Everyone is always saying to those of us that suffer with a mental health condition: “its ok to not be ok”. We should “reach out” and “it’s good to talk” – so many great catchy slogans from national mental health campaigns, all designed to promote awareness and challenge the stigma associated with mental health conditions. Mental health awareness is now at the forefront of everyone’s mind, which is a great improvement from where it was 20 years ago. The will to end mental health stigma is there, but we still have a long way to go.
The slogans and phrases make the task of “talking” and “asking for help” seem relatively easy but being open and honest about something so deeply personal is difficult. Feelings of shame and failure are often linked with mental ill health, because in society we haven’t managed to truly acknowledge mental health illness on a par with physical ill health.
The physical equivalent is someone asking you to walk to the hospital with a broken leg to get it fixed. You wouldn’t ask a person with a broken leg to do this. It would be obvious the person was in pain and needed help. If you were unable to do so you would call someone, help would arrive and the person would be taken to hospital to get their broken leg seen too.
Mental ill health is a hidden illness. It isn’t as obvious for people to notice (although to a perceptive person the signs are always there). You are asking someone with an illness inside their head to find the confidence and strength to articulate it. The person with a broken leg may be able to hobble to the hospital eventually, but it would take a while and that person would be in great pain. We wouldn’t expect a person to do that, as it would certainly make the leg worse. Why then are we encouraging people suffering with a mental health condition to metaphorically “walk with the pain”.
If we are asking a person to make that painful journey, we must make it as easy as possible to accomplish. We also need to make that journey seem attractive, letting them know that at the end they will hopefully feel better. We know if we go to hospital with a broken leg the medical professionals will fix it and the pain will go away. The problem is that the journey for someone with a mental health condition starts with asking for help, which at present isn’t seen as safe and attractive as it could be. Provision for mental health services is a lottery depending on where you live. Services are under strain and the quality of the person you talk to isn’t always guaranteed. Stigma and judgement still exist even within the medical professions. Will you get the person that is helpful and understanding, or the one that is curt, judgemental and dismissive? Quite often this may actually prevent someone from even trying to ask for help in the first place. I hope for a day when this potluck approach disappears, and that anyone with a mental health condition can open up without fear of judgement or stigma. They will simply be heard and can then be sign posted towards help. Every person suffering deserves the same consistency of care on their journey.
Mental health issues leave you weak and run down. Sufferers deal with painful and debilitating feelings associated with whatever condition they have. The simple act of reaching out, asking for help and being honest is a huge task. Imagine your head is full of pain and negative thoughts. Now imagine having to try and supress and manage that while having to continue with your daily life. On top of that you are being asked to find the strength and composure to go and speak about it, to open up and reach out. It is as painful, difficult and as raw as walking to the hospital with a broken leg, and often the journey to asking for help will have made the condition much worse.
I am not advocating that we no longer encourage people to reach out when they need to, but it is important for society to acknowledge just how difficult that can be. Once we acknowledge this and understand what we are asking people to do, we can better understand and make the journey for the mental health patient easier.
More needs to be done to educate people on spotting the signs of deteriorating mental health. Sadly, a lot of the more obvious signs are linked to traits that are associated with lack of productivity, laziness, and a lack of motivation – all qualities that in today’s society lead to judgement and stigma. Our first instinct is to perceive a person as lazy or unmotivated, perhaps unorganised or simply not very good. We need to learn to see beyond the symptoms and take the time to ask why. Why is this person late for things? Why are they not talking to people as much?
This is where the vicious cycle of opening up about your mental health begins. As things worsen, your daily battle with the demons in your head requires more and more of your concentration. Inevitably other tasks in your daily life start to suffer: hygiene, work, housework. These are the more obvious signs to a perceptive person that something is wrong.
The trouble with society today is that we live in an Instagram culture. If we are nothing short of perfect we are deemed a failure. If we aren’t doing fabulous craft activities at the weekend with our children, if we aren’t producing Nigella-standard evening meals, if we aren’t the beacon of organisation at work, then we in some way failing. And so as our mental ill health fails, we feel more and more inadequate. No one can see the pain inside your head, but everyone can see that you’re not coping with daily life. People are unkind and we are judged. So we try to keep up with our neighbours rather than asking for help. The fear of being perceived as failing or being judged prevents us from starting our journey to ask for help and serves as a barrier.
“It’s good to talk” is a catchy slogan on a mental health campaign, and we can all hash tag and quote it endlessly. We can train hundreds of mental health first-aiders in the work place with colourful lanyards saying they are there to talk, but the reality of what we are asking of this person who is suffering needs to be understood. I believe that if we all understand how hard it is to ask for help then our approach to listening to a person will be kinder. We will have more empathy and be better placed to gain the trust needed to point a person towards the help they really need.
The seemingly simple act of asking for help if you are suffering with a mental health condition NEEDS to be acknowledged by the person listening. They must understand quite how much strength and determination it took to make that journey.
So our mental health patient has metaphorically walked to the hospital on their broken leg and made the painful, brave and daunting journey to go and ask for the help they need to get better. The next interactions with that person are even more VITAL. You might be a doctor, a work colleague, a manager, a mental health first aider, or a friend or family member. Whoever you are you have a responsibility to listen to this person. They have been brave enough to talk to you. If you saw someone with a broken leg you wouldn’t leave their side, you would make them feel comfortable and safe and phone an ambulance. The same care and attention needs to be applied to how you help and engage with someone who has disclosed that they are suffering with a mental health issue. I am sad to say that often people are dismissive, they don’t have time, perhaps they simply cant acknowledge the huge achievement this person made to get to this point. Imagine walking to hospital on your broken leg and when you arrive at A & E you are asked “Are you sure its broken?” “I’m sorry to hear you have a broken leg, that’s really unfortunate”, “Do please keep letting us know its broken, its important to continue reaching out” The unfortunate text book responses to mental health issues used with little thought for how they received.
The quality of this interaction is crucial. If it goes badly, if the person feels you aren’t listening or don’t care, then they have effectively made this painful journey for no reason. It’s made them feel worse and exacerbated their condition. They may never find the confidence and stamina to make that journey again. So I stress again the importance and responsibility on the individual that has been charged with listening to any person who has made the effort to ask for help. Think carefully about taking on the role of, for example, a mental health first aid trainer – do you really understand the gravity of the task? Is it something that you are willing and capable of doing? I firmly believe that more work needs to be done on the mental health first aid model. Please understand I am not dismissing it – it’s great we have something at least – but I fear it has become a simple box ticking exercise: showing willing without understanding.
In my life, I have lost count of the times I have made that exposing journey to ask for help. I have also lost count of the times I have been greeted with a curt, dismissive and incredibly unhelpful person. Quite often it has left me vulnerable and bruised. I retreat, hide and don’t want to ask for help again. However, I am also very pleased to say that a few times I have been greeted with kind, understanding and helpful people who have encouraged me to seek the specialist help I have needed. Over the last year I had to make that painful journey again. Sadly it doesn’t get any easier. In fact if anything its harder as it’s the path you have already trodden and its laden with feelings of shame that you are having to do it again. When I reached out it was horrible; I was sad, ashamed and scared at knowing I was getting so poorly. I was distraught it went so badly, I felt stupid and vulnerable. I came home so upset, and ready to give up. My husband convinced me to keep trying, I reached out to a friend with experience in the mental health professional field. He said to me “not everyone is like that, there are good people out there, good people that will want to help you”. So I picked myself up and tried again, it was long painful, judgemental and scary, but I am pleased to say I have the support I need with a professional team that I trust. Its just a shame the journey to finding it was so fraught and hard work.
Those catchy mental health slogans in social media feeds make it sound so easy: “it’s time to talk”. Yes it is, but more work has to be done to make that journey easier safer and less painful for mental health sufferers, and when we get there we need to know that we will get the same level of consistency in care that you would get for a broken leg. It shouldn’t be pot luck. It’s a vicious circle: its time to reach out for help but the journey to seek the help is painfully lonely and we have done nothing to make it easier; when you finally get there you may not be listened to with kindness and understanding, so you might retreat and be too nervous to make that journey again. Only when we get to that place of consistency in how we listen to people with mental health problems can we seek to change the culture of our society and make people feel they can really “talk”.
- Be more perceptive in spotting the signs of mental ill health – let’s not put all of the responsibility on them to reach out because we know it’s hard. Let’s open our eyes and see if a person is struggling. Let’s start spotting the “broken legs” before they are suffering in pain for too long alone.
- “It’s good to talk” goes two ways. If you notice signs of someone struggling, then why don’t you take that bold step and ask them if they need help. Acknowledge how hard it has been for them and make the journey easier. As long as you’re kind and not forceful, you will be surprised at their response. It’s also ok if they aren’t ready. But it’s also ok to try again later.
- Lighten the load, make that journey easier – If I had a broken leg you would probably offer your support to physically help me get to the hospital. You might even drive me there. Making that lonely journey to ask for help is hard and there is no shame in having someone help you. Why don’t you offer to help that person if you can see they might need it?
- Hold back the judgement and stigma on those obvious signs. Ask why? Why is this person being late all the time? Why is their work not up to scratch right now? Why is this person ignoring me? Change your mindset, and hopefully we can start changing the mindset of society.
- Acknowledge the achievement that person has made in talking to you in asking for help. If that person has made that painful journey, give it the respect it deserves, so make sure you listen and understand the achievement this person has made in opening up. How they are listened to and treated at this stage is vital in their journey to get the help and support they need.
- Offer consistent support. This part is crucial. If every journey a mental health sufferer makes ends with the same consistent non-judgemental, kind and understanding interaction then the next time they make it, it might be that bit easier. This is how we change the culture of encouraging people to talk about their mental health.