We need to talk about Mental Health

We need to destigmatize talking and being ashamed about mental health. Especially in times of heightened anxiety such as the global pandemic is creating.

September 10th is observed as the day to raise awareness of Suicide and Suicide Prevention around the world. Whilst people attempt suicide for a variety of reasons including loneliness, depression, physical illness, loss of self-worth, shame, bullying, and hopelessness, compromised mental health is a common factor. In Hong Kong we lose 800-1000 persons a year from suicide. Suicide is preventable death.

We need to help ourselves, our families and our friends better cope in moments of compromised mental health.

In order to help ourselves and others de stigmatize mental health we need to (1) evolve our understanding of mental health and (2) learn to talk to others about their mental health in a helpful, rather than unhelpful, way.

Understanding mental health.

A helpful way to understand mental health is to consider it, as you would physical health, as a continuum.

On one end of the continuum is good mental health and at the other end, very poor mental health. On any given day we may find ourselves moving along this continuum, just as our physical health is sometimes better, and sometimes worse on any given day.

Sometimes we have a chronic illness which lasts weeks, months, years such as a bad flu, diabetes, asthma, and this can make it harder for us to experience good health. We may need medications, undertake a change in lifestyle and seek out expert help to assist movement along the continuum towards better health. At no time do we expect that we will be completely recovered the next day, or do we expect this of others.

Similarly, mental health conditions can affect us for a day, a week, or for chronically long periods. Again, we may require additional help, medications, and a change in lifestyle to move towards the healthier end of the spectrum. Unlike physical health, people sometimes misunderstand that recovery takes time, and is certainly not just a matter of “getting over it”.

Mental health is a continuum.

Talking to someone about their mental health.

So how can we talk to people who might be experiencing mental health issues, or an episode of poor mental health?

Remember you are dealing with a GLACIER of an issue. What you see is not all of the issue. You are just seeing the part of an issue that is above the water. In order to reinforce this message, I have highlighted my “thoughts to remember when you talk to someone about their mental health” within the framework of the word Glacier.

Thoughts to remember.

G – Do no grandstand. Whilst everyone experiences anxiety and depression, we need to avoid depleting someone’s experience by comparing it our own challenges. It is sometimes enticing to share your experience, especially if you think you feel worse than they do. For example, teens often compare each other’s experience of anxiety, each teen detailing, in turn, how their experience of anxiety was worse than the person who spoke before them. This grandstanding is unhelpful for two reasons. Firstly, rather than helping to connect with your friend, you may be dismissing their experience as inconsequential. Secondly, it isn’t a competition where only the person who has the worst experience is entitled to have their feelings acknowledged or be deemed worthy access to help. We all need help and to be heard.

L – Listen. Real listening is an important skill to learn. When we listen properly, rather than focusing on continuing a dialogue we need to take the time to demonstrate that what has been said, has been heard. Reflecting back to the person some of the words that they said, or a summary of it, and asking for clarification, is helpful.  For example, what follows is a conversation between Laura and Sam. Sam is demonstrating reflective listening skills.

Laura: I have been feeling really anxious about the pandemic

Sam: so you feel anxious?

Laura: Yeah, the numbers keep going up, I’m worried if we should be in the office

Sam: So you feel anxious about keeping safe from the virus?

Laura: Yes, every day my stomach is a bundle of knots

Sam: Sounds like you feel pretty worried.

Try listening like this instead of jumping in with our opinion or even a solution. See how it changes your conversations and connections with people.

A – within the listening skill set is the simple act of ACKNOWLEDGEMENT. Help normalize people’s feelings but at least accepting that they are occurring, and that they are valid. In the example above Sam doesn’t give his opinion of Laura’s feelings. He simply allows them to exist and be acknowledged. The process of acknowledgement can be challenging if we believe that our college shouldn’t feel the way that they do. If you feel like this, I would ask you to consider if you can allow your colleague the respect and space to have their experience, even if you disagree with it. It may be more important for them to be heard, rather than “corrected”.

C- use the word CONSIDER rather than give advice. When we see people in distress we can rush to “solve” the issue, including providing solutions to the problem. Its is a real skill to sit with someone in their anguish and just simply experience their condition, rather than move to fix it. This is true empathy. Once you have listened and sat with someone, acknowledged their feelings, if you want to give advice you might like to frame it as a consideration rather than a recommendation. Rather than, “You really should give up drinking”, or “You really need to go to a counsellor”, or “You need to get medicated”, suggest it as something to consider. “Do you think you could consider changing your relationship to alcohol? Do you think you might consider counselling? Do you think you could consider if medication might help you”? Think of any advice as sowing seeds of trees that might start to grown on another day, not necessarily today.

I – Don’t IGNORE. Denial or ignoring a problem will NOT make it go away. Telling someone they “shouldn’t” feel the way that they do, is not a form of treatment. Telling them how you would like them to see the issue, also not helpful. Let people have their experience. Respect their experience of the world, and encourage change rather than deny or demand it.

E- ENCOURAGE people to seek help. As you would if you saw if a friend or colleague had a physical injury, ask them to consider if change could be possible and they could find a resource to help them feel better. Even top performers encourage coaches and counsellors to move from good to great.

R- REFER them to experts. There are people who are great with people in a crisis. Natural talent is not the same as training. Mental health issues are best addressed by mental health experts. These experts are trained in listening, testing, helping to build allegiance, methods of behavioural change, and usually have a network of other experts that they access when required. Like any expert a personal recommendation from another user is always helpful. In the days of Facebook, a recommendation is only one post away.

I hope this helps you to help yourself and others. If you have any questions about your own mental health, or the mental health of a friend, feel free to contact the RED DOOR team at our email. Let’s talk about mental health – our own and that of others. reception@reddoor.hk

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Angela Watkins is a qualified counsellor and psychologist working with teens and adults within the RED DOOR Counseling practice in Hong Kong.

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