The benefits of talking about mental health and the value of human connection and understanding in the first instance are well-documented – and lending a listening ear or checking up on a friend or family member could make a huge difference.
Yet many of us feel anxious about how to respond to someone when they open up about issues such as anxiety, depression or self-harming, for fear of saying the wrong thing.
According to the experts, we might be overthinking it at their expense. Ian Hamilton, senior lecturer in mental health at the University of York and registered mental health nurse, says we shouldn’t let awkwardness get in the way. “The majority of people come to these conversations wanting to make things better, but are paralysed by the fear of making things worse,” he says. “The most important thing to do is to be there, and to listen. So actually, you don’t need to say anything,” he explains.
So sometimes it’s best to say… nothing at all? Well, not quite. There are plenty of ways of showing understanding, and offering support in the role of a civilian “first responder” to family, friends and colleagues, even if you’re not a therapist.
You can sign up for Mental Health First Aid Training with MHFA England, which is accredited by the Royal Society for Public Health – but here’s some pointers on how to listen, reassure and respond in a crisis…
Do say: ‘I’m here to listen’
“We all know what it’s like to be listened to properly. There’s a real difference between your mate looking at you, acting as though they’re listening, but with that glazed look, as if they’re going through the motions,” explains Hamilton. So, give the person your full attention.
“When it’s clear that you’re listening very carefully to what someone is saying, and that you’re understanding them – that alone gives a person such a sense of value.”
Do say: ‘Take your time’
According to Time to Change, the charity behind Time to Talk Day, it can be easier to talk side by side rather than face to face – for example, walking, cooking or during a drive.
Is there also a place for speaking face-to-face about mental health issues, more formally? “Both have their place. If you think about the message you’re trying to give to the person, it can make them feel valued to set aside time specifically for them and say ‘I’ve got as much time as you need, just for you, so that you and I can catch up and I can hear what you’re saying’, suggests Hamilton.
Do say: ‘What do you mean?’
Asking questions can give the person space to express how they’re feeling and explain what they’re going through – and it will help you to understand their experience better, states Time to Talk.
Asking for clarification is a key listening technique, agrees Hamilton: “Use your common sense. Asking three questions in a row might feel like an interrogation, but it’s really important to ask for clarification and for summaries.
Do say: ‘What does it feel like?’
“When people are distressed, anxious or depressed, their thoughts may have been whirling around inside their heads for a long while, so when they come to express it, it might not immediately make much sense to the listener,” says Hamilton.
Do say: ‘Have you thought about hurting yourself?’
“It’s so important for the listener to be able to assess a person’s risk to themselves and to ascertain the risk of self-harm or suicide. You might want to probe a bit around that,” suggests Hamilton.
“It’s OK to ask: ‘have you thought about hurting yourself in any way?’ Contrary to popular opinion, I don’t think that would trigger the person into doing so – but crucially, it does help you to understand the level of risk and whether it’s appropriate to seek professional help immediately.
“People mustn’t worry that to ask the question might introduce the idea to the person, if they haven’t already thought about it. It’s one of the most important things you can do when someone is suicidal.
“Even GPs can be wary about asking, for fear of planting ideas in the person’s head – but there’s no evidence for that.”
Do say: ‘How does that affect you?’
“Other than pills, talking therapy is all we have for mental health,” says Hamilton. “We don’t have high-tech equipment and blood tests, we just have empathy and the ability to listen to people – so it’s critical to do that well.
”Listening properly is a real skill. It can take years to develop: to know the right moment to ask a question, when to paraphrase – that lets the person know you’ve been listening, but it also gives them the opportunity to correct any misunderstanding.
“I know from the years I’ve spent doing this that you can make assumptions. You need to allow people to gently correct that.”
Do say: ‘How are you feeling?’
This year, Time To Talk Day has launched a new campaign, Ask Twice, acknowledging that sometimes people say that they’re fine when they’re not. So if someone is acting differently, or if you’re concerned about them, ask not just once but twice.
Do say: ‘Thinking of you’
The act of checking in and asking how someone is alone can make them feel less alone, and remind them that they’re cared for. According to Time to Talk, simply sending a text to let them know you’re thinking of someone or arranging an activity can be helpful.
Do say: ‘What helps you to feel better?’
Another question that can be useful is to ask on a scale of 1 to 10 how bad a person is feeling. “If 10 is the best they’ve felt, 0 is the worst, and they say 6, you can ask: what would get you to a 4? What would help?” says Hamilton. “It sounds simple, but ask open questions, not fixed, closed questions with a yes/no answer, which limit how much people can explain to you.
Instead, ask “What have you found that’s helpful? What tends to make you feel better?” It could be anything that starts with who, why, where, when or how. It can take practice: some people have a natural way with it, but some of us do have to work on it.
Do say: ‘I don’t think any differently of you’
Treating someone with a mental health problem can leave them feeling more isolated than ever. “When someone has a mental health problem, they’re still the same person as they were before,” urges Time to Talk. “And that means when a friend or loved one opens up about mental health, they don’t want to be treated any differently. If you want to support them, keep it simple. Do the things you’d normally do.”
“Offer lots of encouragement, confidence building and reassurance. If it’s not inappropriate, sometimes there’s also nothing wrong with a hug, with being tactile,” adds Hamilton.
Hamilton’s top tip to avoid coming across as dismissive? Don’t make it all about you.
“While it can be helpful to disclose and share a little bit about your own experience in response where appropriate, the top thing to avoid is making yourself the focus of the conversation instead,” he says.
“Sometimes, it’s helpful to share a bit of yourself, to offer the other person some equity in the act of opening up – but I think you can over do it. The person has been brave enough to talk to you, and it can take a lot of courage to open up about your mental health – so you should give them space to talk about that without burdening them with your problems.”
Making comparisons and looking for the silver lining isn’t helpful, either. “It’s not useful to say ‘oh, that doesn’t sound as bad as what happened to X’, or ‘it could be worse’. You might mean to provide perspective, but no-one will be being as hard on themselves than the person with the problem.”
It’s also crucial not to cast judgement or make a diagnosis. “It’s also really important that people don’t diagnose the problem, whether formally or informally. It’s a very tempting thing to do, but rather than saying ‘that sounds like depression’ and casting a diagnosis on it, encourage the person to seek professional help.
Know the limit of what you can do, which is to listen carefully, be there for the person and then signpost them on to professional help when that’s appropriate.
“If you diagnose a problem, you might be wrong, and that could make things worse and delay the help and support they need. Talking and listening in itself can be enough at the first stages of an issue.”
And even with the best of intentions, don’t try to offer a quick fix solution. “Learning to manage or recover from a mental health problem can be a long journey, and they’ve likely already considered lots of different tools and strategies… unless they’ve asked for advice directly, it might be best just to listen,” states Time to Talk.
Hamilton agrees: “Don’t try to start solving people’s problems for them. Let them come up with potential solutions for themselves. That gives them control. People are very individual in the way they feel and solve things.
“If you’re concerned that someone is suicidal, encourage them to speak to a professional by calling their GP to request an emergency appointment, or by calling the NHS out of hours service on 111 or the Samaritans 116 123