Top 10 Tips: How to help a loved one who is struggling with mental illness.

 Today it's World Mental Health Day 2014! Personally I think that every day should be World Mental Health Day; in fact, every day should be "World Every-Person-Ever Day" because there shouldn't only be one specific day in a year on which we recognise the needs of other people. We should always be aware of the difficulties, discrimination and challenges that people different to ourselves face, and we should work to make others aware of this too. However, since the main focus of my blog as of late is mental health and the stigma surrounding it, I wanted to publish more posts on Mental Health to mark World Mental Health Day. 


 This is the first "Top Tip" post that I've written. I've put together my 10 top tips for those of you supporting someone who is suffering from mental health difficulties. You may have a friend, relative, or colleague who is struggling and you want to know how you can help - hopefully these suggestions can give you an insight into what you can do. Please note, though, that these tips are from my point of view - if you want to support your friend / relative further, ask THEM what they would like you to do in terms of helping them. Everyone is different and what may help one person won't necessarily work for someone else. 

1.) Let them know that you're there to listen whenever they need to talk about what's going on.

Don't pressure them into opening up to you, but make them aware that you care about them and you wouldn't mind listening if they would like to discuss how they're feeling. It likely won't just be once that they choose to talk to you about it - be prepared to listen to their worries regularly. Don't tell them only once that you want to help - tell them over and over; make sure they know that your offer to help hasn't "expired." People who struggle with mental illness often find it difficult to understand that other people are willing to listen to their thoughts, and they may feel like they're just repeating themselves. They may also be likely to withdraw from social groups or isolate themselves, so be persistent with expressing your concerns and willingness to help. Hopefully this will allow them to open up to you, and both of you will probably feel better for it!

2.) Don't feel like you need to give advice when they are talking to you about their feelings. Being a good listener is far more important than trying to "solve" their problems.

You may have some advice to give, but just remember that the most important thing is that you listen. "A problem shared is a problem halved" as the phrase goes, so by being there and listening you ARE being a huge help, whether you feel like you are or not. Don't judge them for what they're saying, don't challenge them unnecessarily - just listen and be supportive. By all means offer your own viewpoint on what they are saying, as this may encourage them to see the situation in a different light, but don't make their feelings seem invalid. Remind them that their feelings are completely real, and acknowledge their point of view; if you can, state a more rational or positive way of looking at it and encourage them to think about it that way too.

3.) Ensure them that it IS possible for them to feel better than they are feeling currently, even if they can't imagine it right now.

Not all mental health conditions can be completely recovered from, but they can be effectively managed with the right support and treatment. The sufferer may be nervous that they will feel the way they currently do for the rest of their life; inform them that this won't necessarily be the case. Acknowledge that they may not be able to imagine or believe it now, but let them know that it IS possible for them to feel better.

4.) Suggest that they make a visit to a GP, Mental Health Professional, or Counsellor; If they already use these services, regularly encourage them to continue using them even if they feel like they don't want to / can't be helped. 

It may be that your loved one has never spoken to a professional about how they're feeling - if they haven't, and have been feeling like they have a problem for more than a couple of months, then you should perhaps encourage them to make an appointment with their GP. Reassure them that going to see their GP doesn't necessarily mean that they will be put on medication or referred to a mental health team, The idea of these things may seem quite daunting at first - remind them that their treatment plan is in most cases their choice. Offer to go to their appointments and wait outside, or ask them if they'd like you to sit with them throughout. Sometimes the person might be too nervous or unwilling to go alone.
If they already see their GP, therapist, or other professional - encourage them to keep attending their appointments. If one doctor or counsellor didn't have the intended effect, encourage them to see a different one. Sometimes people might see several GP's or therapists before finding someone who they can feel comfortable talking to. And if they're on medication, make them aware that not all medications have the same effect in different people, so if one drug hasn't worked it doesn't mean that no drug is going to help.

5.) Set an example - Don't be a hypocrite! 

This is perhaps more important for those who spend extended amounts of time with an individual struggling with mental health problems. Take care of yourself, talk about your own concerns and problems, keep up hobbies, and eat well. This will show your loved one who is struggling that it is OK to need to take care of themselves and talk about their problems - and it may encourage them to keep or find new hobbies and eat well too.

6.) Make plans to do activities with them that you know they'll enjoy, but be understanding if they later cancel because they don't feel up to it.

Don't assume that because they're not feeling too great, they don't want to do anything. Quite often this is the exact opposite of the truth! Suggest a day out to somewhere that they'll like, a trip to the cinema, a movie night or even just a long walk. They might want to use this opportunity to talk about how they're feeling; conversely they might want to use it to forget about how they're feeling just for a little while. Not every conversation or activity has to be something related to their difficulties - sometimes putting their struggles to the back of their mind for a day is exactly what a person with mental health difficulties needs. If your loved one cancels a day out on short notice, be understanding about it. Suggest a less taxing thing to do, or offer to spend the day with them at their own house instead - but don't be offended if they decline. Chances are that they would rather just take some time to themselves, and sometimes this is completely necessary. Be persistent, though - rearrange for another day and don't just stop asking. If you had something special planned for a particular day and your struggling loved one doesn't want to go, take someone else instead - there isn't any reason that you should miss out too.

7.) Make sure they are aware of helplines they can call or actions they can take in a mental health crisis. The exact advice you give for this will depend on their specific condition and you may need to do some research yourself.

I've taken the definition of a Mental Health Crisis from 'Mind', found here. 

Mental health crises include:

suicidal behaviour or intention

panic attacks/extreme anxiety

psychotic episodes (loss of sense of reality, hallucinations, hearing voices)

other behaviour that seems likely to endanger yourself or others.

If you go onto the local council website for your loved one, you'll be able to find a contact number for their local crisis team. They are usually 24/7 helplines for anyone experiencing the symptoms listed above, or similar, to use. Another helpful one is The Samaritans. They can be contacted via email, telephone, in person or by post, and information on how to do so can be found if you click here. If your loved one has no minutes or credit on their phone, they can ring and ask for their freephone number. 

8.) Take the risk of suicide very seriously.

If you are worried about someone and think they may be feeling suicidal, don't worry that asking them if they are considering suicide may give them the idea. If anything, asking them whether they are having thoughts like that may actually encourage them to talk to you about it instead of keeping it to themselves - and that may just save their life.It is a myth that those who speak about suicide are not likely to attempt it. In fact, the majority of people who complete suicide have tried to ask for help with their thoughts prior to their death. To be considering suicide your friend / relative must be in a very difficult place in their mind, and the last thing they need is for you to be angry or dismissive of their thoughts. Oftentimes, the suicidal person does not want to die; rather, they just want their pain to end - remind them that suicide is permanent and their pain may not be.

If your friend or relative is talking about suicide, make sure you do not shun their feelings or make them feel like they are overreacting. Listen to them, and if you think they are at immediate risk then ask them to go to the hospital or use one of the contact points listed in (7) above. If they tell you that they have already taken actions that are harmful, take them to the hospital or if this is not possible, encourage them to do so or ask someone else to take them. If no one can take them and they are refusing to go themselves, and you know their address, ring an ambulance or paramedic team and tell them that you believe someone at the address may have tried to complete suicide. Don't do this without telling your friend - make sure they are aware of the actions that you have taken. They may lash out in anger - don't take it personally, they will understand later why you have tried to help.

Warning signs of suicide include: preoccupation with death, having an overall negative attitude towards their life, or withdrawing from friends and family. Strangely, though, another common warning sign is sudden contentment after a long period of feeling suicidal. They may have the idea in their head that they won't be in pain for much longer if they have already made the decision to attempt to end their life, and this might be comforting to them. If you are worried, talk to them and tell them so.

9.) Make sure your expectations are reasonable. Don't expect them to feel better quickly and don't blame them if they are not making progress.

Mental illness is, in a lot of cases, a persistent problem. If you are expecting your loved one to improve overnight, you're going to be disappointed. Similarly if you're expecting that your help and support will "fix" them then again, you are wrong. It may be very frustrating for you if they are not improving, especially when you are helping them as much as you can, but chances are it's much more frustrating for them! It is not your responsibility to make them feel better, so don't feel like you are failing them if they are still not feeling good. And remember that it isn't their fault that they aren't better. Sometimes a persons lifestyle doesn't help with their mental health conditions - if this is the case, perhaps suggest improvements to their lifestyle. An example of this would be, if they drink a lot of alcohol or have a tendency to take drugs, you could encourage them to cut down on their intake. Either way, make sure that you are patient with them throughout their recovery, and if they appear to be taking steps backwards, don't blame them for it. 

10.) Take care of yourself too! Don't do more for your loved one than you are comfortably capable of doing. You know your own limits - don't exceed them. 

Gently talk to them if they are asking too much of you - don't think you will offend them, they will respect that you need to take time for yourself too. Sometimes when a loved one is depressed, your own emotional health can suffer - and that is the last thing you need! Set boundaries that are clear if you feel that you are at risk of pushing yourself too hard to help them, and don't hesitate to seek support yourself. It might help you to confide in someone else about how you are helping a friend / relative that is struggling - that way, they know to look out for you too. Some people find it useful to speak to a counsellor themselves about how to support their loved one through their mental health problems - don't feel like this isn't an option available to you. It would definitely benefit both of you. 

Good luck, and I really hope this either enables someone to start helping their loved one, or confirms for someone that they are doing the right things to help. 
- Rachael x

Self harm: It's not a joke. (TW)

 Imagine that your thoughts are racing so quickly that the only distraction you can think of is hurting yourself repeatedly until you are exhausted. Or, perhaps, imagine yourself in a situation where self-inflicted pain seems so natural that it becomes part of your routine. In either case, or any other, you'd feel lonely, scared and completely numb. You'd feel like there was no other way of getting through that moment.

 Self-harm is often used as a coping strategy; a way of deal with overwhelming emotions (or perhaps a lack thereof.) Is it funny, imagining yourself or a loved one in a situation like this? Is it something that should be laughed at and joked about? If you're a decent human being, you'll recognise that it's not humorous in the slightest.

 By contributing jokes or insensitive comments about this issue to a conversation, encouraging such behaviour, or even just condoning your peers to do so without speaking up, you are essentially laughing in the faces of people who suffer from self harming tendencies. And as we decent human beings recognised above, it is not funny. Joking that a situation makes you want to "slit your wrists", or saying that someone who self harms is "only doing it for attention" is wrong. In fact, by saying such things you could be triggering a sufferer and they may find themselves in a difficult situation later. Or, perhaps, you may be driving a sufferer to feel even more ashamed of their coping strategy and thus making them much less likely to seek the help they need. Basically if you have nothing constructive or supportive to say about the matter, just keep your mouth shut. It's not worth it.

 Let's get a few things straight. "Self Harm" refers to the practice of intentionally hurting oneself. It can be anything from picking at skin with fingernails to punching or kicking hard surfaces, from burning oneself to cutting deep through several layers of skin. In some cases self harm may prove fatal, for example if an artery is damaged and the person suffers severe blood loss. There's also a very high risk of infection developing in the resulting wounds. For most sufferers, it is a highly addictive and very unhealthy coping strategy; some use it as a last resort, others use it as a daily ritual. In ALL cases it is a serious problem that should not be ignored, and most importantly, sufferers should not be made to feel ashamed of their actions.

 Just like with any addiction, it is possible to stop self harming. However, if we consider how difficult it is for a drug user or an alcoholic to stop their substance abuse, we can get an idea of how much support and guidance may be needed for this to happen. Let's look at a common addiction - smoking. Intentional, harmful, and in some cases, fatal. Yet if a friend, family member or colleague approached you explaining that they were struggling to give up cigarettes and needed a bit of extra help, would you tell them to speak in hushed tones about it? Would you tell them that they're weak, weird, or stupid? Make them feel ashamed for not being able to stop? I bet you wouldn't, and if you would then you're incredibly ignorant. I'm hoping that you'd instead understand that it is an addiction, and therefore it is no one's fault. I hope you'd offer your support or direct them towards gaining more information on quitting. So why is it that I've literally heard people say things such as "Why don't they just stop doing it?", "Why would people intentionally harm themselves?" and "I don't think you should speak so loudly about that, someone might hear you." to - or about - a person who self harms?

 There is so much stigma surrounding the issue of self harm and it really, really needs to be erased. The only way we can make that happen is by speaking up: we need to confront those contributing to the stigma and educate them on the topic. That way, sufferers are much more likely to feel able to seek help and won't have to try and cope with it in silence for fear of being judged.

 If you notice scars on someone's body, please do not ask them what they're from - especially if you don't know the person that well. Do not touch their scars without permission. Do not make jokes about them. Do not make any assumptions. Sufferers aren't really going to want to talk about their self harm to someone unless they're certain they can trust them to not be judgmental about it. If you're concerned about a friend and think they may be self harming, by all means let them know that you're there to support them but please don't pressure them to talk about it. They will talk about it to you only if and when they feel ready to.