#MindYourself: How to help a loved one battling depression or anxiety
What can we do for friends and family who are struggling to cope? Our reporter asked the experts
It's a difficult situation to be in, when you suspect a loved one might be finding life tough, or even battling depression or anxiety.
And it can sometimes feel impossible to know what the best approach is - should you talk about it? And how do you even start that conversation? But if someone you love - a friend, a colleague, a child, a parent - is diagnosed with depression or anxiety, there are a number of simple, practical things you can do to support them. We asked the experts for their advice.
What to look out for
Of course when dealing with individuals there is no hard and fast manual of what to look for to tell you they might be struggling. "If it's someone you know well, then you are the expert, you know if they are behaving out of character," says Dr Gillian O'Brien, director of clinical governance with Headstrong, the National Centre for Youth Mental Health. But she believes there are some generic alarm bells to look out for: changes in sleep, changes in appetite, a loss of interest or pleasure in something they previously enjoyed doing, any kind of withdrawal from others isolating themselves and changes in mood. "Particularly irritability," she says. "People assume that people might be sad or tearful, but in men especially, a mental health issue can manifest itself in irritability."
Look for a window of opportunity and chose your time well. If someone is displaying irritability then there might be a temptation to confront them in the moment but you're far better waiting until later before saying 'you've not been yourself lately, is everything OK?' when it won't sound confrontational and make the other person defensive."
Choose your words carefully
"Asking 'how are you feeling?' is a really difficult question for someone who is struggling with their feelings and unsure how to articulate what they're going through, says Gillian, who suggests using more leading questions like 'I've noticed you're not yourself lately, is everything OK?"
"The reason so many of us reply with 'I'm grand', even if we're not, is because we don't think the person asking really wants to know," says Gillian. "I think we all could be better at listening," agrees Edel Fortune, Day Services Programme Manager from the Wellness and Recovery Centre at St Patrick's Mental Health Services. She says we need to get better at making eye contact and stopping to talk rather than just going through the motions.
"We do it all the time, asking 'how are you?' more as a greeting than a real question," she says. "We need to genuinely listen to what the other person has to say. They might give hints rather than say anything explicit so listen out for cues like 'I'm not really feeling myself' or 'I haven't been sleeping the best," and, instead of just brushing it off, ask if they're OK. Often just giving someone the opportunity to talk, and feel they're being listened to, is key."
Don't jump in and hijack the conversation with your own experience, even if you think you're being empathetic, it can sound like you're being dismissive.
Don't be judgmental
"If your reaction is very negative to whatever the person is saying then they will probably clam up," says Edel. There's also a very natural instinct, particularly if you're a parent, to want to push away your child's distress and try to dismiss it - "sure you're only 17, what have you got to worry about!" Step into the other person's shoes and show you understand that what they feel is real and valid.
Don't rush in with solutions
"The initial phase is to listen and give space to what they've said," says Gillian. "Often people rush into phase two, the 'what can we do together about this' phase too fast." You need to acknowledge the person's feelings, not try to 'fix' them.
Consider consulting another person
Sometimes older people won't want to 'burden' their children with their problems even if the child is concerned and wanting to help. "It's not as easy for people to open up to their own children but someone outside the family, often an in-law, may have better success because there is that little bit of distance," suggests Edel.
Remember you are not an expert
Perhaps you've watched a documentary or read about depression online, but the chances are you are not a mental health expert. "Do not diagnose," urges Edel. But do suggest they visit their GP who can rule out an underlying physical cause or advise them on accessing support if needed.
Don't avoid the subject - but don't make it everything either
People often have a fear that in mentioning something difficult, they'll 'remind' the person of it and upset them. But often avoidance just creates a stigma around the issue. "You don't need to jump in saying 'I hear you have X'," says Edel. "But do ask them how they are and it there is anything you can do."
Don't try to quantify or compare what they're going through
"There can be a tendency, and it's not malicious, for people to want to try and compare what someone's going through with someone worse off," says Edel. "But a person's mental health issue is their own reality and that's what's important to them."
"I think we can all have trouble relating to someone who has suffered trauma and the stock phrases that can be used are understandable but are rarely helpful and annoying," agrees Dr John Hillery, Consultant Psychiatrist and Director of Communication and Education at the College of Psychiatrists of Ireland (irishpsychiatry.ie). Nor should we set a stopwatch for when things 'should' get better. "We say things like 'they should have got over it by now' because we have our own traumas and concerns and, without meaning to be cruel, we can be impatient with others, especially if we've not experienced similar ourselves. It's human nature," he explains. But if you're genuinely concerned someone's mental state isn't improving, it could be a sign that they need professional assessment.
Offer practical help
You might be concerned that you have no experience of helping someone with a mental health problem but helping doesn't have to be all or nothing. "Support can be offering to help with their workload, offering to pick up the kids or walk the dog. You don't need to know all the ins and outs of their situation to help," says Edel. "You can do the shopping because sometimes. when someone has a mental health issue, even the simple things can become major obstacles. If you can help take the pressure away then that can give them time to heal and feel better."
"Even though it may be the last thing they feel like doing, exercise and good sleep are important at this time for them and encourage them to get both," says Naoise Kavanagh, online communications manager at ReachOut (ReachOut.com) an online youth mental health service. "The best thing we can do is be there and help with the activities of daily living and be available. Simple things like an invite for coffee or a walk," agrees John. "Encourage engaged normality while acknowledging the pain."
Don't push happiness
"I think the expectation that we should be happy all the time is unrealistic and puts huge pressure on people," adds John. Instead we should accept that sadness is a legitimate feeling that will pass - don't try to gloss over it.
There are lots of brilliant support organisations (many cited here) with great resources on mental health. Also remember that the person experiencing a mental health issue is still the same person. "They're not defined by depression or anxiety," says Gillian. "And if all your conversation is focused on that or treating them differently then that can become a problem."
When people talk about mental health they often mean mental illness, but, just like we all have physical health and will experience physical health issues, so too will we face mental health challenges. Even if it is something clinical: "Remember that many people who do receive a mental health diagnosis manage their condition well and go on to live healthy and fulfilled lives," says Naoise.
Don't forget your own mental well-being
"We recommend that everyone has five supporters in their lives," says Edel. "Not one person who feels they are taking on all the responsibility of everything. You need to take time to yourself or you're going to run yourself ragged to the detriment of your own mental health."
'It was hard for James to talk about his distress'
Midwife Jeannine Webster (49) from Donabate, Co Dublin is a mum-of-three. Her son James (23) was diagnosed with schizoaffective disorder when he was 15, meaning he suffers bouts of psychosis, depression and anxiety. Jeannine says:
"When he was little, James always hated loud noises and he would have had night terrors where he'd wake talking about a 'man saying bad words in his head', but it was only when he was 15 that he was diagnosed. We were watching Stephen Fry's documentary about depression and the fact that he sometimes would hear voices in his head and James went very quiet. A few days later he said he felt the same.
"Communication is huge. You can't make someone tell you how they feel and when they do, you have to be prepared to hear what they're saying. It was hard for James to vocalise his distress and tell me that he felt like 'banging his head off a wall' or felt like killing himself… and it was hard to hear. But I needed to say it's OK and just give him space to speak."
James' condition is now managed with medication and helped with a balanced diet, frequent exercise, routine and social contact. He also attends a course in St Patrick's once a week, challenging his way of thinking.
In supporting her son, Jeannine has come up against limitations in the system but is grateful for the help organisations can bring. She's a member of REFOCUS, a working group of carers and service users at the College of Psychiatrists Ireland. "Caring for someone with a mental health issue can feel a very lonely experience and support groups, with other people in the same situation, are a lifesaver," she adds. It's hard to completely switch off and Jeannine says it's important to find time for yourself. "I went to stay with my cousin the other week and we'd gone out for the night when I realised I'd two missed calls from James," she says.
"Straight away I'm stressing when I can't get him on the phone." She laughs. "When I finally got hold of him he was fine, he'd just been calling to see if I was enjoying myself!"