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Imagine yourself with a head cold that turned into a sinus infection that wasn’t going away. What would you do? Would you feel embarrassed or ashamed to go to the doctor and get treated? Likely not. Why do we feel differently about seeking help when it comes to mental health?

Just like physical health, we all have moments where our mental health is compromised. Someone struggling mentally doesn’t mean that they have a mental illness such as bipolar disorder or schizophrenia. One might be struggling because they suffered a loss or a series of losses or experienced a traumatic event. There are a multitude of factors that can impact someone’s mental health. Yet, rather than address it we tend to brush it under the rug.

Despite the advances in psychiatry and psychology, the stigma surrounding mental health is still a reality. Mental illness has a long history of being stigmatized. Some thought it was the mark of the devil and others thought it to be a punishment from God. While certain individuals may still hold onto these beliefs, many do not in today’s world. So, what is the deal? Do people continue shying away because they do not know how to respond to someone with a mental health issue?

Students often give the feedback that they would like more training on the topic of how to respond to someone in a mental health crisis. In our first responder trainings, I have often included patients with a history of anxiety, depression, schizophrenia, bipolar disorder, drug related psychosis, dealing with intense grief, or dealing with trauma. In debriefs, the idea of wanting to fix the problem typically arises. It is important to understand that it is not our job to fix things and that attempting to may do harm. Oftentimes, when we try to “fix” the problem it makes things worse and may even encourage the one needing help to build thicker walls of isolation. So, now what?

Keep In Mind: You are a host!

What is a host? It is a person that provides a “safe haven” for the soul. Hosts can be a parent, a child, a partner or spouse, a friend, a co-worker, a mentor, a teacher, a coach, a first responder, and the list goes on. When you host the soul all sorts of issues pop up. How we approach someone having a mental health crisis is what determines whether they will view us as a “safe haven” or not.

Recognition

The first step is recognizing that a person is in distress. The National Alliance on Mental Illness (NAMI) lists the following as warning signs of a mental health crisis.

Retrieved from https://www.nami.org/ February 11, 2020.

Response

Three tools I highly value are compassion, empathy, and active listening. Many do not truly understand what active listening is about. It requires that the listener fully concentrate, understand, respond, and then remember what is being said.

It is important not to diagnose, not to heal, fix, or solve, and not to decompensate with them. Many make the mistake of trying to “help” by sharing a personal story with the intent that if they share, it will show understanding. This falls under “too much talking” and turns the conversation to be more about you. This can do more harm and cause a wall to build. If you think sharing a personal story may help, ask the person if hearing it would be beneficial. Be ready to stop sharing if it is having a negative impact.

Megan Devine, a psychotherapist that studies grief, points out that acknowledgment, allowing someone to be in pain, and trying not to fix things are important messages for us all in how we support each other through difficult times. While the video “How do you help a grieving friend?” is focused more on the grieving response, this applies to mental health in general. She, also, gives great advice about dos and don’ts.

Retrieved from Refuge In Grief February 11, 2020. Click on photo for link to website.

 

Approach with an Action Plan

ALGEE is an acronym utilized in mental health first aid courses.

Retrieved from Mental Health First Aid February 14, 2020 (click photo for website).

ASSESS for risk of suicide or harm.

Try starting the conversation by showing you care and opening the door for them to speak about it to you or someone else.

Retrieved from https://www.nami.org/ February 11, 2020.

Warning signs may include:

  • Threatening to hurt or kill oneself
  • Seeking access to means to hurt or kill oneself
  • Talking or writing about death, dying, or suicide
  • Feeling hopeless
  • Acting recklessly or engaging in risky activities
  • Increased use of alcohol or drugs
  • Withdrawing from family, friends, or society
  • Appearing agitated or angry
  • Having a dramatic change in mood
  • Showing signs of reduced self-care (i.e. odor, soiled clothing)

If you are concerned that someone is thinking about suicide talk to them about. It is OKAY to ask them if they are thinking about suicide. Questions that can save a life…

  • “Are you thinking about suicide?”
  • “Do you have a plan?”
  • “Do you know how you would do it?”
  • “When was the last time you thought about suicide?”

If the answer is yes, they are at risk, seek help immediately by calling a health care professional, removing items they could harm themselves with (i.e. weapons, medication), and call the National Suicide Prevention Line (1-800-273-8255) or call 9-1-1.

More information on this topic can be found on NAMI’s website: Navigating a mental health CRISIS: A NAMI resource guide for those experiencing a mental health emergency.

LISTEN non-judgmentally.

  • Use open body posture (i.e. mirroring, sitting off to the side)
  • Use comfortable eye contact
  • Affirmative head nods
  • Avoid distracting actions or gestures (i.e. looking at phone, shuffling papers, doodling)
  • Ask questions
  • Paraphrase
  • Avoid interrupting
  • Do not over talk
  • Remain calm
Retrieved from https://www.nami.org/ February 11, 2020.

GIVE reassurance and information

  • Don’t blame the individual for their symptoms
  • Provide…
    • Information
    • Resources
    • Emotional Support
    • Practical Help

ENCOURAGE appropriate professional help

  • Types of Professionals
    • Doctors (PCP or psychiatrist)
    • Social workers, counselors, and other mental health professionals
    • Certified peer specialists
  • Types of Professional Help
    • “Talk” therapies
    • Medication
    • Other professional supports

ENCOURAGE self-help and other strategies. Recognize that what works for you might not work for them. Avoid advising them. Instead, work with them to find things that are helpful. Examples may include:

  • Exercise
  • Relaxation and meditation
  • Participating in peer support groups
  • Self-help books based on cognitive behavioral therapy
  • Engaging with family, friends, faith, and other social networks

Role model being kind to yourself. Mental health is more difficult to understand than human anatomy and physiology. Willingness to be open to talking about the struggles of the psyche, showing compassion and empathy, and active listening are all ingredients in a recipe for healing. Encouraging someone to open the door from within by whispering “It’s OK to not be OK” (Megan Devine) can be life saving!

References

National Alliance on Mental Illness – great resource for information about various mental illnesses/disorders

Mental Health First Aid – Find a course near you!

Refuge In Grief – Megan Devine, psychotherapist, writer, grief advocate, and communication expert provides a wealth of resources with the goal of helping people through the grieving process.