How to talk to loved ones when you’re worried about their mental health

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“The collective way a lot of people in the United States might be feeling right now is probably indicative of mental fatigue,” said Stephen O’Connor, a clinical psychologist and chief of the Suicide Prevention Research Program at the National Institute of Mental Health. “The impact of the pandemic and the necessary response to limit its impact have really changed people’s lifestyles in dramatic ways that reduce the quality of life for many people.”

Some people might be finding it harder to access the usual social supports, O’Connor said, such as being around loved ones. But he and other experts emphasized that there are many ways to be there, even from a distance, for those who are struggling.

“There’s a difference between being alone and feeling alone,” said John Draper, executive director of the National Suicide Prevention Lifeline. “Feeling alone is feeling like nobody cares about you, nobody values you, so it’s really important now for us to let people who we care about or we’re worried about know how much we care about them and value them.”

Here are some ways experts say you can be there for loved ones, even if you can’t be there.

Pay attention

It is possible to spot signs that someone might be going through a difficult time, even if you’re not interacting in person, experts said. Regular video calls can give you “on-site eyes,” said Dan Reidenberg, executive director of Suicide Awareness Voices of Education. And if you feel as though you can’t observe enough, Reidenberg recommended asking targeted questions about the person’s behavior and home life. “We want to know if somebody is getting up and taking a shower,” he said. “Are they brushing their teeth? Are they changing their clothes? Are they keeping their place clean? Is their refrigerator filled with food or is it not?” Those questions, Reidenberg said, “can give us an indication of how significant the impact of the covid loneliness and isolation is.”

It is also important to pay attention to an “absence of things,” said Nadine Kaslow, a professor of psychiatry and behavioral sciences at the Emory University School of Medicine in Atlanta. If people are ignoring your phone calls and text messages, not posting on social media as frequently as they used to or are declining invitations to virtual holiday celebrations, those are potentially concerning signs, Kaslow said.

Normalize conversations about mental health

Although one the “silver linings” of the pandemic is that it has made it more acceptable to talk about mental health, some people are still having a hard time opening up, Kaslow said.

“Everybody’s kind of stressed and burned out, and so they don’t have the sort of mental resources to engage in them either way,” said Kaslow, a past president of the American Psychological Association. “I also think people don’t want to add burden to other people’s lives when everybody seems so burdened already.”

Still, Kaslow and other experts encouraged making the effort to learn how to have these critical conversations.

Talking about mental health should be similar to asking people about their physical health, said Doreen Marshall, vice president of mission engagement at the American Foundation for Suicide Prevention.

“If someone says they’ve been having stomach trouble, we have no trouble going back to them and saying, ‘Hey, how’s your stomach doing? You weren’t feeling well last week,’ ” she said. “We need to be doing the same about mental health conversations and say, ‘Hey, I’m following up with you. I know you sounded pretty down last week, and I wanted to talk more with you about that.’ ”

Marshall recommended regularly asking people how they’re feeling. Then, it’s important to really listen, Kaslow said.

“When you ask somebody how they are, you need to stop and wait for the answer, and you need to let them know that this is something that you really care about and want to hear, and you want to pay attention,” she said, adding: “A lot of people just want to fix it, and a lot of people who are stressed out just want somebody to listen.”

Don’t be afraid to ask about self-harm or suicide

Many people are reluctant to directly ask someone whether they have thought about harming themselves, Draper said. They may be worried about causing offense or putting the thought into that person’s head. Or they’re afraid they won’t know what to do if the answer is yes.

Research, however, has shown that asking about self-harm or suicide doesn’t increase risk, Draper said. “In fact, especially if you say, ‘I’m just concerned about you, I want to make sure you’re doing okay,’ that’s actually a signal to them that you really care,” and that you are someone they can turn to for support.

“If you are thinking about suicide, there’s a sense of total relief: ‘You mean I could talk with you about this?’ ” he added.

Explain why you’re concerned — for instance, telling people you noticed that their mood has changed and that they’re not using social media anymore.

“Not only are you asking the question, which is an incredibly rewarding thing to do, you’re noting, ‘I’m paying attention to you. I’ve noticed. I’m concerned,’ ” said Bart Andrews, chief clinical officer at Behavioral Health Response in St. Louis.

And if people tell you they are having suicidal thoughts, “let them know that you’re going to continue to support them during this time and you’re going to help them get assistance,” Draper said.

Know how you can help

The first thing you should do after someone opens up to you is respond in a way that is “affirming and validating,” O’Connor said. “Thank them for telling you, for trusting you with the truth and having the courage to tell you that.”

But it is critical that you don’t promise to keep admissions about self-harm a secret, Kaslow said.

Telling others may make the person angry, “but if you get them help and they’re alive, it’s way easier to live with that than if they’re dead,” she said.

Help them connect with a trained professional fairly quickly, experts said. Offer to assist them in reaching out to a therapist or contacting a 24-hour crisis hotline. You can also call a hotline yourself if you need guidance for what to do.

Though experts don’t recommend trying to handle the situation alone, there are ways to provide support. If you live with the person, do what you can to remove access to weapons and potentially harmful substances, O’Connor said. Rather than trying to fix the person’s problems, he suggested helping them focus on feeling better through short-term solutions, such as encouraging them to get out of a stressful environment by taking a walk outside or planning a distanced meetup with a friend.

If someone is struggling but isn’t at the point of considering self-harm, you may be unsure of how involved to be. If you’re concerned, O’Connor suggested being proactive by scheduling times to talk and finding other ways to increase connection. This could also help take the strain off someone worried about burdening others.

“You don’t want to get in a situation where the only time that you received the message from somebody is if they’re having a hard time,” he said.

If you can’t check up on someone in person and are worried they’re not telling you everything, Reidenberg encouraged sharing crisis hotline information. Andrews noted that you can also have conversations framed around a hypothetical situation, for example, saying: “Maybe this isn’t true now, but if that does happen, I really want to be there for you. What would you do if you did get to that point?” Or see if they would feel more comfortable talking to someone else.

“You can plant the seed,” he said, adding: “Then you leave that conversation open.”

Stay connected, and follow up

For people living in the same household, Jonathan Singer, president of the American Association of Suicidology, suggested spending more time around whomever you may be concerned about.

“There is a physical sense of, like, comfort, safety and security when someone’s feeling anxious and they’re like, ‘Oh, that’s the person that is ultimately responsible for making sure I’m safe and secure, and they’re literally across the table,’ ” Singer said. “There is something powerful with that.”

Even if you can’t physically be with someone who is having a hard time, there are many ways to remind them that they still have strong connections to people who care, Draper said. Beyond scheduling regular check-ins over phone or video, you can also offer support in more spontaneous ways, such as sending a random card or little gifts and trinkets. “Anything to let people know that they’re on your mind,” he said, adding that you should make a list of people you want to stay in touch with who will also support you in return.

It is important to remember, Draper noted, that you may be more capable of helping someone through a tough time than you realize.

“There are certain things that, as a loved one, I can say to somebody that therapists can’t say or don’t say,” he said. “And that is, ‘No matter what, I’ll always be there for you,’ or, ‘You mean so much to me,’ or, ‘I love you.’ Those are lifesaving words that only loved ones can say that are incredibly connecting and powerful for people who are feeling desperate and alone.”

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