How to Communicate When Someone is Struggling With Their Mental Health

When a loved one shows signs of anxiety or depression, it’s not easy to know how best to help. What’s the right way to express concern? What can you say to support them without overwhelming them?

According to Dr. Zachary K. Blumkin, a psychologist at NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian Morgan Stanley Children’s Hospital, a helpful way to start is by actively listening. “When we care about someone and we notice they’re struggling, an urge for many people is to immediately tell them ‘It’ll be OK’ or try to help them solve whatever problem they’re experiencing,” says Dr. Blumkin. “Unfortunately, this often leaves the individual feeling misunderstood, alone, and sometimes even worse.” Instead, focus on listening without judgment.

Dr. Courtney DeAngelis, a psychologist at NewYork-Presbyterian/Columbia University Irving Medical Center and Columbia University Clinic for Anxiety and Related Disorders-Westchester, suggests utilizing validating language, such as “That must have been such a stressful experience” or “I’m so sorry you went through that.”

For more insights, Health Matters spoke with both Dr. Blumkin and Dr. DeAngelis about how to communicate more effectively with loved ones who are struggling with their mental health — and how best to support them through difficult times.

Remember that anxiety and depression can manifest in a wide range of ways. Some people can mask their worries; others may display more obvious signs, like changes in hygiene or avoidance of social activities. If you notice signs in a loved one, it can be tough knowing how to address the situation. But using words like “I’ve noticed” to begin a conversation about what you’ve observed can be a helpful tool, suggests Dr. DeAngelis.

Ask open-ended questions about how they’re feeling. “A constructive way to broach the topic is to take a gentle, curious tone and try something like ‘I’ve noticed you haven’t been acting like yourself.’ Or ‘I’ve noticed that we haven’t gotten together in a while. Is everything OK?’” says Dr. DeAngelis.

Don’t focus on any negative behaviors, such as listing the times they’ve missed plans. “If you start off by laying out evidence like an attorney investigating a case, they’ll probably feel uncomfortable and defensive,” Dr. DeAngelis says.

Once you’ve started the conversation, remain engaged. “Show you have been listening by communicating back what you have heard,” says Dr. Blumkin, who is also the senior clinical director of the psychiatry faculty practice organization at Columbia Doctors. “You can try repeating people’s last few words back to them or offer nonverbal cues that you’re listening. Try not to rehearse your response while the other person is talking and monitor your own emotions in the conversation.”

When someone opens up about their depression or anxiety, try not to downplay their emotions. Even though it might be your instinct, don’t rush to tell them everything will be fine and bombard them with solutions. Instead, be genuine, nonjudgmental, and validating, advises Dr. Blumkin. To validate someone, Dr. Blumkin explains, is to communicate that you understand them and that their response makes sense within their personal situation. “It doesn’t mean you agree with their thoughts or think their behaviors are effective,” he says. “It just means you get it.”

“Try to sit in the negative emotions, as these conversations can take time and will sometimes be uncomfortable,” says Dr. Blumkin. You may have to work at tolerating the difficult feelings.

And remember that happiness is not a switch that can be turned on and off at will. “Telling another person ‘Happiness is a choice’ can be discouraging,” says Dr. DeAngelis. It can make people feel ashamed, defective, or weak. “Nobody chooses to struggle with their mental health,” Dr. DeAngelis says.

It’s important to show consistent support to someone struggling with anxiety or depression, even if they pull away or don’t answer your texts or calls. While it’s easy to take this behavior personally, try to have patience and continue to validate their experiences.

“We can’t force others to act in a certain way,” says Dr. DeAngelis. “We can only guide, support, and encourage them.”

If you’re close to the person, you can encourage them to reach out for mental health services. But make sure to initiate the conversation when the person is in a calm state; be specific about your concerns; and offer help with finding the right therapist, program, and level of care, says Dr. Blumkin. He also stresses the importance of normalizing getting help.

“If your teeth hurt, you’d see a dentist. If you broke your arm, you’d see a doctor. The same is true for anxiety and depression,” he says. “If someone is talking about death or dying, feeling hopeless, having no reason to live, being a burden to others, feeling trapped, or encountering unbearable pain, it is imperative you support that individual in finding professional support.”

If you’re worried someone might be thinking about suicide, it’s best to address those concerns directly. It’s a myth that discussing suicide will cause a person to make an attempt, Dr. DeAngelis says. In fact, research shows that talking about suicide increases the likelihood that someone will seek help.

“Asking if someone is thinking about suicide, death, or dying will not ‘implant’ this idea,” says Dr. Blumkin. “Talk to the person in private and listen to them. Express that you care about them and ask directly if they are thinking about suicide.”

Avoid debating the value of life, minimizing the issue, or trying to “fix” the situation. “Remind them that their suffering is temporary, call 911 or 988, and check on them after the crisis has ended,” says Dr. Blumkin.

While supporting someone who is struggling with their mental health, it’s important to protect your own. Dr. Blumkin says the best way to do this is to get enough sleep, exercise, and make time for activities that bring you joy. Connect with family and friends and talk to your own therapist.

“At the end of the day, the responsibility is not all on your shoulders, and you’re allowed to set personal boundaries,” says Dr. DeAngelis.