Supporting someone you care about through a mental health crisis can be a challenging process, particularly if it all feels new and confusing to you. Many people feel daunted by the prospect of helping a loved one with their mental health, often because they do not understand it, or do not feel qualified to step in.
The language of psychiatry can be hard to access, and diagnoses can sometimes be quite ‘othering’, which can create barriers to meaningful connection.
But in fact, the most important part of any kind of mental health support is seeing someone for who they are as a human being, empowering them to meet their own needs, and providing them with the support that they need to make the changes necessary for recovery. This can be done by anyone, anywhere - no training or certifications are needed.
Let’s talk about what you can do to support someone you care about through a mental health crisis.
First, Understand The Terminology
If you are new to learning about mental and emotional health, mental health conditions may seem like psychiatric jargon, and this can make many carers feel under-resourced and lacking in confidence.
In fact, while many mental health professionals are experts in their clinical fields, the individual with the condition - and the people closest to them - are the experts in their own lives and experiences, so loved ones and carers shouldn’t feel daunted by the language used. Most good professionals will use simple and easily understood terms, but if you have any questions, never be afraid to ask.
Terms like ‘depression’, ‘anxiety’, ‘psychosis’ etc., may seem complex at first, but are simply descriptive terms that mental health professionals use to summarise a range of behaviours, and to assign an individual a treatment ‘pathway’ that will help them to recover and learn skills for recovery.
For example, if an individual has Major Depressive Disorder (MDD), they are likely to suffer from long-term low mood, consistently low energy levels, and poor motivation. They are also likely to over or under sleep, struggle with personal care activities such as eating regular healthy meals, bathing, or keeping their environment clean, and they may also have problems with memory and concentration.
Common Mental Illnesses And Their Symptoms
Here are the symptoms associated with some of the most common mental health conditions, although please note that proper diagnoses should only be made by a trained medical professional, such as a psychiatrist:
DEPRESSION - Depression is a symptom of several mental health conditions, most notably mood disorders such as Major Depressive Disorder and Bipolar Disorder. The term ‘depression’ indicates a significant period of low mood, energy, and motivation levels, which may manifest in self-neglect, potential self-harm, and feelings of emotional distress or numbness.
ANXIETY - Anxiety is associated with anxiety disorders such as Generalised Anxiety Disorder (GAD), Panic Disorder, Obsessive Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder. Anxiety is classified as persistent and excessive feelings of fear, obsessive and/or repetitive worries, and may result in physical sensations of sweating, increased heart rate, and shaking.
PANIC ATTACK - Panic attacks are a feature of anxiety disorders - particularly Panic Disorder. Panic attacks are characterised by an intense feeling of dread, such as the feeling that you are about to die.
Panic attacks may also include feelings of dissociation or de-realisation (feeling disconnected from your body and your surroundings), shaking, sweating, increased heart rate, and frequently quick, shallow breathing, known as hyperventilation. People experiencing a panic attack may also experience extreme moods and irritability, and may be sensitive to high levels of noise, crowding, or stimulation.
MANIA - Mania is an elevated mood, often experienced in Bipolar Disorder. It generally lasts between a couple of weeks and up to six months. Mania can cause impulsivity, restlessness, increased activity, fast speech, rapid and jumping thought patterns (known as flight of thoughts), and hallucinations.
HALLUCINATION - A hallucination is a sensory experience of something that is not happening in reality; for example, seeing, hearing, or even feeling, tasting, or smelling something that isn’t there.
Hallucinations are frequently associated with schizophrenia, bipolar disorder, some personality disorders, and substance misuse. People with certain neurological conditions - such as epilepsy or Parkinson’s - may also experience hallucinations.
DELUSION - A delusion is a belief that does not align with the commonly accepted reality, for example, believing that you have been abducted by aliens, or that you are being listened to through the telephone. However, it’s important not to confuse a delusion with a difference of perception or opinion, and as such, identifying delusions is best left to the individual, or a mental health professional.
PSYCHOSIS - A prolonged period of experiencing hallucinations, delusions, and disrupted or distorted thought processes. A person experiencing psychosis may struggle to express their experience in a way that other people can understand.
DISSOCIATION - Dissociation is the feeling of being ‘disconnected’ from oneself. This can manifest in a sense of being disconnected from your body, having difficulty accessing memories, slowed speech and cognition, poor concentration, and ‘zoning out’.
DEREALISATION - Derealisation is the feeling of being ‘disconnected’ from the world around you. This may include visual distortions, a sense of familiar situations and things suddenly seeming unknown or strange, and a distorted perception of time and space.
TARGET BEHAVIOURS - Target behaviours are behaviours that are destructive or unhelpful and that need to be addressed, for example, violent, self-harming, or maladaptive behaviours.
ACTING OUT - Directing emotions outwards towards the world in an unhelpful manner. For example, breaking things, reckless behaviour, or being violent.
ACTING IN - Directing emotions inwards towards the self in an unhelpful manner. For example, internalising experiences, self-harm, or eating disorders.
The Importance Of Social Support
It’s important to remember that any diagnosis is simply a description of the behaviours and personality traits that are already there.
A diagnosis does not change anything about the individual - they will still be the same person that you have always known and loved. Diagnosis is simply a ‘language’ that professionals use to communicate the causes of their distress and the treatment that they might need.
As such, everything you know about that person still applies, and your knowledge of who they are as an individual is the best resource you have to support them. For example, if a book about depression suggests going outside for walks, but you know that your loved one hates walking, then it is unlikely to be the best course of action for them.
You might, however, know that they enjoy going to the beach, so you might take them to the beach instead and get the benefits of being outdoors in a way that is right for them.
All support should be tailored to the person you are supporting and what is best for them - and who knows that better than the people closest to them?
The truth is, you don’t need to understand diagnoses and treatment pathways. If your loved one is seeing a professional, they (and yourself, if you are a carer) will be guided through this process.
What they might need, however, is for someone to support them in sticking to their treatment plan. If you live with them, you might prompt them to take medication, for example, or eat regularly if needed. You could encourage them to go out if they find it difficult, or offer them a lift to an appointment.
However, some people might not appreciate other people being involved and may prefer to handle it on their own. If this is the case, you should accept their boundary and move on.
Supportive Conversation
When the subject of mental health first comes up, many people don’t know what to say. Our culture encourages people to just ‘get on with things’, so for many people, this is unfamiliar territory.
Here are a few pointers about how to engage a loved one in talking about their mental health in a therapeutic and meaningful way:
• SAFETY FIRST! - Always make sure you are safe before initiating any difficult conversations. Talking about mental health can be an emotive subject, and when you are speaking to someone who is already feeling fragile, this can increase the likelihood of all sorts of emotions arising. Make sure you position yourself near an exit, and ideally let someone know where you are before you go.
• ASK - Many people, particularly men, feel uncomfortable bringing up the topic of their mental health due to stigma. By showing that you want to listen, you are providing them with a space where they will feel safer talking.
But also remember that not everybody is comfortable talking about their wellbeing, and some people just may not be ready. If they don’t want to talk, don’t be offended or try to push the issue - simply accept it, and let them know that you are there for them when they are ready.
• ACTIVE LISTENING - Active listening shows that you are listening and empathising actively with the person in question. It involves giving verbal signals that you are listening, such as saying ‘Yes’, or ‘I understand’ when they are describing something, or by summarising and repeating what they’ve said back to them. For example, ‘So you felt angry because that person was rude…’
• VALIDATE - For someone to feel comfortable disclosing their feelings, they need to feel like they are being supported, and that their feelings are reasonable. If you feel that somebody is being ‘unreasonable’, find an aspect of the situation that you can support instead.
For example, Dave cheats on his wife Hillary. He is upset that their marriage falls through. You might feel that Hillary had every right to leave, but telling Dave this will not help his state of mind. Instead of saying how you feel - or lying by saying that Hillary was wrong to leave Dave - it may be more helpful to say that ‘It’s natural to feel upset after a divorce…’ and to talk about ways of managing those feelings.
This helps you to support Dave without taking sides or betraying your own beliefs.
• NON-JUDGEMENT - Where possible, you should approach these conversations non- judgementally. You may have your private thoughts, but keep them to yourself to avoid causing further distress.
For instance, if somebody is hallucinating and isn’t making sense, don’t tell them that their perception is ‘wrong’ - it’s simply different from yours right now. Try asking them to tell you more about their experience, and ask for clarification. A little respect goes a long way.
• BOUNDARIES - Some people may overstep your boundaries. Healthy boundaries are crucial to maintaining a positive relationship and protecting yourself and the person you are interacting with. Assert your boundaries verbally in a firm, but gentle and empathetic manner.
Likewise, respect their boundaries. Don’t force anything on them that they don’t want to do. A member of the public does not have the legal right to restrict an individual’s liberties, regardless of their physical or mental health condition.
However, if someone is posing an immediate threat to their own safety or the safety of others, you should call 999.
• OFFER CHOICES - Being treated for a mental health condition make individuals feel disempowered in their own lives. This can contribute to feelings of depression and frustration.
Instead of telling someone what they ‘have’ to do to recover, try to give them choices instead. For example, ask ‘Shall we go out? Perhaps you want to go swimming or for a walk today?’
• ROUTINE - If you live with your loved one, make sure you support them to keep a healthy routine.
A balanced diet, regular exercise, personal care, activities, and social support are all the pillars of good mental health, but feelings of depression can cause people to neglect these. Giving your loved one some support to do these things can help to get them back on the road to recovery.