When you’re concerned about a friend’s or loved one’s mental health, you may think, “I should mind my own business.” But under the right circumstances, you can do a lot of good by reaching out, says psychiatrist Minnie Bowers-Smith, MD.
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What do you say to a young person who seems unhappy?
Say you notice your 16-year-old niece isn’t particularly happy. She’s doing poorly at school. She’s not interacting with people, taking care of herself or getting along with family and friends.
“When it seems like something isn’t moving in the right direction for her as a normal 16- year-old, have a conversation with her,” says Dr. Bowers.
“It’s difficult to talk to teens unless they want to talk to you, so I try to tap into the here and now. If I see a tattoo, I’ll ask, ‘When did you get that tattoo, what’s it mean?’”
Eventually, you can say, “Is there anything you think you want to talk about?” or “Can I help you in any way?”
If you see scars on a young person’s wrist, if they always dress in black, if they always seem unhappy, Dr. Bowers suggests asking, “Is there any chance you might hurt someone, or hurt yourself?” or “Have you had any thoughts about dying?”
“It’s better to ask than to not ask,” says Dr. Bowers. “With teens, you always want to know about suicidal thinking, to prevent harm to themselves and others.”
Or you can ask the parent to pose these questions to their child. If that doesn’t work, the parent should talk to the child’s pediatrician.
“When teens are violent toward themselves, their siblings or their parents, that demands an ER visit,” says Dr. Bowers. “If drugs or alcohol are involved, or if they overdose, go to the ER. Then let the experts decide when to bring them home.”
How do you talk to an older adult who seems depressed?
The risk of suicide isn’t confined to the young. “Suicide is also a concern in older adults,” says Dr. Bowers.
Say your 55-year-old uncle has been laid off. He’s isolated himself, grown irritable and doesn’t bother to shave or put on clean clothes.
Midlife crises — a job loss, financial setback, health challenge and/or relationship problems — increase suicide risk, especially in men. Alcohol abuse only adds fuels to the fire.
How do you tackle this sensitive subject with the older generation? Dr. Bowers recommends a gentle, respectful approach. Start by asking how they’re doing and if they’re still able to enjoy their favorite pursuits.
“Then, ever so gently, you can say, ‘Are you happy with what you’re able to do now or not?’ and ‘Are you feeling kind of sad?’” she suggests.
If they don’t volunteer information, you can observe that they don’t seem happy, and aren’t getting around well. Ask if they’re sleeping, eating and taking care of themselves.
“Then you can ever so gently move into, ‘It may be helpful to talk to somebody — medication can help you feel better,’” Dr. Bowers suggests. Ask if they have a family doctor, then help them make an appointment.
But if your relative admits to hoarding medication or says, “Life just doesn’t seem worth living,” take them the ER or urgent care, or call your local suicide prevention hotline or the police.
“If you say you have a suicidal relative, you’ll be connected to the services you need,” she notes. “Large cities often have mobile crisis teams that come out to the home.”
What should you say to a troubled friend or coworker?
It’s trickier talking to someone you’re not related to — like a friend whose difficult or erratic behavior has landed them in hot water at work.
Without judging, offer your concerned support. “It won’t help to discuss what they should have done, or what the boss should have done,” advises Dr. Bowers.
“Just say, ‘I’d like to help you stop having the troubles you’ve been having.’ Show them that you’re working with them and not against them.”
You can tell them, “I know a guy,” and offer the name of a doctor or counselor. But if you think the situation might escalate, get help.
“Use your judgment,” advises Dr. Bowers. “If you think the person might get angry — or if they own guns or knives, or have said they’re going to hurt someone, or slash someone’s tires, then call the police, or the security officer at work.”
Offer support, but know your limits
Compassion is key when you’re dealing with someone who may be mentally ill. After all, they may not even realize they have an illness.
“Pose your questions thoughtfully,” advises Dr. Bowers. “Some people with serious mental illnesses may decline our help. But sometimes we’re just not asking the right questions.”
And remember, you can’t fix their problem — only a mental health professional can. But you can get those you love going in a healthy direction by referring them to experts for help.
Community resources are useful as well. The National Alliance on Mental Illness (NAMI) is a free resource for the mentally ill and their loved ones. Self-help groups like Recovery International and Emotions Anonymous (a 12-step program) can also be invaluable.
Good mental health is a lifelong goal
We tend to think about mental health only in the midst of a crisis, Dr. Bowers notes. But our own mental health, and the mental health of those around us, should be a lifelong concern.
“Many life events can be confusing, scary and overwhelming,” she says. “Good mental health will see you through declining health, the loss of loved ones, natural disasters, societal turmoil and the many other challenges life can bring.”