TCS Voices: Up-Front with Mental Health (Part 1 of 4)

Ben Fraser 17 May 2019
Image Credit: Pixabay

As we move towards a consensus that people know it’s #okaynottobeokay, the reality of what this means is only beginning to take shape, and it will require more than just a Facebook status or Movember to properly address mental health.

The most common advice that gets shared around mental health is that we need to talk about it, and that often all it takes to change the general narrative or to help someone is a conversation. However, how to actually start or have this conversation does not really seem to be expanded upon.

As someone with many friendships that do not necessarily consist of talking about emotions or how we’re really doing, broaching the topic is something I have struggled to do and occasionally find awkward. It can often seem like too sensitive an issue. I worry about putting my ‘foot in it’ and saying the wrong thing, or the time and place never seeming quite right. I find myself creating an excuse that if a friend wanted to talk to me they would – they obviously know I am here if they need me – whilst forgetting how difficult it can be to start a conversation when you’re already feeling down.

I would like to get better at and more proactive in having a conversation about mental health. As such, I have gathered together some online advice and some of my own thoughts on how to do so. This is in no way comprehensive, nor do a I pretend to be an expert on this topic. It is also worth noting that I am writing this from my perspective, but I hope some of the points may be relatable and that you may find something helpful to you (as writing this has been for me). I also recognise that people’s experiences can be very different depending on their gender, cultural and class background.

I have split my approach into four different sections: noticing that someone might be struggling, starting a conversation about how they’re doing, having that conversation, and then moving forward from the conversation.

NOTICING:

We are around our friends all the time, so sometimes it is difficult to pick up on certain changes that could point towards a struggle with mental health – even though it eventually feels like they were so obvious. Create a list of friends who you feel particularly close with and make a concerted effort to check in on them, let them know you’re thinking of them, and communicate with them. You may not feel like you need to physically create a list but doing so might make you realise you actually haven’t spoken to a good friend in a while.

Noticing that someone is struggling with their mental health can take a number of forms, such as a change in behaviour, a change in mood, distancing themselves, or even drunk disclosures. It is important to be aware of these, and observe shifts in routines, motivations, energy levels, eating habits, laughter and happiness, confidence, even eye contact or outright ignoring you. Any of these differences could possibly point to a problem with mental health, but you should not necessarily respond or react impulsively.

Pressuring your friend to do the things they normally enjoy when they’ve stopped recently, criticising them for not replying to messages, or perhaps trying to respond to a drunk admission whilst also drunk yourself, may not be the best approach. This is where the conversation comes in: sober, calm and in a safe space.

– Create a list of friends to check in with

– Do not rashly judge or get upset with a friend if they ignore you or change their behaviour

– Explore the changes in sober, calm, safe space

 

STARTING THE CONVERSATION:

Once you have noticed that a friend may be struggling with their mental health, you may decide that the best course of action is to have a conversation with them.

In this instance, you should consider the timing and environment: there may be no good place to have such a conversation, but it is certainly worth taking into account timing, privacy, and associations in order to make it as proactive and comfortable as possible. Think about familiar locations that they may usually be comfortable in, a certain bench, or lying on bed or going for a walk.

As well as physical parameters, consider the ‘energy’ and ‘atmosphere’ of the conversation: an open space where vulnerability is possible and acceptable is hugely important; you can help create this by offering your own experiences where appropriate. This may also help let the person know that they are not alone in their experience and break their bubble of isolation.  However, be cautious and do not necessarily try and equate your experience with theirs. It is also important to allow time for the conversation, so you can avoid pushing for answers. Don’t be afraid of silences, or reformulating questions to help your friend get to their response. Try and be as present as possible, limit your distractions and listen. Of course, you are ultimately having a conversation with a friend, so to a degree it should feel normal, not clinical or forced. Your body language will impact this, so think about how you are sitting, and whether you appear focused and engaged.

In terms of questions, start specific: such as, how are you finding your new job? From there, allow for more openness and scope: are you enjoying …. ? How have the last couple of weeks been?  How are you doing? Are you feeling alright about things? Is there something on your mind at the moment? You may feel comfortable asking them about a change in their behaviour that you have noticed, but be aware of phrasing to avoid defensive reactions or causing offence.

– Choose a time and place where you know they will be comfortable

– Do your best to create an open and non-judgmental conversation

– Maybe ask about something specific before more general questions

 

HAVING THE CONVERSATION:

During the conversation it is important to consider your role as the listener and confidant. You should be aware of ‘active listening’: maintaining eye contact, considering body language, asking for clarifications, summarising what they have said to ensure you understood, avoiding interruptions and rebuttals, allowing for silences and processing, and ultimately focusing on your friend.

As a friend, it is important to show empathy, whilst not being patronising. This should hopefully come naturally, especially towards someone you really care about, but remember your facial expressions and tone.

Avoid making assumptions, which can be especially difficult when dealing with a close friend who you may feel like you know really well. Remain open-minded and engaged. Do not judge their situation or feelings, and take them seriously (even if their reactions seemed out of character or contrary to how you think you may have reacted). Saying something like “I hear you” can offer them validation for their thoughts. Try not to act confused either, statements such as ‘but you’re so popular’ or ‘but you’re doing so well’ can imply a lack of faith or a degree of cynicism and judgement.

Continuing with open questions will allow what may be a particularly difficult conversation to flow:  How did that make you feel? What do you mean by that? Is this something new? How long have you been feeling like this? Have you felt like this before?

It may be helpful to share your own experiences, so they feel like they are not alone. Although you should avoid directly relating it to theirs, or acting like you understand how they are feeling. Here you do not want to act as a victim, but as someone who is supportive, letting them know it’s okay to feel this way. Equally they should not be treated as a victim but an equal companion in exploring mental health, perhaps offering you an ear and support when needed. In this way the conversation should hopefully feel relatively organic.

– Active listening without assumption

– Give them time and empathy without pushing

– Dispel myths but do not trivialise

 

MOVING FORWARD:

Opening up may have been a hugely difficult or liberating (or both!) experience for your friend. You should let them know how much you appreciate them sharing with you; being confided in is a huge vote of confidence. Even saying ‘thank you’ can go a long way.

Being proactive is a positive step, without being controlling or forceful; be a friend not a therapist. As before, continue with open questioning, such as: Have you thought about seeking further help? Is there anything I/we can do to help? Focus on listening, not advice (unless they ask for it as a friend). Simply giving them the space to talk is enough, it may be all they want. They may not want to act immediately, and although this may frustrate or frighten you, it is important to remember that they have taken the significant first step of talking to someone.

If appropriate, try and help them to make a positive plan for the future, considering what they would like to do and what they would like to see change. The future can be a very uplifting place to look, and you may want to talk about things to look forward to that they enjoy or makes them feel well and happy.

Let them know that you are free and happy to talk whenever. This will show them that you will remain supportive and that the content of your conversation has not deterred you in anyway. Recognise that they may have been openly vulnerable to you and that they may feel anxious about this; acknowledge this, but try not to treat them differently as a result (if appropriate).

Make a note to actively follow up. Ask to hang out with them after the conversation and do purely casual things. Perhaps set a time and place for another conversation, or schedule a future activity you could do together (like cooking a meal or going for a walk). Make an effort to show that you care and can be involved, but don’t push too much.

– Thank them for sharing

– Focus on listening not advice

– Make a note to actively follow up

These conversations may be difficult and tiring for you as a friend so make sure you give yourself the time and space you need to be in the best place to have the conversation – put your mental wellbeing first.

Take a kind and gentle approach towards the way you view your friend, but also with yourself. In the same way that you would want your friend to open up to you and be honest, want that for yourself. If you are in need of someone to talk to, whether it is a friend or a professional, let this be the message that once you take that first step to opening up, things can only get better.

Helpful links:

https://www.time-to-change.org.uk/get-involved/activity/have-conversation-about-mental-health

https://www.suicidecallbackservice.org.au/blog/conversation-mental-health/

https://www.gardeninglove.co.uk/mental-health-conversation-starters/

https://www.verywellmind.com/what-is-active-listening-3024343