What To Say When Someone Is Struggling With Mental Illness

Recently I wrote the following essay: I Work In Suicide Prevention, And This Is What I Want Everyone To Know. The main take-away was: Check-in with your friends and loved ones, always, and ask the hard questions. Are you thinking about hurting yourself? Are you considering suicide as an option? There was a lot of conversation around this piece, which is wonderful, because we need to talk about mental health, and we need to keep talking about mental health.

Most people wanted to know more about starting those conversations, and how to respond when someone tells you they are struggling. What do you say? How can you help them? So, let’s start there. How do you start those hard conversations and how should you respond when someone opens up to you about their mental health?

I want to be up front about one thing, there is no script for this, every person and situation is different, but that’s where you come in. These are your friends and loved ones—you know them best, so talk to them like you always do. Start the conversation with things that are comfortable for each of you—simple questions like:

“How are you?”

“How is work?”

“How is your relationship?”

“How are the kids?”

You know what is important to them, so ask about it. The simple questions will get the ball rolling and open the door for more complex questions. Ask how they are sleeping, eating, and spending their free time. What do you notice? Are they still doing things they enjoy? Are they withdrawing or isolating themselves in any way? Are they quieter than normal? Are they indifferent? Are they angry?

If you notice something is off, but they seem guarded, you can say:

“I just wanted to check-in, because you used to [love coming to the park with me], but you haven’t seemed interested lately. Is everything OK?”

“I’m worried about you.”

“You seem down, do you want to talk about it?”

Don’t drop subtle hints or dance around the topic; if you love someone and you are worried about them, tell them. Tell them what you notice about them or their behavior that is concerning to you. Sometimes when people are in a dark place, whether it be depression, PTSD, anxiety, or anything else, it can feel like no one cares. Let them know you see them struggling, that you care, and are there to support them however you can.

Sometimes support is listening and validating their feelings. Validating their feelings, whether or not you understand them, is so important. It’s not always easy to know what to say when someone shares their darkest moments or struggles with mental illness, but here are a few examples:

“That must be hard for you.”

“I’m so sorry you’re going through this.”

“It sounds like you’re really struggling.”

“I hear you.”

“I’m here for you.”

Compassion. Empathy. Acceptance. Support. These words should guide your response.

And remember, support can look different for everyone. Sometimes being their safe person is all they need—a sounding board to listen without judgment. Someone they can trust no matter what, someone who won’t judge them, but will be there unconditionally, day or night. Let them know they can call you at 3 a.m., and you will be there. Sometimes support means attending a doctor’s appointment with them, spending an evening together so they aren’t alone, or holding their hand as they call the crisis line.

Don’t be afraid to ask how you can best support your loved one. They may not know, so offer what you can to help them. And if someone tells you they’re having thoughts of suicide, encourage them to reach out to a professional, or reach out for them—they may not be able to do it on their own. Help them call the National Crisis Line or their mental health provider. You can make these calls on their behalf if needed. If the situation is emergent, take them to the emergency room or call 911.

Bottom line: let your friends know you care about them as often as you can. Reach out to them; don’t wait for them to come to you. This goes for all of your friends and loved ones, not just those you suspect are struggling.

Sometimes those carrying the greatest burdens are the best actors. Send them a text message just to say good morning, or that you want them to know you’re thinking about them. Be a safe person for those you love and make sure they know it. Make it a habit to check-in with your friends, always, not just after a tragedy. Have those tough conversations when you need to, and be an advocate for everyone with mental illness by talking openly about mental health, every chance you get.

I know it’s difficult, but honestly, if they are someone you care about just talk to them like a friend. The hard questions about suicide are the ones we don’t think to ask or are too afraid to ask, but they can make all the difference in the world. Try not to overthink it, just be there.

If you or someone you know is struggling with thoughts of suicide, there is help available. Call the National Crisis Line, day or night. 1-800-273-8255.