Talking About Mental Illness: Reaching In

Social support plays a key role in mental health and mental illness recovery. Tapping this support sooner would have accelerated my own recovery. Getting support starts with talking about our mental health. But friends and family shouldn’t just wait for their loved one struggling with mental health to reach out.

When you “reach in” to your loved one, it not only helps them, it also breaks through the communication barriers often created by stigma. Talking about mental illness requires thoughtfulness, but it’s not as hard as people may think. There is no universal way to talk about mental illness, but there are best practices that can help supporters start the conversation.

A Few General Best Practices

The following strategies might help set the right tone for communicating with your loved one.

Learn more first

Supporters often don’t know what to say in the first talk. Knowing a little about mental health can help. This may include learning basics like emotions, symptoms and treatment modalities from reliable sources, such as NAMI.

Watch out for stigma

Always be aware of stigma, which includes self-stigma and perceived stigma. Remember and emphasize that mental illness is a lot like physical illness and is not their fault. Also, try not to talk to your loved one any differently than before they got sick.

Give encouragement

The key is to listen more and talk less. Ask open-ended questions to encourage them to share more. Emphasize their strengths and validate their emotions, which will make them feel more comfortable talking to you and opening up.

Offer support and empathy

Provide support and informed guidance, not advice. When it comes to mental illness, advice should come from mental health professionals and can cause heightened barriers when it comes from a supporter. Additionally, offer empathy and compassion, not sympathy. To understand the difference, Brene Brown explains it well in this video.

Meet us “where we’re at”

When addressing mental illness, ask your loved one if they’re comfortable discussing it and respect their wishes. Some of us just need more time to process our illness. Let us know that you’re there whenever we want to talk and gently check in from time to time.

The First Talk

An initial discussion may be the most important so plan and prepare accordingly. These suggestions may help.

• If possible, talk to your loved one while they are well. It can help minimize adverse reactions and they will be able to give guidance on how to be supportive when they are not well.
• Normalize the conversation. Personally, I feel a casual talk can relieve pressure and make it easier on both sides.
• Prepare for varied and sometimes unpredictable reactions. Many people are ashamed and embarrassed about their illness. They may be angry or hopeless.
• If they refuse to talk, gently nudge them. It they continue to resist, stop and respect their privacy. A loved one may respond very angrily if they feel pressured.
• If the first conversation goes poorly, which is common, don’t be afraid to try again at a later time.

What to Say and What Not to Say

While supporters act out of love and care, how they communicate affects how their loved one perceives their true intentions and feelings. The following do and don’t suggestions may help strike the right tone.

Be sensitive

Don’t say: I have to talk to you.
Say: I noticed that you have not been sleeping or eating as much lately, would you like to talk about it?

Don’t say: This has to stop.
Say: How can I help you feel better?

Don’t say: It’s your fault.
Say: Mental illness can happen to anyone.

Don’t say: It’s all in your head. It’s not really that bad.
Say: I noticed that you haven’t been yourself lately, would you like to talk about it?

Don’t say: You need to […].
Say: Can you tell me how you’re feeling and how I can help?

Avoid stigma

Don’t say:  You are bipolar.
Say: You are a person with bipolar (always use person-first language).

Don’t say: Stop acting crazy.
Say: You don’t seem like yourself lately. Would you like to talk about it?

Don’t say: You’re just lazy.
Say: I know that you’re not feeling well and that must make it hard for you to do things.

Cooperate

Don’t say: You have to see a doctor
Say: I can’t say for certain, but a doctor might be able to help you. Would you like to look for one together? I can go to an appointment with you.

Don’t say: You need to focus on getting better.
Say: We can get through this together.

Encourage

Don’t say: This is your life now, and you have to accept it.
Say: I have seen examples of people with mental illness living full lives. Things can get better. I will help any way I can.

Don’t say: You’re not getting better. Why doesn’t therapy work?
Say: Mental illness can be managed and treated, sometimes it just takes finding the right treatment team and plan. I’ll help you as much as I can.

Special Cases to Consider

With mental illness, there are certain situations that may need to be addressed in a more specific way.

Refusal / Resistance

Some of the most difficult conversations involve accepting diagnosis and treatment. In these cases, applying a strategy called LEAP can be very effective. LEAP is an acronym for:

• Listen. Use reflective listening to understand what your loved one feels, wants and believes without commenting, disagreeing or arguing.
• Empathize with your loved one’s reasons to resist talking taking action, even those you disagree with.
• Agree. Look for common ground and acknowledge that your loved one has personal choice and responsibility.
• Partner to accomplish common goals.

Suicidal Behavior

It is important to talk openly about suicidal behavior, including suicidal ideation. Studies have found that “acknowledging and talking about suicide may in fact reduce, rather than increase suicidal ideation, and may lead to improvements in mental health in treatment-seeking populations,” contrary to popular belief.

All conversations about suicide must be taken seriously. Never promise to keep the conversation confidential. The website “Speaking of Suicide” is a great resource and Living Works also offers a two-day Suicide Intervention Skills Trainings (ASIST) across the country.

After the First Talk

It is important to continue to engage your loved one after raising the topic as mental illness is an ongoing experience. “Talking” can happen through many modes. Initially, I preferred to talk by text. It was easier for my mom to share a sentiment without me getting defensive or risking an argument.

When I was saddest, I’d love “emoji text” exchanges without words — they showed me my mom was thinking of me and showed my mom I was well enough to text her back. She would also send me cards and flowers, which I always loved. All this made it easier for me to open up to my mom when I started to feel better. Sometimes not talking, just listening, just being there, can be really helpful.

Talking about mental illness can be difficult. Sometimes it requires repeated or creative attempts. These attempts may result in disappointments and feelings of frustration, helplessness or worry, but supporters should keep trying.

The more a supporter tries, the more likely it is for their loved one to truly understand how much they are loved, which is a powerful force. It can be the single most important factor in getting a person with mental illness to open up. Your patience and endurance will show them the truth and allow them to get the care that they need.

Author’s Note: Thank you, mom, for never giving up on me, for always “reaching in,” and for respecting my space. You became a master of finding creative, non-intrusive and non-pressured ways to stay in touch. You made it impossible for me to ever doubt your love and commitment to me even in my darkest moments. It was in those periods that our mother-daughter bond grew strongest. 

Katherine Ponte is a mental health advocate, writer and entrepreneur. She is the founder of ForLikeMinds, the first online peer-based support community dedicated to people living with or supporting someone with mental illness, and Bipolar Thriving, a recovery coaching service for caregivers and their loved ones affected by bipolar disorder. She is also the creator of the Psych Ward Greeting Cards program in which she personally shares her recovery experiences and distributes donated greeting cards to patients in psychiatric units. She is in recovery from severe bipolar I disorder with psychosis. She is also on the board of NAMI New York City.