Starting conversations about mental health concerns with family and friends is an important step in helping them.
Ever so often, when a patient comes to a specialist psychiatry clinic, it may already have been some time that the symptoms have been present and that the patient had been in the doldrums of mental health difficulties for quite a while.
This is replicated in our local research; the Singapore Mental Health Study in 2016 noted that there remain significant treatment delays for many mental health conditions. For example, the time of symptom development to seeking formal help ranges widely from a one year gap for major depressive disorder to as long as 11 years for obsessive compulsive disorder.
When one is inflicted by mental illness, it is often the case that their judgement may be clouded or significantly affected by despair, negativity and doubt. There could be real concerns of being stigmatised when seeking formal help, or just a denial that what they are facing is indeed within the remit of mental illness. After all, there is no objective blood or rapid test kits today that could definitively separate the line whether one has a mental illness or otherwise.
Among other things, it takes a good clinical assessment to identify that one’s mental well-being is affected so greatly to the degree that his capacity to function at work, socially interact with others or self-care has declined.
What that means then is that it takes a keen eye from the people around them to be able to take notice the oddities of their behaviour early. They would know him well, have interacted with him on a daily basis and can tell when he is “off” his usual baseline jovial self. These people are often family members, a close network of friends or colleagues at the office.
However, this awareness and attentiveness of others does not have to be proportionate to how long we see each other throughout the day. It could be that the person is a mere acquaintance – the “uncle” at the usual hawker stall we buy our kway teow from, or the neighbour upstairs with whom we exchange regular greetings and pleasantries with in the lift every morning – who happens to notice a shift in mannerisms or mood, or vice versa.
How then do we broach this topic sensitively? Would the person see it as an affront to them if we asked directly whether they are facing some form of “mental problem”, and could it just send them further into a spiral of negativity, stigma and isolation?
First, while we may have our suspicions that someone is not well, it is important that we come from a position of seeking to understand the person first.
Casting judgement early and only on account of mere suspicion may only drive a wedge in the relationship and strain it further, rather than convey closeness. Even though you may have had experience of other friends with similar symptoms and may be quick to “diagnose”, it is important to know that permutations and overlap of mental illness symptoms are numerous, and how they present in each individual will be unique.
Approaching it with active listening, being empathetic to their difficulties, being respectful of their space and needs, and relaying your genuine thoughts from a position of concern will inevitably unearth some of the struggles of the person you care about. This then forms a starting point to discuss further options to get help.
Second, it is important to let them take the lead as much as possible, and for other supporting persons to pace alongside and help pave the path towards recovery. For example, you may feel strongly that the individual may require a specialist consultation at the onset, but he is only comfortable seeing a counsellor for now.
Instead of expressing disdain, you could facilitate the process for him to seek help that he prefers. As long as he maintains on a road to recovery, this remains a positive step that should be supported.
Studies show that when a person maintains agency, insight, and feels invested and supported in the recovery process, they are more likely to be compliant to treatment over the longer term, with better prospect of recovery and remission.
Third, if you already notice that someone is indeed struggling, but are not comfortable to ask, an indirect way is to normalise talk about seeking help and services that are available in the community.
For example, if you’ve read an article on mental health in the local news and find it useful to share to a colleague who appears to be struggling, it may be a good starting point for discussion.
As a result of that initial conversation about mental wellness, he may find it easier to talk about his emotions or better still, seek help on account of it.
There are plenty of ready articles, websites or YouTube videos about how one can cope with stress and relaxation techniques, news coverage about mental health initiatives for elderly, students or working adults, and media coverage of national campaigns de-stigmatising mental health.
These may not necessarily cure the mental illness per se, but sets a comfortable stage and gets your foot through the door, in terms of broaching the topic of mental well-being.
Of the three broad approaches, I must add the caveat that these are limited to situations where one only has mere suspicions about a possible mental illness, and that there is no overt evidence of incapacitation due to mental illness, nor acts of self-harm or harm to others.
In such a context where clearly there is clear neglect of personal care, and exhibition of risky and dangerous behaviours, one’s care of the individual must be expressed by resolute firmness to seek treatment, quickly calling attention to his struggles and rallying support for the individual before things get worse.
In summary, broaching the topic of mental well-being with our loved ones can be a delicate issue. It is not always the case that a struggling individual will realise immediately that he needs help.
In this regard, the people around him may be the first to notice the change his ways. A strong, supportive network and circle of trust with people around is protective for one’s mental well-being.
The issue could be approached directly in a non-judgemental way, conveying respect, care and concern. It is important to allow the individuals themselves to take the lead, and maintain their autonomy and dignity during the recovery process. Indirectly, they could be socialised with articles or material on mental health as general topic of discussion and common interest, without making them feel accosted or pressured about their own struggles.
Lastly, if someone is already exhibiting self-neglect, significant risk or harmful behaviours, it is important that specialist help is rendered urgently rather than to wait.
Dr Syed Harun is a council member of the National Youth Council and a Consultant Psychiatrist.
Where to get help:
– Samaritans of Singapore (24 hours): 1767
– Institute of Mental Health (24 hours): 6389 2222
– Singapore Association for Mental Health (Adults): 1800 283 7019 (Mon to Fri, 9am to 6pm)
– TOUCHline (Youth): 1800 377 2252 (Mon to Fri, 9am to 6pm)
– Care Corner (Mandarin hotline): 1800 3535 800 (Daily, 10am to 10pm)
For more mental well-being resources, check out Youthopia’s resource page with everything from mental health self-assessments to tips for coping with challenging seasons in life.
Other articles in this Mind Matters series:
Five signs that someone you know may not be coping well with stress
Five ways to better manage stress while alternating between working from home and the office
Mind Matters: Five tips to manage exam stress during the COVID-19 pandemic
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