Not sure how to help someone struggling with mental health? Learn how you can actually be there

Ryan Martin (Courtesy photo)

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Ryan Martin remembers the day he finally said the words “I need help.”

It was March 2017. He was 22, driving back from the family cottage with two of his best friends. As they chatted back and forth, a lump formed in the back of his throat.

“I just wanted to cry,” he said.

The Guelph native – “funny, smart and sociable,” to those who knew him, had been silently grappling with mental illness for four years – and couldn’t do it alone anymore.

So, he burst into tears.

“It was unbelievably nerve-wracking, and terrifying, especially when you start crying and they’re looking at you like, ‘What is going on?’” he said.

“I pretty much just said, ‘I’ve been in so much pain for so long, and I haven’t been able to tell anyone. I’ve been trying to do this all on my own, but I can’t. I’m scared and I need your help and my family’s help to get through this, because it’s so much bigger than me. And I can’t do this alone.’”

The three got out of the car at the side of road, and “had a big hug, all three of us,” he recalled. “They said they were there to support me and that they loved me.”

That response, experts say, is exactly what’s needed in such situations. But having that conversation is far from easy – for anyone involved.

“You have to have the courage to open up, but the people supporting you have to have courage too,” Martin said. “It’s a really hard conversation to navigate.”

But more of them are needed. Despite efforts like Bell Let’s Talk Day to end the stigma around mental health, many of the one in five Canadians facing a mental health issue are still afraid to open up.

With so many Canadians affected, it’s important to be able to talk about it. Not only those struggling, but the friends and family around them.

Ryan Martin (Courtesy photo)

And as Sarah Hamid-Balma knows, many people aren’t sure how to support someone battling a mental health issue.

Hamid-Balma is Director of Mental Health Promotion at the Canadian Mental Health Association (CMHA) division in British Columbia. She’s also affiliated with HeretoHelp and the BC Partners for Mental Health and Substance Use Information.

One of the most common queries they receive, she says, is from friends or family members who are worried about someone but aren’t sure what to say or do. Another, she says, is from people who are suffering but don’t think their loved ones would know how to respond.

Would you know what to do if someone you cared about needed help? If you’re not sure, read below to learn how to support someone who’s struggling.

As Martin said, your response could “change their life – or save their life.”

Key signs someone may need help

While there are hundreds of types of mental illnesses and combinations of symptoms, experts say just a few key signs can help indicate if a friend or loved one is struggling with a mental health problem.

The best thing to look for, said Hamid-Balma, is “change” – in a person’s physical appearance, emotions or behaviour.

Dr. David Gratzer, psychiatrist with the Centre for Addiction and Mental Health (CAMH) agrees.

“If somebody was very active and now they’re lying in bed all day, or if someone normally takes pride in their appearance, and now they’re suddenly looking like they haven’t showered recently, or maybe it’s a change in comments they make, or they’re talking about feeling less well or motivated, these are all indications that something is off,” he said.

The second thing to note, said Hamid-Balma, is “time” – that is, how long you’ve seen the change occurring.

“It’s not just a few days,” she said, noting we all have “ups and downs in life,” but typically, our usual patterns resume after a short time.

Fardous Hosseiny, National Director of Research and Public Policy at the CMHA, says it’s often also the onset of multiple symptoms that cue something is wrong. For instance, if someone shows signs of confused thinking, that alone may not indicate there’s a bigger problem.

“But if a person is showing signs of confused thinking and then they also have feelings of extreme highs and lows, and then they have excessive fears, worries and anxieties, then with those three in combination, you can say, ‘OK, there might be an issue here,” he said.

Hamid-Balma also says our instincts are important.

“We have a gut sense about people close to us that something’s not right,” she said.

Ryan Martin (Courtesy photo)

She also says since many people are afraid to speak up, proactively approaching that person could make a big difference.

“We know that asking for help, or saying we’re having trouble coping, is really hard for a lot of people. So, we can’t always wait for those words,” she said.

Looking back, Martin says it would have been relieving if someone had approached him.

“I was always so desperate to talk to someone, but I was never given that good opportunity with someone I trusted,” he said. “I think I would have been like, ‘Thank God, this feels painful,’”.

How to start the conversation – and what to say

In terms of how to approach someone who may be struggling, experts say to be mindful of timing – that is, to try to speak with the person when they won’t be interrupted, and to find a safe, private place to chat.

As for what to say, Hamid-Balma emphasizes that tone is more important than the words you choose.

“What’s really important is how you say whatever it is. It’s being non-judgemental, caring and compassionate,” she said. “It’s letting them know you’re there for them, regardless of what they tell you.”

Noting that many people worry their loved one will get angry if they approach him or her, she says, “It’s hard to be angry at a friend or family member if they come to you really compassionately, and say, ‘You know I’ve been noticing something is off, are you OK?’”

Martin says another even less direct approach might involve simply mentioning something you’ve noticed and saying that you’re not sure if anything’s going on, but that you’re there for that person if they want to talk.

That way, he explained, “You’re not actually saying anything is wrong,” and, if that person isn’t ready to open up yet, “They know you’re someone who’s available to them and has their back.”

If a loved one comes to you…

If a friend or family member turns to you to say they’re struggling, experts emphasize, again, a few simple things can go a long way.

“Start by listening carefully and attentively,” said Dr. Gratzer, noting that it takes a lot of courage to talk about a health problem – let alone one that comes with stigma.

A compassionate tone and non-judgemental attitude, again, is critical – along with being empathetic.

“You can’t tell them, ‘Everything is going to work out,’ but you can say, ‘I can see how you might feel like this, given what’s going on for you’. Empathy is really important when people feel very alone, when they think no one can appreciate the feelings that they’re sharing,” said Hamid-Balma.

Experts also say to resist the impulse to give advice or offer a solution.

“It can be easy to want to try to solve their problems. But we shouldn’t try to be that mental health professional,” she said.

Dr. Gratzer also says while it’s tough to hear a loved one is struggling, we shouldn’t dismiss or deny what the person is saying.

“It may be easier to believe that the person isn’t actually sick with depression, and perhaps they can’t get out of bed because they’ve just been working too hard,” he said.

“But it’s important …that we pause and remember it takes courage to speak about these things and to provide support,” he continued.

Responding with anything less could have major consequences.

“They’ve taken that brave first step… If the response they get back is quite negative and not very supportive…that perpetuates the stigma to them in their mind, and the person could close down even more,” Hosseiny said.

Which could be dangerous, he continued, since mild to moderate depression or anxiety – untreated – becomes more severe over time and can become a crisis.

Ryan Martin (Courtesy photo)

How to support your friend or loved one

So, the conversation has started, you’ve expressed your concern, and you’re genuinely letting your friend or loved one know you’re there for him or her. Now what?

If the person admits they’re having a tough time and are open to receiving support, Hamid-Balma says one way to help is to look up mental health resources*.

That might include getting information for a distress line or a chat site, seeing if there’s access to counselling through the person’s school or workplace, seeking out local mental health organizations, or helping the person see their family doctor.

Experts caution that while seeking professional support is crucial for someone who’s struggling, as long wait lists show, mental health resources in Canada are severely lacking. As Hosseiny says, years of underfunding means that among G7 countries, Canada ranks the among the lowest when it comes to total public health spending on mental health. Despite progress in recent years, he and others stress that much more needs to be done.

Promising to check in on the person regularly is also important – and as Martin and Hosseiny point out, that goes beyond the common, “How are you?.”

For instance, Martin said that on one particularly tough day, he received a text from a friend that said, “How’s the day going?”

“I was like,‘What is he asking about?’ Sometimes it’s just nice when people say, ‘How have you been feeling mentally?’ It’s just that willingness to have that conversation and make it feel normal. If you have the courage to ask that, it’s amazing,” he said, also noting that phone or video calls can go a long way, instead of just a text message.

You can also support someone by giving them hope, said Dr. Gratzer.

“One of the biggest myths is that people with mental illness don’t really get better. But the vast majority do get better,” he said.

The next possible scenario is more difficult: If the person denies anything is wrong, or, they’re resistant to seeking help, experts say to continue to be supportive and let them know you’re there if the person wants to talk.

“Because you never know, they might get to that place where they say, ‘I really do need help now,’ and they know you’re that person they can turn to when they’re ready,” Hamid-Balma said.

Another option, she continued, could be to enlist the support of someone else the person is close to.“You could say, ‘They’re never going to listen to me, I’m just their roommate, but they come to you all the time, have you noticed anything wrong?’” she said.

If the person still refuses to address the issue, unless they’re in danger of hurting themselves, they can’t be forced to get help, Hamid-Balma explained.

When that happens, experts say reminding the person of others who have sought support in the past could have a real impact.

In fact, Hamid-Balma says a 2017 study from the University of Ottawa showed that people were 30 per cent more likely to seek treatment if they knew of a friend or relative had also sought professional help.

Ryan Martin (Courtesy photo)

And, what if it’s a situation where the person could be in danger of harming themselves, or committing suicide?

Experts say that if someone makes suicidal comments – which could be phrased as wanting to “escape,” saying they’re “better off dead,” or not seeing a reason to live – to try and talk with the person about how they’re feeling and how they can get help.

“Suicidal thoughts are a medical emergency and need to be taken seriously,” said Dr. Gratzer.

Experts say that while every scenario is different, if you feel a situation is urgent, it could mean that you call that person’s family doctor or emergency services. At that point, what’s crucial is you don’t leave that step to the person who’s in crisis.

“I think the most important thing is to speak to the person and try and engage them,” said Dr. Gratzer, outlining this example conversation:

-“I don’t want to go to the emergency department because I would wait hours.”-“I’ll come with you. We’ll wait together.”-“I will have nothing to do at the emergency department.”-“I’ll bring magazines.”-“I’m scared.”-“I’ll be right beside you.”

“Those are the sorts of comments that can make the world of difference,” Dr. Gratzer said.

It’s that type of conversation that Martin’s loved ones faced when he got back from the cottage that day.

After telling his friends on the way home, Martin, who was later diagnosed with anxiety, depression and bipolar II disorder, told his parents and sister what he’d been going through.

Their response, he said, was exactly what he needed.

“It’s an amazing feeling to take that leap with people you trust, and they respond with love and support,” Martin said.

And it was quickly needed. When Martin told his family he was having suicidal thoughts, they went with him to the hospital that night.

In the waiting room, Martin sat in disbelief.

“Because, as soon as that happened, I realized it wasn’t my problem anymore…we were all in it together,” he said. “You know it’s not just you fighting this anymore.”

The battle does continue, he said, “But what changes is that you have people to talk to and you’re not alone,” he said.

Hamid-Balma said that’s the most important message you can send.“Just being alongside them as they seek help – that’s the biggest gift you can give,” she said.

If you are crisis, please call 911.

The Canada Suicide Prevention Service (CSPS), by Crisis Services Canada, enables callers anywhere in Canada to access crisis support by phone, in French or English: toll-free 1-833-456-4566 Available 24/7