20 things not to say to someone with a mental illness

Mental illness is hard enough to handle on its own. Having other people make insensitive comments just make it even worse. It is, however, important to acknowledge that these remarks are generally not meant to be hurtful. They often reflect a lack of understanding mixed with a desire to seem helpful or comforting. Still, words can hurt. Here are 20 things to avoid saying when speaking with someone about their mental illness (and what I’m thinking when you say it).

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“Just snap out of it.” If I could, I would.

“Stop feeling sorry for yourself.” Mental illness is a legitimate problem and it’s okay to have feelings about it.

“I promise it will be okay.” You have no way of knowing that.

“Why are you like that?” That’s for me and my therapist to figure out.

“Can’t you just try to be different?” I’m pretty sure I have.

“Yeah, my brother has depression, too.” Everyone experiences mental illness differently, so I don’t want to be compared to someone else.

“That’s weird.” I know. I don’t need to hear you saying it, though.

“You’ve been doing it long enough now. Stop.” There would be no need for therapy if we could go in and out of mental illness at will.

“There are others who have it worse.” I know, but suffering is not a contest.

“At least it’s only depression/anxiety.” Even the most common mental illnesses can be extremely difficult to handle.

“That’s just how you are.” Mental illness is not a character flaw.

“You brought this on yourself.” Even if I did contribute to the problem, I did not ask for this. 

“I know how you feel.” No, you don’t, and I’m offended that you think you do.

“Things will change soon.” Timing is always a big question mark with mental illness.

“It’s all in your head.” That’s why it’s called mental illness. But it affects physical health, too.

“Do something to distract yourself.” This is not nervous anticipation. It won’t just get better if I wait.

“Don’t be so negative.” I am entitled to my feelings. Besides, I’m pretty sure you would be “negative,” too, if you were in my shoes.

“It could be worse.” Yes, it could, but that doesn’t mean this isn’t difficult.

“But you have so many things to make you happy.” That doesn’t change that I’m also struggling.

“You don’t seem to have a mental illness.” Mental illness is not always apparent on the outside.

Sassy remarks aside, feel free to share this post with someone who might need a little perspective. For things you can do that are actually helpful, read this post.

What have people said to you about mental illness that you have found hurtful? How do you respond? Tell us in the comments.

5 ways to support a loved one in inpatient treatment

Sometimes, mental illness or substance abuse requires more intensive treatment than can be provided on an outpatient basis. Situations like being suicidal, the inability to get substance abuse under control, going through a medication change or an eating disorder becoming life-threatening call for inpatient treatment. The amount of time someone is gone varies, too – rehab can take months while most stays at the psychiatric ward of a local hospital are only a few days. The uncertainty of how long it will take can make the situation even more distressing.

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While this is a lot to deal with for the patient, it also leaves loved ones not knowing what they can do. Visiting hours are often very restricted and you might not even know if your loved one wants you to come. Besides, these programs are sometimes pretty involved, with individual counseling, doctor’s visits, group therapy, psychoeducational classes and more. You want to help; it’s just hard to know what to do.

In these times, grand actions are not very viable. It’s the simple shows of support that end up being meaningful. Following is a list of suggestions for showing that you care. Keep in mind, however, that the rules and policies of each treatment center varies. If you are uncertain of whether a specific item is permitted, call the unit your loved one is staying at and ask a staff member. 

1. Let him know you are there for him… 

An in-patient stay cuts someone away from the world, leaving most of society’s currently used methods of communication off limits. She likely won’t have access to her cell phone or the Internet. This brings up the question of the best way to show support. Even if your relationship is close, he might not be ready to accept you reaching out. A card or a letter is a non-threatening way to show support that allows her to decide if she wants to give you a call or invite you over to visit. Include your phone number, as he might not have it memorized.

2. …but respect her privacy. 

Because it is closed off, knowledge of what goes on within the program can seem mysterious to outsiders. Your curiosity might naturally be piqued, however. But unless you are the parent of a minor, you most likely don’t have a right to know what is going on. You have to trust that the treatment team has the situation under control and will make good decisions. If your loved one wants to talk about his treatment, he will. Be nonjudgmental and a good listener. Avoid giving advice at this time. Besides, after a long day of processing issues and psychoeducational material, hearing about the latest game or celebrity gossip might actually be relaxing. 

3. Pictures 

Due to risks of patients harming themselves or others, there are a lot of restricted items in the inpatient setting. Pieces of paper, however, are generally considered benign, so bring pictures. Don’t just stick with family portraits. Go to your loved one’s Facebook page and print out a few of her having fun with her friends or on a vacation. A picture of a beloved pet can also be appreciated. If your loved one has a strong attachment to a particular location, a photograph of a place that soothes her can also be calming. If permitted, bring Blu-Tack so he can hang them up. Frames will not be allowed, at least not with the glass in.

4. Entertainment 

Despite intensive treatment, there is downtime. If left with the facility’s resources, however, your loved one might spend a lot of time coloring pictures with crayons or playing checkers. While often highly regulated, entertainment is appreciated. Some books and magazines are restricted based on the content, but you probably won’t know until you get there, as it is very arbitrary. Less frequently, a center might allow an iPod or MP3 player. They may, however, require a small speaker, as headphones can be a safety risk. With this, it’s especially important to talk to the staff before you bring something over.

5. Something from home

It is normal to get homesick when in an inpatient setting, seeing as one is pulled away from all the comforts one is used to. Bringing something meaningful from home can ease some of that feeling. Take over a favorite stuffed animal, pillow or blanket. A small, unbreakable trinket with personal significance can be a lovely connection to home. Avoid brining valuable or irreplaceable items. Not all inpatient stays are planned, so a fresh change of clothes can be much appreciated. If you are allowed to bring food or treats, a comfort food can also mean a lot. A connection to life outside the treatment center can serve as a lifeline when treatment is at its toughest.

Have you spent time in an inpatient unit? What shows of support did you find helpful? Add to the list in the comments.

Make a 5-step safety plan right now

In the midst of a crisis, it’s hard to think clearly and make good decisions. That’s why it’s important to know ahead of times what to do when the going gets tough. A safety plan gives you a template for action when you are feeling suicidal, tempted to self-harm, drawn into addictions, engaging in unhealthy behaviors or feeling self-destructive. 

Having a written safety plan can be a huge help when you’re symptomatic, so let’s make one. One way of doing this is by looking at all the questions surrounding the issue. By using those five Ws, you can pretty quickly explore the many facets of staying safe. Grab a piece of paper or copy the questions into your word processor and finish this post with a safety plan in hand. 

 

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Who can I talk to?

You don’t have to go through tough times alone. Write down the people in your support system who are good listeners and who know how to make you feel better. Include their addresses, phone numbers and/or email addresses just in case you don’t have access to that information. Put a suggestion by each name stating what this person can be helpful for, like “Call my boyfriend to hear why I am loved,” or “Visit my mom to get advice.” 

What can I do to feel better?

Think about difficult times in the past and try to identify what, exactly, you were feeling and maybe even what caused those feelings. By identifying what’s setting you off, you can better find ways to manage it. Write a list of your most common triggers and a healthy way to deal with each one. This might look like “When I feel scared to go outside, I can have someone come with me,” or “When I am disappointed, I can create a gratitude list.”

When do I need to seek help?

Know your limits. Create a guide showing what to do at the different stages you might escalate through. This takes away the decision making element that can be overwhelming when you are upset. It could look something like this: “Feeling sad: Go for a walk. Wanting to hurt myself: Spend time around friends. Engaged in self-injury: Care for my wounds, then do something nice for myself. Feeling suicidal: E-mail my therapist. Actively suicidal: Call a suicide hotline or 911.”

Where can I go?

Sometimes a change of scenery can make all the difference. Make a list of places that you enjoy or that are helpful to you. While still being safe, make sure you have options for both day and night, even if it’s just a different room in the house. Some places you might want to consider are the homes of loved ones, support groups, your favorite park, a local coffee shop, the library, a scenic route for driving or even your own backyard.

Why should I not do this?

Make a list of all the reasons acting on your impulses aren’t a good idea. Acknowledge the negative consequences, but make sure to also stay positive. Having something worth not giving in for is really helpful. This could range from “I want to keep my body healthy,” to “I want to reach three months without this behavior,” or simply, “I deserve to be happy.” If you need help getting started, a list of reasons to recover can be found here.

Keep copies of your safety plan in accessible places, like in your purse, wallet, backpack, car, nightstand, comfort box and on your phone. You can also give them to people you trust who will notice when you are having a tough time so that they’ll have a guide for how to best help you. If you haven’t already been following along, I really suggest you do this. Having a safety plan is invaluable when you are in the midst of being symptomatic. It’s a lot easier to think of things now than in the moment.

What did you include in your safety plans? Is something important missing? Make suggestions in the comments.

5 things suicidal people talk about

    

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Being suicidal can come with a wide range of symptoms and behaviors. It will manifest in as many different ways as there are people. But there are commonalities that tend to appear. One of those is what they talk about. If the following topics come up, you may want to pry further to check on the wellbeing of the person in question.

1. Wanting to die

The idea that suicidal people don’t talk about suicide is definitely a myth. They frequently give indications of their desire to die, sometimes even flat out saying that they want to commit suicide. Saying it does not mean that they won’t do it. Sometimes it’s more indirect, with statements like, “I wish I’d just get hit by a bus.” If someone says anything at all that indicates a desire to be dead, it should be pried
                                                                                                                    into.

2. Feeling stuck, hopeless and having no reason to live

Suicide sometimes happens because there seem to be no other options. Talking about hopelessness or entrapment can therefore be a warning that the person is headed in that direction. There are always options. We may not like them, but they are there. When suicidal, though, those options can seem to disappear. This topic is an indicator that should be taken seriously.

3. Being a burden

Being suicidal can make one feel like a waste of space. Suicidal individuals might feel like they are simply a problem in the lives of others. They might think that others would be better off without them. This can be especially true when illness is present that requires assistance. If the person can’t contribute in the same way others are contributing, it can set off thoughts about the lives of loved ones being better without him or her.

4. Suddenly making big improvements

Sometimes, suicide is preceded by a significant increase in mood. The person might be a lot happier and more positive. This can come from feeling at peace with the decision to actually end ones life. Talking about how something “won’t be a problem any longer” or “doesn’t matter anymore” can stem from the decision to not be around at all. The more rapid and extreme the change is, the more you should ask questions to see what’s really going on.

5. Saying goodbye

It is normal to want a sense of closure. That’s why suicidal people sometimes go around and say goodbye to or make amends with others. It might be in an indirect way, such as, “I value our friendship and would miss it if we were away from each other,” or, “If anything happens to me, I want you to know…” The hypotheticals might not be so hypothetical after all, so it’s important to look out for these statements.

In combination with other warning signs, especially, it is important to take action. Always make sure that the person you care about has resources. There are suicide hotlines, doctors, therapists and community mental health organizations. If you aren’t sure of what to do, you can reach out to these resources as well and ask for appropriate advice. If you believe suicide is imminent or there is an actual attempt, call 911 or take the person to the emergency room. It may cause some upset in the short term, but having an angry loved one is better than having a dead one.

Have you talked to someone and worried about suicidality? How did you know that you needed to reach out?

7 ways to support someone with an eating disorder

Eating disorders have the highest mortality rate of any mental illnesses. Because of this, it is extremely important to work towards recovery. It is easier to get better when friends and family are supportive. But eating disorders are complex both physically and psychologically, so it can be hard to know what to do and say – or what to not do and say. Here are some suggestions on how to be supportive of someone with an eating disorder.

1. Remember that eating disorders don’t discriminate. A person of any age, gender, race or size can have an eating disorder. They’re not all bone-thin, white teenage girls. There are several different kinds of eating disorders and it’s impossible to tell by a glance whether or not someone is struggling with one.

  

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2. Understand that it’s not just about being skinny. Eating disorders are complex. While societal pressure to be thin can be a factor, it’s not the only one. There are usually intricate emotional reasons behind the disorder. Risk factors that can influence the development of an eating disorder include having another mental illness, substance abuse, perfectionism, sexual abuse and being involved in activities focused on weight (sports, dance, modeling, etc.).

3. Focus on positive non-physical traits. Eating disorders are often accompanied by a lot of insecurity. It’s therefore important to help build self-esteem in areas not related to the body. Compliment your loved one for his kindness, intelligence, skills, etc. Encourage participation in hobbies and activities that she excels in.

4. Be a good listener. If you are consistently paying attention and responding appropriately to your loved one, he will find it easier to talk to you about difficult subjects. Don’t push the topic of eating disorders, but if it comes up, be supportive and gently encourage recovery. If she has brought up the topic, you can carefully try to follow up, but follow her lead.

5. Do things together that don’t involve food. Eating disorders can be very isolating. It’s important to still have a social life, but a lot of social activities are centered around food. This can be very difficult. Invite him to do things where food is not the focus. Instead of going out for ice cream, go to the arcade or a concert. She’ll feel a lot more comfortable.

6. Don’t make demands about recovery. You can’t force someone to change. Recovery can only happen at the pace that someone is able to work at, so you need to respect that. Not doing so can damage your relationship and make your loved one feel uncomfortable around you. Trust his treatment team to keep tabs on how he’s doing.

7. Get emergency help if needed. Forcing treatment on someone can be ineffective and potentially counterproductive, but sometimes intervention is necessary. If symptoms get severe enough, call 911 or take her to the emergency room. Fainting, seizures, an irregular pulse and other severe symptoms call for medical intervention.

How do you maintain relationships with someone who has an eating disorder? If you have one, what do you find helpful? Share your thoughts in the comments.

When you're upset with your therapist

When it comes down to it, the process of therapy is a relationship. It is being able to open up to someone and finding acceptance, care, empathy, hope and help. But like any other relationship, there can be times when things aren’t going so well. No relationship is perfect.

 

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That doesn’t mean that when you get upset, you should go and replace your therapist. You don’t just switch out family members or close friends. There are certainly circumstances in which changing practitioners is warranted, but you should always try to work things out with your current mental health provider. 

Part of why it’s important to work on repairing ruptures in your therapeutic relationship is because therapy is not entirely unique. You have probably had someone else similarly hurt you. You might have had someone react negatively to you in that particular way. But the great thing about therapy is that you have a chance to work through those problems. You have a captive audience, so to speak, where you can play out the difficulty to its full extent. This can give you incredible
                                                                                                                 insight into your other relationships.

But that doesn’t mean it isn’t hard when something upsetting happens with your therapist. Try hard to see what is actually going on. Was something she said offensive to you? Are you maybe working towards separate goals? Do you disagree with your current treatment plan? Was there a misunderstanding? You need to know what has gone wrong in order to fix it.

And if you want to know what it is, the only way you can find out for sure is through talking about it. Don’t be afraid to say something to your therapist. Some phrases you might try using include:

• “I feel like there is something off in our relationship and I want to work through it. What do you think about that?”
• “I’m not sure we’re heading in the same direction. Could you explain to me why you are choosing the interventions you are using?”
• “I’ve noticed that whenever I ______, you ______. Can you tell me why that is?”
• “It offended me when you said ______, which made me feel ______.”
• “I’m not sure if I/you understood what you/I meant when you/I said ______. How did you interpret that?”

The most important part is getting the conversation going. Therapists know to expect these ruptures. They are trained in how to deal with them. It happens all the time. You are just two people talking and that won’t always work out ideally. It can be a great learning experience. If handled properly, it can help both you and your therapist make progress.

It’s not easy, though, to negotiate when there’s been a breech. At one point my therapist used an intervention that ended up causing me some distress. This caused me to become hesitant to talk about the topic that lead to the intervention. We talked about why he did what he did and why it upset me. We then discussed how that situation could be handled should it arise again. It took me some time to be comfortable discussing that particular topic. I am still very careful about what I say when I talk about it. But we both have a better understanding of how to work with that issue now. I learned to trust him in a new way. He now knows more about what that topic means to me and can act accordingly. 

All in all, you can either look at ruptures in the therapeutic alliance as personal insults that causes resentment and mistrust or you can look at them as a genuine aspect of relationships being played out in the therapy room. I don’t think I have to tell you which is the most helpful when it comes to progressing in your healing. The skill of repairing ruptures is important to all relationships and therapy is an excellent venue to practice doing so.

Have you and your therapist ever not seen eye to eye? Tell us what you learned from it in the comments.

Who do I call?

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Sometimes, it’s hard to know where to turn to for help. Loved ones may not always be available or you might not be ready to share some of your concerns with them. That’s why hotlines exist. 

Below is a list of hotlines that can be used within the U.S. My blog stats show that my readership is currently almost exclusively here, so that’s who I kept in mind when I made the list. If you are wondering about getting help in another country, feel free to leave a comment and I will see what I can find.

Even if you think you’re okay, read through the list of numbers. They are very varied and you might find something helpful you didn’t know was out there. All numbers are listed in alphabetical order and available 24/7 unless otherwise stated.

Boys Town National Hotline (at-risk teens and kids): 800-448-3000

Bulimia and Self-Help Hotline: 314-588-1683

Childhelp National Child Abuse Hotline: 800-422-4453

Crisis Call Center: 800-273-8255 or text ANSWER to 839863

Crisis Text Line (teens): Text SUPPORT to 741741

Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury (military and others affected): 866-966-1020

Depression and Bipolar Support: 800-273-8255
IMAlive chat support: www.imalive.org
Lifeline Crisis Chat: www.crisischat.org

National Alcohol and Substance Abuse Information Center: 800-784-6776

National Association of Anorexia Nervosa and Eating Disorders: 630-577-1330 (10 a.m. to 6 p.m. EST, Monday to Friday)

National Center for Posttraumatic Stress Disorder: 802-296-6300

National Council on Alcoholism and Drug Dependence: 800-622-2255

National Domestic Violence Hotline: 800-799-7233

National Eating Disorders Association: 800-931-2237 (9 a.m. to 5 p.m. EST, Monday to Friday)

National Institute on Alcohol Abuse & Alcoholism: 800-662-4357

National Institute of Mental Health Information Center: 866-615-6464 (8 a.m. to 8 p.m. EST, Monday to Friday)

National Mental Health Association Hotline: 800-273-8255

National Runaway Safeline: 800-786-2929

National Safe Place: Text SAFE and your current location to 69866

National Suicide Hotline: 800-784-2433

National Suicide Prevention Lifeline: 800-442-4673

National Teen Dating Abuse Helpline: 866-331-9474

Postpartum Support International: 800-944-4773

Rape, Abuse, and Incest National Network: 800-656-4673

Safe Horizon’s Crime Victims Hotline: 866-689-4357

Safe Horizon’s Rape Sexual Assault & Incest Hotline: 212-227-3000

Substance Abuse and Mental Health Services Administration: 800-662-4357

Suicide Prevention Services Depression Hotline: 630-482-9696

The Trevor Lifeline (LGBTQ): 866-488-7386

Thursday’s Child National Youth Advocacy Hotline: 800-872-5437

Veteran Combat Call Center: 877-927-8387

Veterans Crisis Line: 800-273-8255

Update: Here is a link to international suicide hotlines.

If you have any corrections or additional hotlines for the list, please leave a comment. I have not personally called each number to verify the information, so I don’t make any guarantees about them. This list is not intended to be comprehensive. 

5 ways to help a loved one with a mental illness

When someone faces an illness, either physical or mental, it can be very overwhelming to those around him. There’s a lot of new information to take in while at the same time a whole new set of questions that open up. Most people want to be helpful when a loved one is facing difficulties. Here are some guidelines for how to be supportive to someone with a mental illness.

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1. Respect your loved one. Everyone, no matter one’s circumstances, deserves respect. This is especially true of those that society doesn’t overtly value. There is a lot of stigma around mental illness and chances are your loved one has been treated poorly because of it at least once. People say hurtful and uneducated things and have unrealistic expectations. Show your loved one that with or without a mental illness, you value her as a person. Be proud of him for the things he does accomplish, even though they might seem minimal to an outsider. Just remember that respect is not about treating this person exactly like everyone else. It’s about treating others with the consideration they deserve, which is something that varies between individuals.

2.. Educate yourself about your loved one’s condition. It’s hard to help someone when you don’t know what the problem is. That’s why it’s important to learn about the condition(s) your loved one has. You are by no means trying to be this person’s therapist. It’s actually more preventative. If you have a better understanding of your loved one’s challenges, you are less likely to have missteps and offend, hurt or be unhelpful to that person. Talking to someone who is depressed differs markedly from talking to someone with anxiety. It can be hard to find the right information, though. Have your loved one ask her therapist for recommendations of books or websites that appropriately explain the condition. 

3. Talk and listen. Dealing with a mental illness can be very isolating. Take time to have conversations with your loved one. Ask him how he’s doing and listen carefully when he answers. Mental illness presents many unique challenges and sometimes, it feels like no one else understands. That’s why active listening (reflecting back what she’s saying, asking questions, acknowledging emotions) can make a real difference. Make sure you also talk about things other than his mental health. Those with mental illnesses have most of the same needs as everyone else. Talk about the upcoming game, weekend plans and hobbies. Making everything about the mental illness is limiting your relationship. There is so much more to a person than what she is diagnosed with.

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4. Help with daily living tasks. Part of what qualifies someone as having a mental illness is that it causes impairment and/or distress in important areas of functioning. That’s why even simple, every-day things liken getting dressed or taking out the garbage can sometimes become overwhelming. Pay attention to your loved one and see what areas he is struggling in. If she is too anxious to leave the house, offer to do her grocery shopping for her. If he’s depressed and can’t take care of his apartment, clean the kitchen. If she is in shock after a traumatic experience, see if you can drive her to her appointments. The important thing to remember is that it can be hard to ask for help or even know what one needs, so saying, “Let me know if I can do anything,” doesn’t always work. Notice the specific needs of your loved one and attend to those. 

5. Take care of yourself. Being a person of significance in a mentally ill individual’s life can take a very real toll. You might experience compassion fatigue, a state in which one becomes more indifferent to the needs of others because of overexposure. Simply put, if you help someone a lot, you get tired. This is why it’s important to take care of yourself. Make sure that you are getting your own needs met, including leisure and self-care. You are not expected to, nor should you, be there 24/7. Take advantage of resources and other people. It is a whole lot easier to make sure someone is getting what he needs when you work as part of a team. If your loved one needs a lot of help, reach out to other family members and friends so you can coordinate how to best help her. When everybody does a little bit, a lot can get done without one person getting too worn out. Sharing responsibility is one aspect of making sure you get what you need, too.

There are other resources to help you find out how to help someone with a mental illness. The American Psychological Association keeps a list of resources for caregivers. A very practical guide for how to help care for your loved one with a mental illness is When Someone You Love Has a Mental Illness by Rebecca Woolis. Remember to also communicate with your loved one. He or she will always be your best resource in terms of determining what you can do.

What have you found that is helpful in terms of giving or receiving help and support during a mental illness? Share your tips in the comments.