What to do and what to say when someone is struggling with their mental health

It is the most natural thing in the world. When someone isn’t well or isn’t happy, we want to make them feel better. We want to cheer them up. We want to find the right words. We want to take away their pain. We want to fix the problem. 

This is especially true when it comes to mental health. To see someone looking sad is hard to endure. It hurts us just to witness it. It pains us.

But with mental heath, it’s not about an extra pillow; some tissues; a hot drink or water bottle; or some medicine, as welcome and kind as these things can be. It’s about the pain of difficult feelings for which there is no easy solution or quick fix. It is deeper and more intangible. It is a distress that cannot be taken away easily. 

I am asked all the time how to support those who are struggling with their mental health: what to say and what to do. I am asked how best to have a conversation with someone who is feeling down, depressed and/or anxious. I am asked for the manual or guidebook of how to handle each situation. 

The uncomfortable truth is that often saying and doing nothing - or not very much - is sometimes the best answer. Sometimes less is more. Sometimes it’s not what you say or do, but what you don’t say or do that matters the most. 

What most people need when they are struggling - and I include myself in that when things are tough, which they are currently and have been for two weeks now (a longer than normal dip in mood for me) - is space and peace. We need to be seen and heard. We need to feel accepted. We need to feel that we are not being judged. We need to feel that we are not adding to someone else’s worries or stresses. We need to feel like whatever we need is fine. We don’t want to be fussed but we also don’t want to be ignored.

That means listening, not speaking. It means not asking too many questions. Ideally, it means not asking any questions. It means actually helping not just offering a generic offer of help. It means putting the other person first and therefore sometimes being comfortable sitting with our own discomfort at not being able to help, or fix, or solve, or cure, or soothe, or make better.  It means just being alongside the person who is struggling for what ever they need.

In practical terms what am I suggesting?

Avoid “are you ok?”. They are not ok. You know they are not ok so asking them just puts them on the spot and will often prompt an avoidant answer: “I’m fine” or “I’m just tired” or something similar.

Avoid “why do you think you feel sad/down etc”? This can be tricky to answer or just be something the person doesn’t want to talk about. Maybe you are part of the reason they feel like that - directly or indirectly. Maybe the person doesn’t know. Maybe they will tell you, maybe not. Let them decide. Whatever is happening, answering questions like it’s an exam - well-meaning questions or not - is unlikely to be helpful.

Avoid trying to offer equivalence: “I know how you feel……..this thing happened to me” or “one of my colleagues at work/neighbours etc has depression”. These are classic “trying to find the right thing to say” things that rarely, if ever, are helpful.

Avoid pestering. No need to text every five minutes.

Avoid ignoring. No need to avoid the person because you don’t know what to say or because it’s awkward. It’s more awkard for the person struggling. Giving them space isn’t about cutting off contact. There are ways of reaching out, whilst giving space (see below).

Avoid cliches. “It will pass”. “It will get better” etc. These are well-meaning and may be accurate but in the moment, what people need isn’t a focus on the future and how it will change but on how they are feeling right now.

Avoid questions full stop - if you can. There is only one exception. If you think, fear or even partly suspect, the person may be suicidal. If so, just ask. No euphemisms, not code words about “dark places” or cagey language. Ask outright: “have you thought about killing yourself?”. Wait and listen for the answer. If they say yes, ask them do they still feel like that. If yes, ask them if it’s ok to reach out for help from a professional - through the NHS, Samaritans or others. Being direct when it comes to suicide risk is critical. This is one area where questions - offered with kindness and openness - are essential.

As well as avoiding stuff, there are things you can actively try to say or do.

You could try" “I can see things are rough for you, I am here to listen if you want to talk”. Then hang around. Sit in silence - for ages - if that feels required. Don’t expect immediate talking or a response. You might not get one if you wait for 100 years but you might get one if you wait for a few minutes.

You could try to show you have noticed and that you care: “I am so sorry you are having a difficult time”. “That looks really shit for you”.

It is often helpful to tell the person how you feel about them: “I love you, I care about you etc”. When we feel very low it can feel like a world without love and care - a reminder that someone does care can make a big difference.

If we want to help, just help. Don’t say: “Let me know if I can do anything” or “you know where I am if you need me”. Just do something. Send a card. Make some food and take it around. Bake a cake. Send a gift. Clean their house. Walk their dog. Rake up their leaves. Buy them a magazine or a book. Send them a picture of a memory of you together. Whatever we think can help lift the load or show them we care could make a difference.

Asking someone who is struggling to ask for help or specify what they need is unlikely to get a positive response. We are already likely to be feeling bad about ourselves - saying we need someone’s help and adding to their load is unlikely to make us feel better. It is likely to make us feel more guilty, worse about ourselves and lower in mood. If you want to help, just help.

You can try checking in with a message but include the phrase “there’s no need to reply” and that “I am just telling you that I love you/I am thinking about you/I care about you etc”. Checking in is important to show you care - but making it clear that a non-response is fine is important. The exception is if we are concerned for their safety - then we can say: “No need for a big reply - just want to know you are safe - any reply is fine - I want to give you space but want you to know I care”. Be explicit. Don’t expect them to mind-read. Say what you mean, plainly and simply.

Don’t ever, ever take offence if you efforts are rebuffed, ignored or not appreciated (at least explicitly). You are doing it for the other person, not for you. They are the one struggling. Whatever they need is fine - even if that is to be grumpy or to tell you to “fuck off”. Be accepting. Be non-judgmental. Remember you are not the one struggling. You can’t imagine their pain. Just accept they are in pain.

Ultimately, there is no manual or guidebook - despite my best efforts here. Our attempts at finding the “right thing to say” fails because there is no right thing to say or to do. There is only a right way to be.

That way is to be present. To listen. To wait. To be curious and open not questioning. To respond not react. To not make it about you. To want to help by actually helping. To let them know that you care about them. To show in your actions that you care. When someone is struggling - and I know this from first hand experience - the people that help us the most - the way my wife helps me - is by showing us that they care about and accept us. That our struggles don’t change how they feel about us - not telling us how worried they are about us - but instead how much they love us.

Clients tell me their stories and experiences every day (the examples I have used above) and I live with these stories and experiences in my own life. People mean well but sometimes they do harm. I don’t blame them for it but I do wish they wouldn’t make things worse. I wish they would do better.

I hope these suggestions help.

The people that help us do so because they meet us where we are at, with no expectations, no pressure and no questions of us. They just sit alongside us. Sit and wait. For us. For whatever we need.