How to support someone struggling with their mental health

Sanford Health experts offer guidance for what to say and what to avoid

A man seems depressed as he sits near a window and looks out in this illustration for a story about suicide

Ask. Then listen.

Those are key actions someone can take if they fear a family member or friend might be struggling with their mental health.

To have a conversation may seem difficult, but it’s better than doing nothing.

“Friends and family typically are willing to take the more difficult route if they think it will result in a good outcome,” said Dr. Jerrod Spring, a Sanford Health psychiatrist. “I think now is one of those times that people should lower that threshold for just asking how people are doing.”

Make the question “How are you doing?” more than a greeting. Encourage an honest answer. Listen and make a connection with the person.

Dr. Spring and Ashlea McMartin, a licensed professional clinical counselor and clinical manager for Sanford Health who specializes in trauma and crisis response, offer insights about mental health support. They also have guidance for what to say — and what to avoid — when you’re checking in with someone.

Signs to watch for

When a person isolates from others and stays out of touch, that can be a worrisome sign, McMartin said. An increase in substance use is another sign — and high substance use can affect a person’s ability to make rational decisions.

Watch for other changes in behavior, too, such as their day-to-day routine, McMartin said. Do they show signs of sadness or hopelessness? Do they show less interest in activities they once enjoyed? Consider these signs as an indicator to have a conversation.

Suggestions for what to say

  • Express concern. The best approach, Dr. Spring said, is to come from a nonjudgmental place of love: “I’m concerned about you. I’m concerned about what I’ve seen today. We tried to get you to come out, but you didn’t want to come out. I notice you don’t talk to your friends anymore. Is anything going on? Anything I can do that will be helpful?”
  • Relate through a similar experience. If you can relate to the emotions a loved one might be going through, connecting on that level will help them feel less alone, McMartin suggested: “A couple of years ago when I had this really hard thing happen in my life, I started to think about what it would be like if I weren’t here. And my gut is worried about you. And I’m wondering if you’re having that same experience.”
  • Don’t be afraid to bring up the topic. McMartin said parents, friends or family members express fear that if they ask too directly, it may put the idea of suicide into someone’s head. But research refutes that notion, she said. “If someone has been feeling suicidal and you ask it directly there’s actually relief from the person suffering,” she said — relief that they can acknowledge it openly with someone who truly wants to know.
  • Plan to share a resource. Dr. Spring urges people to already have a resource in mind to share with their loved one, such as a suicide or crisis hotline or team.
  • Ask a resource for help. Resources such as suicide or crisis hotlines also can be consulted if a person needs help figuring out what to say or do to help their loved one.

What to avoid saying

Although they may be well-intentioned, some statements are best avoided, McMartin and Dr. Spring said.

  • Don’t tell the person, “It could be worse,” Dr. Spring said. While technically it may be true, “it’s not helpful,” he said.
  • Avoid using the words “always” and “never,” which are rarely true, he added.
  • Spring also advises against saying, “It’s going to get better.” He said, “That can feel like too much — too overwhelming and unrealistic.”
  • McMartin says to avoid invalidating statements such as, “Well, at least you have a job,” or, “Well, at least you have your family.” Those types of statements don’t reflect “the current emotional state that people are in,” she said.

Getting professional help

Many resources can help a person struggling emotionally or from a mental illness.

Jeffrey Leichter, Ph.D., is a clinical psychologist and the lead administrator for behavioral health integration for Sanford Health. He recommends that patients consult with their primary care provider first. A primary care provider can conduct mental health screenings and connect them with mental health specialists.

“We find that sometimes these problems have both psychological and physical components,” he said. “We want to make sure that people are medically healthy — that they’re not struggling with something that can be easily corrected by an intervention from the family physician.”

In primary care clinics, screenings and integrated behavioral health therapists can also help recognize potential problems when people have appointments.

“We know that typically, a large majority of people that died by suicide had contact with their primary care within the last six months,” McMartin said.

Another resource is cognitive behavioral therapy for suicide prevention, which is an effective therapy focusing on what people tell themselves about suicide and about the future, Dr. Spring said.

Medications can help treat some mental health disorders. Crisis response teams can provide skilled and experienced crisis care.

Peer support has emerged as an effective role as well, McMartin said. Similar to AA sponsors, these peer supporters have had a similar life experience as the people in crisis they’re working with and are strong advocates for healthy outcomes.

Dr. Spring wants people who are suffering to know that help and support are there. They should make a call if they’re having a crisis.

“If plan one is call Mom, plan two is call a best friend,” he said. “But if it’s 3 in the morning and nobody answers, call 911. We consider this a medical emergency. Use the resources available.”

Where to text or call

National Suicide Prevention Lifeline: Call or Text (800) 273-8255

National hotline for community resources: Call 211

Crisis Text Line: Text “HELLO” to 741741

Learn more

Posted In Behavioral Health, Coronavirus, Family Medicine, Wellness

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