Society’s self-imposed gag order on the subject of mental health means opening up to loved ones about one’s own struggles can often have a coming-out-of-the-closet feel to it. But what about the reverse? What happens when the one struggling isn’t you—it’s someone you care about? Suggesting that someone else seek help isn’t easy, with fears of offending fueled by the same stigma that silences so many sufferers. With an estimated one in five Americans1 over the age of 18 suffering from a diagnosable disorder and fewer than one in three 2 receiving the treatment they need, odds are we all know someone who stands to gain from seeking help. Not sure how to encourage a loved one along that path? Here are a few points to keep in mind.
Know the Signs
A difficult boss, problems at home—it’s easy to get weighed down with the concerns that all of us experience from time to time. How then do you know when a loved one is merely in need of a listening ear versus when professional help is required? According to the American Psychiatric Association,3 a few indications that a serious condition is taking root include:
- Social withdrawal
- A decrease in functioning, be it failing at school or missing deadlines at work
- Problems concentrating
- Increased sensitivity to sights, sounds, smells or touch
- Dramatic mood swings
- Sudden changes in sleep patterns or appetite
- Fear or distrust of others
As Baltimore-based psychiatrist Dr. Mark Komrad notes in his book You Need Help! A Step-by-Step Plan to Convince a Loved One to Get Counseling, “It’s one thing to be down in the dumps… It’s altogether different, however, if you are so distressed or out of control that your functioning begins to shut down, or you are hurting those around you, or are destroying your relationships by slow degrees.”
Once you’ve established that something is wrong, it’s a good idea to do a little research on your own before approaching the person, says Ashley Groesbeck, a licensed clinical social worker practicing in New York City. Groesbeck, who has worked with veterans and traumatized youth and families for seven years, suggests the Mayo Clinic and the National Alliance on Mental Illness for basic information to help guide your conversation.
It is not your job to make the actual diagnosis.
But as Komrad adds in an interview, it is not your job to make the actual diagnosis. Rather, “you know that something is wrong with your loved one’s thoughts, feelings, or behaviors. You aren’t sure how to understand it, what to call it. But you do know that the problem needs more help and more evaluation than you as a caring supporter can provide.”
Approach with Love
So you’ve established that professional help is needed. What’s next? According to Groesbeck, making the conversation a dialogue is more likely to result in a positive outcome than launching into a lecture. She suggests starting with a statement of how much you care about the person before noting that something seems different about him or her. “’You’re my sister, and I love you. I’ve noticed things have been really off lately’ is more helpful than ‘Hey, you keep canceling on me. What’s your problem?’” Grosebeck explains.
This is something M.* experienced firsthand when her boyfriend of three years and her boss of five stepped in to express their concerns (*her full name is being hidden to protect her privacy). The 26-year-old Utah native was already coming to terms with a lifetime of sexual abuse at the hands of her grandfather when her 19-year-old brother drowned himself during a schizophrenic episode. She admits she was stubbornly against the “foreign” idea of meeting with someone at first and credits the way her boss and boyfriend approached her as part of the reason she finally was able to open up to the idea of getting help.
Making the conversation a dialogue is more likely to result in a positive outcome than launching into a lecture.
In the case of her boss, the conversation was one of concern, not criticism. “He pulled me aside and said, ‘We can see it behind your eyes. What can we do to help?’” Her boyfriend, meanwhile, suggested it “organically” after an especially bad day. “We were in bed and I was crying and he was holding me when he said, ‘We need to find somebody.’ It was a very soft suggestion. He just said, ‘Maybe if you find someone to talk to, you won’t be this sad,’” M. remembers.
Still, the decision wasn’t an easy one. “I felt defeated. You want to be a strong person who can get through anything and to admit you need help is a big step,” M. says. In the end, it was knowing there were people in her life who were anxious to see her take that step that gave M. the motivation to move forward with getting treatment.
When They Say “No”
Of course, not everyone will respond to the suggestion of professional help as quickly and openly as M. did. “Don’t push it,” Groesbeck recommends. “If they don’t want to talk about it, the conversation isn’t going to be very productive.” That doesn’t mean dropping it permanently. Rather, leave the door open by asking if there is a better time to talk. If they say no, let them know you may bring it up again. “The risk here is the person might start avoiding you, but you’ve set yourself up to be available,” she explains.
Leave the door open by asking if there is a better time to talk. If they say no, let them know you may bring it up again.
In his book You Need Help!, Komrad warns readers to “be prepared to put the relationship at stake” as a last resort should all other approaches fail. “Obviously that is an end-stage measure,” he tells DualDiagnosis.org. “Nor is that going to be a successful maneuver in many cases,” with one possible outcome resulting in any problematic behavior being merely pushed underground as much as possible. “Sometimes, however, this needs to be done to give the helper some respite, to recharge, gather new allies, get the oxygen mask on and try a different angle,” he says.
A Risk to Themselves or Others
R. was in her junior year of college when she received a late-night phone call from a friend who had seen another friend’s car abandoned at the side of a road in a forest. Together they searched the woods, where they found him alone, speaking incoherently. Taking him back to R.’s apartment, they sat through the night with him. By morning, R. and her friend decided to take him in to the school clinic. “He wasn’t trying to harm himself but he was definitely talking about self-harm,” she says. Though he didn’t feel safe going—he was still in the middle of the episode at the time—he eventually gave in. “He trusted us; we were his friends.”
According to Komrad, other indications a loved one is a danger to himself and/or others include:
- Explicit threats to hurt self or others
- Expressed fantasies or plans of hurting others or a suicide plan
- Escalation of violence from verbal to physical
- Lack of self-care leading to medical risk
- Lack of self-care or care of environment leading to physical risk
- Obvious impairment in coordination, motor skills or judgment in a person who continues to drive a car or has a driving/piloting profession
- Obtaining a firearm or ammunition for a preexisting firearm in a person already having problematic changes in thoughts, feelings or behaviors
- Escalation of reckless behaviors
- Extreme social withdrawal, such as locking oneself in a room
- Growing paranoia with increasing expressions of intention for violent self-protection or revenge
“I don’t think that the helper needs to sort out whether a behavior meets the threshold for being serious enough for involuntary treatment,” Komrad adds. “If you are worried, mobilize the authorities,” and “don’t hold back” on what you tell them.
Don’t Forget About You
Any time a loved one is struggling, it’s easy to let concern for him or her override concern for oneself. “Make sure you get the support you need and don’t get totally sucked in,” Groesbeck cautions. Establishing boundaries is essential, especially when you are living with the person, as is making time for self-care, be that going for a run or out to the movies with friends.
“Yes, you want to get them help. Yes, you want to support them in the recovery process,” Groesbeck adds. “But at the end of the day, you also have to realize it’s not your responsibility to fix the person.”
1 National Institute of Health, “Information about Mental Illness and the Brain” (2007), accessed Sept. 5, 2015 <http://www.ncbi.nlm.nih.gov/books/NBK20369/>
2 Messias E, Eaton W, Nestadt G, Bienvenu OJ, Samuels J., “Psychiatrists’ ascertained treatment needs for mental disorders in a population-based sample” in PubMed.org (2007).
3 American Psychiatric Association, “Warning Signs of Major Mental Illnesses,” in pamphlet Healthy Minds, Healthy Lives (2009).
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.