered on behalf of Pathway to Hope, a mental health organization, I share how I found help and hope.

Julie Connor, Ed.D., is a TED speaker, educator, and author of the award-winning personal goal-setting book, Dreams to Action Trailblazer's Guide. Connect with Julie on LinkedIn, Facebook, Twitter, and Pinterest. Visit www.DrJulieConnor.com for more information.