Any unusual changes in behaviour. These may include drinking more than usual or other substance abuse, increased anger or anxiety, withdrawal and isolation, any marked decrease in time spent with friends or family, work or school absenteeism, aggression/ lashing out verbally, excessive neglect of personal appearance or hygiene, dangerous or illicit thrill-seeking behaviour, consistent problems with memory, attention or concentration, big changes in energy levels, eating or sleeping patterns, continuous or frequent mentions of feeling hopeless, sad, anxious or powerless, crying often. Any obsessive or compulsive behaviours. Self harm, talk of suicidal ideation or ‘not wanting to be here anymore’, seeing or hearing things that other do not, paranoia
2. What are some of the different ways you might be able to help?
Despite the increased awareness and de-stigmatisation of mental health issues, it is usual for anyone who is suffering to feel ashamed. One of the most important things we can do is reach out to someone in a compassionate and gentle way to let them know we are there and to ask them if they would like to talk.
3. What if they say they don’t want help but you clearly feel they need it?
In the end, intervention is always tricky, and it inevitably comes down to instinct and how well you know the person and their ‘normal’ personality or behaviours.
First of all, ask them again if they would like to talk or need help. Often, human instinct is to say ‘I’m fine’ and it takes a second opportunity to persuade them to reach out.
If the person is reluctant to talk and you feel they are at risk of harm – either from others or themselves – then the best course of action may be to talk to a health professional via the NHS (https://www.nhs.uk/service-
But if you feel there’s no imminent threat, it could be that the person just needs some space to either resolve the issue themselves or to reach a point where they’re ready to ask for support.
You can let them know you care about them and that you are there for them if they change their mind. You can also be practical in showing them how to access help when they are ready – either professional help or self-help.
4. If you want to let them know you’re available to listen – how should you start the conversation?
The following are good openers:
How are you doing, I’ve noticed you’re not seeming quite yourself of late, do you want to talk about it? I’m always here for you
I’m aware that things are stressful recently, what can I do to help?
How are you? I’m aware you’ve had some really difficult things going on and I just wanted you to know I’m here if you want to talk
I just wanted to check in as I hadn’t heard from you a while and make sure you were OK? And if you’re not OK, that’s really OK, would you like to talk about it?
You’ve been on mind recently and I just wanted to offer my support, or a cup of tea, a chat, a catch up, just see how you are doing?
I’m aware you’ve gone through XXXX recently, how are you doing on it?
5. Any other tips for having a constructive conversation?
Imagine how you would feel in your friend’s situation. They may well feel highly sensitised, anxious, frightened, confused, overwhelmed or ashamed. Be calm, patient and sympathetic. Try to bring up the subject when there is plenty of time and space to talk and when you feel relaxed, and treat them with kid gloves.
One of the worst symptoms of any mental health issue is the (false) belief that is it permanent, and people often feel hopeless for this reason. Reassure them that many people in the world have overcome incredibly difficult mental health issues and that it is possible to recover with the right support.
Ensuring you create a safe space for them is vital. Reassure them that anything they tell you is confidential and don’t take any responses personally.
Most important of all, don’t judge and don’t feel under pressure to solve the problem for them. That is not your role here, and you shouldn’t take on that burden. By listening actively and making sure you are impartial you can help them to seek the right help for themselves.
And don’t forget to look after yourself too. Your own mental health is vital too you must not lose sight of that when helping others. Sometimes that might mean you might need to ‘book-end’ the conversation by getting support yourself before or after the conversation/s.
6. Any advice to ensure the talk doesn’t turn confrontational?
We can never know how someone will respond when we approach them with compassionate concern. Some individuals will feel relief and gratitude, others many get angry and defensive, but we can only ever take care of our side of the street.
If they lash out verbally then take care to understand and believe that it is not personal – they are coming from a scared and angry place.
If they do attack verbally make an agreement with yourself not to retaliate but simply let them know that you will speak to them if and when they are ready to talk to you but that you aren’t prepared to be attacked in the process. Leave the door open for the conversation to resume when they are ready and reaffirm your intentions are simply that of concern and not judgement.
7. How much should you listen versus trying to lead the conversation?
Listening is far more important, people deeply want to be heard and the reason they don’t speak up is due to fear or shame.
Listening in a compassionate way and letting them know you are not judging them and that you simply care can be a great relief for someone who has been struggling internally for weeks, months or even years.
It gives them the opportunity to unburden and express what has often been circulating endlessly in their own mind and lets them know that they are not alone.
Feeling isolated is an extremely common factor of poor mental health. When you listen to others, they are far more likely to listen to you – from here you can suggest they get support, reassure them they are not alone, and point them towards good resources to get them the support they need to recover.
8. Why is it important not to try and diagnose or solve their problems for them?
Because it’s not your job, it is the job of a mental health professional, and they are likely to feel judged or shamed and more likely to avoid you / shut down / retreat further into the trenches of their isolation / withdrawal.
It is dangerous for both of you to try to diagnose, because this diagnosis may well be wrong and may scare them further. It may also be dangerous to try to solve their problems for them – even the mental health professionals don’t personally solve the problems people face; they simply facilitate self-recovery.
We can’t think someone’s thoughts, believe their beliefs or perform their actions for them. The mental health professional is there to help them understand why they are feeling the way they do, offer support, compassionately challenge negative beliefs or thinking patterns, and help them build their self-esteem and recovery.
Mental Health professionals are trained to do this and also have the training around boundaries that are essential for keeping everyone safe in these situations
9. Is there any benefit to trying to act as normal as possible?
I think it is important when approaching anyone with a mental health issue to remain as calm and centred as possible. This way you are more likely to be seen by the other person as being ‘safe’ to open up to.
When someone is anxious or distressed the most important thing we can do is be the ‘adult’ in the situation. Mental health issues trigger people into their ‘scared inner child’ response, so the last thing they need is a critical ‘parent’ or another anxious inner ‘child’. By being in our calm adult place we are more likely to soothe and reassure.
10. What should you do if someone suggests their suicidal?
Believe them. That’s more important than anything, because to do anything else further minimises their feelings. But you then need to seek professional support immediately such as calling https://www.nhs.uk/
Evidence shows asking someone if they are suicidal can protect them, because by asking directly it gives them permission to let you know how they feel. You are not there to take away all their problems, but encourage them to talk about how they are feeling and to stress to them that they are not alone. Ensure they get professional support & make an emergency appointment with their GP.
11. Is there an easy way to know your own limits?
We can know our own limits by acknowledging how you feel. If you are feeling continually drained, exhausted, angry, resentful or anxious then it’s a red flag from you to yourself that you are outside your own limits
12. At what point should you suggest they seek professional help?
If any red flag behaviours are not resolving themselves within a fairly short period of time.
13. Are there any specific issues which should always be left to a professional?
We can help our friends with temporary painful disruptions to their lives such as heartbreak or job loss and support them when there is general malaise or they are fed up, but I personally believe that if someone is unhappy for a continued period of time then professional help is the most empowering thing they can do for themselves.
We are not here to suffer and most things that we believe we have to just ‘live with’ we don’t. We live in a world now where there are many fantastic therapists, mental health professionals, organisations that can offer good solid support.
14. Any specific organisations or resources which might prove useful if paying a therapist is out of the question?https://www.nhs.uk/service-
Samaritans 116 123
Anxiety UK 03444 775 774
CALM 0800 58 58 58
PAPYRUS 0800 068 4141
YOUNG MINDS 0808 802 5544
CRISIS TEXT LINE – TEXT ‘SHOUT’ TO 85258
MIND – MIND.ORG.UK
NOPANIC – https://nopanic.org.uk/
THE MIX https://www.themix.org.uk/
NATIONAL SELF HARM NETWORK https://www.nshn.co.
THE GLITCH https://glitchcharity.
ANXIETY UK https://www.anxietyuk.org.
15. Finally, any tips to ensure your own mental health doesn’t deteriorate as a result of helping someone else?
It’s really important if you are supporting someone else to ensure you have support, too – that might be your partner, family, other friends, a professional, or a support group.
We can’t pour from an empty cup so make sure your cup is full through self-care practice, support and plenty of rest, laughter, exercise and good nutrition – in other words, ensure you’re looking after the basics for you.
Be aware of your own boundaries and what your body is telling you. If you’re feeling tired and wired, drained, stressed then it’s your body letting you know that you need time and space for you.
Bring as much awareness to your own mental health as you can so you can notice how you are doing. It is a beautiful and an important part of being a good human to look out and after others, but not at the cost of getting burnt out yourself.
Remember that we can help and support but we are not here to rescue. Ultimately we are all responsible for our own mental health and whilst we can guide to good resources and professional support we also have our own limitations, you deserve your own compassion too.