How to Talk to a Loved One About Getting Psychiatric Help

Many times, conversations concerning someone's potential for receiving a mental health intervention can be emotionally charged. While determining the "right" way to talk about this issue is just one part of this problem, the overall challenge is how to balance several factors such as affection for the individual, respect for their independence and autonomy, fears regarding the stigma associated with mental illness and/or seeking mental health services, and ultimately, a sense of responsibility to assist the individual in potentially receiving the level of care needed to address their current issues.

While it is true that many individuals close to someone experiencing significant behavioral/mood/thought/functional changes may be aware of some type of a problem prior to the individual acknowledging that they/they needs help, it is equally true that having a legitimate concern (no matter how sincere) does not automatically grant the individual who is concerned with regard to an individual's treatment.

Therefore, when approaching the topic of a loved one receiving mental health service(s), the individual concerned must provide more than simply a persuasive rationale for the individual in question to seek professional assistance. The individual concerned must demonstrate compassion, restraint, awareness of their own behaviors/interactions with regard to the individual in question and an understanding that mental health interventions are most successful when the individual being treated receives treatment that includes a high degree of respect.

The goal of a discussion of this nature is not to convince someone that they are mentally ill. Rather, the goal is to develop a dialogue in which the individual in question is comfortable enough with discussing their potential for needing professional assistance.

Start with your worry, not judgment.

In most cases, the initial impression created by the manner in which an issue is presented determines the direction of the conversation. If the presentation initially appears accusatory, the individual may become resistant to exploring options to resolve the situation before they can express their point of view.

Examples of presentations that could convey concern but may also present judgment include: "you need psychiatric help," or "something is seriously wrong with you." These types of statements present a conclusion. A better way to present concern would be to focus on what was observed and explain why it creates concern. Using more "i" language helps to avoid a confrontational atmosphere. For example, instead of using "you're causing worry for everyone," use "i am worried about you." This difference may seem minor, but it can greatly influence whether the individual presents themself as being assisted or evaluated.

Choose your setting wisely.

An important consideration with regard to initiating a sensitive conversation is selecting a suitable location. Choose a private area where interruptions are unlikely. Do not bring up the subject while in the midst of an argument; immediately after a disagreement; or when either party involved in the conversation is intoxicated; fatigued; or extremely agitated.

Timing is also very important since symptoms of psychological conditions can negatively impact an individual's ability to concentrate; regulate emotions; and comprehend information. Therefore, a conversation that could be productive in a calm state may be overwhelming to an individual experiencing severe psychological distress.

However, timing becomes secondary to safety. In situations where there exists an imminent danger of suicide/self-injury/violence or an individual is unable to remain safely oriented/cared for, waiting for an optimal time for a conversation is inappropriate. In such situations, safety must take priority over sensitivity and emergency/professional assistance may be warranted.

Describe behavioral patterns, not diagnoses.

Family members and friends frequently identify multiple symptoms exhibited by a person and then formulate a diagnosis based upon those symptoms. A person whose sleep pattern has altered may appear to exhibit mania; a person whose social withdrawal has increased may appear to have depression; a person expressing unique belief systems may appear psychotic. Such observations can be valuable; however, establishing a diagnosis without formal evaluation can lead to additional controversy and may result in misdiagnosis.

As opposed to stating, "i believe you have bipolar disorder," consider stating:

"i've recognized that your sleep, energy levels, and behavior have been substantially different recently; i'd like to explore possibilities for speaking with a mental health provider to determine if we can find ways to understand what has occurred."

Specificity is helpful. Instead of stating that someone has "changed"; reference specific behavioral patterns such as lack of adequate sleep; lack of enthusiasm for previously enjoyed hobbies; excessive agitation; extreme withdrawal from social contact; inability to function appropriately at work/school; substantial increases/decreases in food intake/appetite; appearing extremely restless.

It is essential to realize that these references are intended to clarify concerns rather than establish guilt.

Listen before you try to persuade.

The greatest mistake made in conversation after hearing of a serious mental health condition is saying too much.

Often times, family members bring many lists of symptoms, treatments, articles, and reasons to believe that the mentally ill individual needs to see a psychiatrist. However, if the individual believes that they is being given all of this information so that they can agree with the family's conclusions regarding their need for a psychiatrist, then the individual may shut down.

Thus, instead of telling the person what to do, ask themself questions and listen.

"What has the last couple of months been like for you?"

"Have you noticed that anything has gotten worse over the last month or two? Is there something that is bothering you that you haven't wanted to talk about? What do you think could help? What concerns you the most about visiting a psychiatrist?

Asking those types of questions accomplishes two things: (1) It provides a way to gather information about how the individual has been feeling and what they thinks might be helpful. (2) Those questions demonstrate respect.

It is possible to listen without agreeing. When listening to someone, you can recognize/acknowledge that the person has experienced emotions without agreeing with some of the conclusions they may draw based on those experiences. For example, responding to someone's statement of fear with "I can understand why that would frighten you," acknowledges their fear but doesn't validate everything that they may conclude about that fear.

To put it another way, listen first. Don't assume that your conclusions about the person's problem are better than theirs. Give the person space to tell you how they're doing and what they've thought about their problems.

When someone resists getting psychiatric help, it does not necessarily mean that the person is irrational, uncooperative, or resistant to improving themselves. The resistance is frequently due to valid concerns.

Many individuals believe that receiving psychiatric treatment is stigmatizing or demonstrates personal weakness. Some individuals worry about the potential side effects of medications, the possibility that they will alter their personalities, dependency upon prescribed medications, previous negative experiences with health care providers, loss of independence, monetary costs associated with treatment, or that once they begin treatment, they will be viewed as less competent than others.

Family and cultural attitudes towards mental illness may also affect an individual's decision-making process related to seeking mental health services.

Before assuming what someone's objections to psychiatric treatment are, ask about them.

"Of course, I want to know. What scares you the most about meeting with a psychiatrist?"

If the apparent objection is really a fear of judgment, being medicated/hospitalized, losing independence etc., you will now be able to deal directly with those issues rather than dealing with a caricature of their objections.

Preserving Autonomy While Allowing for Necessary Interventions

An important ethical consideration when assisting someone suffering from a mental health issues is preserving their autonomy. A person who is above 18 years of age and undergoing mental health issues does not automatically forfeit their rights to make decisions concerning their own medical care.

Therefore, support (or encouragement), often leads to better results than forceful persuasion.

For example: Instead of stating:

"You'll see a psychiatrist whether you want to or not."

Try:

"Will you at least go see a Mental health professional for one appointment to discuss what you've been going through?"

Or:

"Are you more likely to start by seeing your primary physician or a therapist?"

Providing options allows for an individual who feels impotent to regain control. People who are fearful of being forced into some sort of involuntary treatment or other form of treatment may refuse to accept treatment simply because it represents giving up autonomy.

This principle takes precedence over concerns for preserving autonomy when there is an imminent danger to the individual or others. In emergency situations where there is a serious risk to either life or physical harm, professional assistance may be required despite the wishes of the individual.

Deciding whether to implement involuntary treatment (emergency evaluation, hospitalization), is a complex task requiring adherence to local laws and clinical guidelines and should never be determined by family members without consulting a qualified mental health professional.

Make the First Step Manageable

Sometimes "get psychiatric help" seems too much for someone who is already feeling overwhelmed. Breaking down the steps to the process of getting help could make it seem less daunting.

You may be able to assist the individual with researching potential providers, setting up an appointment, driving them to the initial consultation, assisting with preparation of questions to ask the provider, etc.

A particular helpful distinction is that of obtaining an evaluation vs. committing to a specific treatment. The purpose of the first psychiatric appointment is to describe the events occurring and to get some professional advice. The person does not necessarily have to plan out the whole course of their treatment at this point.

Practical support can address many issues which are not emotional. An individual with depression, severe anxiety or other psychiatric disorders may experience significant difficulty finding time to schedule appointments, make phone calls, complete paperwork, travel to a provider's office, etc.

Assisting with the practical barriers that exist may turn an unworkable suggestion into one that is possible.

Do Not Use Shame as a Motivation for Mental Health Treatment

Shame rarely motivates individuals to participate in mental health treatment.

Statements that use shame (e.g., "you're embarrassing the family", "you've got to quit doing things this way," "people will think you're nuts") typically increase those emotions that discourage individuals from pursuing treatment.

Psychiatric difficulties should not be seen as moral failures. A person can be having a tremendous amount of trouble while still being smart, responsible, loving, capable and deserving of respect.

It would be better to tell the individual that they deserves support with this issue and that it is a resource available to themself rather than a punishment. ("You deserve support with this" is vastly different than "You're a problem and we need to fix you.")

The difference in how this is communicated protects the individual's dignity while still indicating how serious your concern is.

Know the Difference Between Being Supportive & Doing a Crisis Intervention

Many discussions regarding psychiatric services occur when there is enough time to talk through various options and allow the individual to make their own decision. However, there are times when a situation requires immediate intervention.

There are several warning signs that indicate an individual requires immediate attention including:

• Expressions of suicide or self-harm

• Any recent attempts at self-harm

• Credible threats toward others

• Significant confusion

• Extreme behavioral disorganization

• Inability to meet basic needs

• Loss of contact with reality.

If an individual states that they intends to kill themselves or harm themselves, consider taking this statement seriously. Do not rely on vague statements of reassurance; instead, ask directly about their immediate safety. If there is a threat of physical harm to oneself or others, immediately call for emergency assistance and do not attempt to handle the crisis by yourself.

Never expect to perform safety planning and place yourself in jeopardy. If the individual becomes violent, extremely upset or is in any way unsafe, establish a safe distance and call for professional assistance; do not try to physically intervene.

Be Prepared For Ambivalence

Seeking mental health treatment is almost always a complex issue of whether or not an individual accepts or rejects help. There are often instances where an individual acknowledges that something is amiss but fears the treatment itself. They may consent to an appointment and then refuse to attend. They may consent to therapy but reject medication. They may seek help months after hesitating.

Ambivalence is not necessarily a sign of failure.

If the individual refuses help, do not continually challenge themself each time you interact about seeking help. Leave the door open:

"I respect that you are not ready right now; I remain concerned about you and will continue to support you."

This message shows you have continued interest and desire to see themself succeed yet does not turn the relationship into a persistent effort to convince themself to receive treatment.

Maintaining the Relationship

Maintaining relationships can also contribute to a sense of balance and stability. As a person struggles with mental health issues, conversations with family members and friends can easily turn into interrogations regarding medications, medical appointments and symptoms. A struggle to help can often result in a person avoiding those who are most trying to assist.

Engage with your loved ones as people. Discuss everyday topics. Engage with them socially (when possible). Discuss their interests. Eat meals together. Go watch a movie. Go for a walk. Show them through common social interactions that they are valuable beyond their mental illness.

A mental illness can consume an individual's entire life and especially their families; however, this should not require a family member to "perform" wellness in order for them to maintain a connection.

Setting Healthy Boundaries

While showing compassion is always important, it is equally as important to recognize that compassion does not translate to unlimited responsibility.

Sometimes family members become so focused on supporting their loved one that they forget about their own well-being, both emotionally and physically. When individuals find themselves in a position where they feel they are sacrificing their own needs for others, feelings of resentment and burn out develop. Neither of these options creates a positive environment for the family member receiving support.

Healthy boundaries need to be established and communicated in regards to money, living arrangements, communication, substance use, aggression and other behaviors. These boundaries should be communicated in a clear manner and consistently enforced.

Example:

"I want to support you but I am unable to continue our conversation once I'm being threatened. In that case, I'll leave until we're able to discuss things when we've had some calm."

Healthy boundaries are not punitive measures. Establishing healthy boundaries is simply establishing what type of support you can realistically offer while maintaining safety and dignity for yourself and your loved one(s).

End of Discussion

Ultimately talking to a loved one about seeking professional help for their psychiatric issues is finding a way to strike the perfect balance of compassion vs. respect for their autonomy. The most effective approach is usually inviting someone to explore the possibility of seeking professional help because doing so would likely improve their ability to manage their life.

Start with observations of changes in behavior instead of using labels such as diagnoses. Use concerns about your love one's well-being, rather than frustrations you may be experiencing. Be mindful of your loved one's fears and objections. Avoid causing your loved one to feel ashamed or threaten them unless you believe there is an immediate threat to their safety. Provide specific ways to assist them while allowing them to still make decisions on their own. Be patient if the first conversation does not produce the results you were hoping for.

Lastly, keep in mind that the goal of having this discussion is not to create a label based on your loved one's diagnosis. The goal is to let your loved one know that seeking help does not indicate weakness; that requiring professional assistance indicates strength; and that they/they do not have to endure significant psychological distress alone.