**Trigger warning: this article contains references to suicide and mental health that some readers may find distressing. Please read with caution and exercise self-care.
September 9 marks R U OK? Day 2021 — an annual event that encourages all Australians to engage in meaningful conversations around mental health in the hopes that we can reduce the risk of suicide and get people whose mental health is suffering the help they need.
The event was started in 2009 by Gavin Larkin, who was inspired to create the organisation due to his own father dying by suicide. Tragically, Larkin passed away from cancer in 2011, making this year’s R U OK? Day even more poignant as it marks his tenth anniversary.
The concept behind R U OK? Day is fairly simple: a conversation could change a life. However, you might be feeling apprehensive about the best way to approach someone whose mental health you have concerns about, which is entirely understandable given how delicate a topic it is and how far we have to go in terms of talking about mental health in Australia.
With that in mind, we asked three experts in the field for some advice on how best to broach the topic and what the right steps are for following up and ensuring our loved ones get the support they need.
What are the warning signs that someone is struggling with their mental health or having suicidal ideations?
According to Amber Rules, Psychotherapist, Director and Founder of Rough Patch Affordable Counselling, the signs that someone is struggling with their mental health can sometimes be subtle.
“You may notice changes in their normal behaviours, changes in appetite or sleep patterns, difficulties at work or school, not finding pleasure in the things they usually enjoy, becoming quiet and withdrawn, or becoming irritable or aggressive,” she says.
Mental Health Specialist Sandi Givens from Psychological Safety Works also cautions to look out for changes over a two week period such as changes in appetite (eating more or less), changes in sleep patterns (sleeping more or less), noticing the person is finding it hard to concentrate and make decisions.
In terms of what to look for when it comes to recognising if someone is experiencing suicidal ideation, Principal Psychologist and Co-founder at Get Mentally Fit, Emily Johnson advises to keep an eye out for warning signs such as expressing a sense of finality within a conversation; when an individual starts giving away something of sentimental or personal value and if they have dramatic mood changes, including a rapid increase in a positive mood.
“The incongruent nature of the individual demonstrating an increase in positive mood may be due to them committing to a time, means and place to take their own life,” Johnson says.
What are the things you should have in place before broaching these conversations?
Given the extremely sensitive nature of the topic, it’s important to do some preparation before initiating these conversations. While, of course, some chats around mental health will happen organically and spontaneously over the course of a catch up with a mate, if you are planning to start a conversation with someone you are concerned about there are some steps you can take beforehand.
“It can be useful to formulate a few ideas about how you can offer help,” says Rules. “For example, you may research mental health services in your area so you’re ready with phone numbers, or think about ways in which you’re willing and able to support the person.
“Perhaps you want to offer to spend more time with them, drive them to an appointment, or offer to cook them dinner once a week. Think about what you can reasonably offer by way of support and then ask them if that would be useful for them. It can be really useful to discuss this with your own counsellor first to get more ideas.”
Givens also suggests having some notes at the ready to help you stay clear and ensure you don’t forget important information.
“Have a dot point list of the changes you’ve observed in them that are causing you concern,” she says. “Also, consider what time of day and day of the week they seem at their best, and therefore possibly most receptive to the conversation as well as where you could have the conversation in which they will be most at ease and feel certain of the confidentiality of your talk.”
What are the dos and don’ts when approaching them about their mental health?
It’s human nature to want to avoid having difficult conversations, and the topic of mental health can be particularly tricky to broach. However, having some simple frameworks in place can make it seem a little less daunting and ensure that your conversations are as effective as possible.
One way to approach these conversations is to keep in mind some simple dos and don’ts such as do ask how they are feeling respectfully.
“Assure them of your genuine concern and of confidentiality, give them as much time as needed or even suggest different locations and times when/where they might feel more comfortable to talk,” says Givens.
“Give them examples of the changes in them you have noticed that are the reasons for your concern, ask open questions to help them express how they feel and offer resources they might find helpful (such as the Beyond Blue and Black Dog websites and support phone lines) and ask if they think seeing their GP or trusted health professional might be a good idea.”
Adds Rules, “When discussing mental health, it’s always a good idea to ask permission first. You might say ‘Hey, is it okay if I talk to you about your mental health? I’ve noticed you might be struggling and want to offer you support’.
“Be sure to ask open-ended questions and listen without interrupting, and offer to help them find a professional if that’s what they’d like to do. You might offer to help them make the first phone call or drive them to their first appointment with a GP or counsellor.”
When it comes to things to steer clear of, Rules advises avoiding giving advice or telling them what to do.
“Don’t tell them to ‘just stay positive’ or use platitudes,” she said. “Avoid making it about you or telling them what you did in a similar situation.”
If the conversation you are having is with someone you work with, Johnson suggests that timing is key.
“In the workplace, if the person works a traditional Monday to Friday, do raise your concern early in the week to enable the appropriate people to organise any necessary support or modifications to the individual’s role,” she offers.
“Don’t have an R U OK? conversation on a Friday, and don’t give too much notice of an informal meeting regarding the matter, especially if you are the person’s manager, as this can cause high levels of anxiety. It’s also important to not approach someone when they’re surrounded by people in a noisy public place or when they’re in a hurry to get somewhere.”
And, no matter how uncomfortable it might be, Rules cautions that being vague is not an option when it comes to concerns about the risk of suicide.
“It is vitally important that if you are concerned about someone possibly being suicidal that you ask them directly — don’t beat around the bush because it might be uncomfortable,” she warns. “You might say ‘I want to make sure you are safe, so I need to ask you directly — are you feeling suicidal?’ If you suspect they are suicidal, do not hesitate to call emergency services for support and advice.”
How can you tell when to escalate things and call professional help?
“Ideally, you will escalate to seeking professional help if you suspect a noticeable pattern of concerning behaviour or mood change emerging in an individual, and you ideally have a quantified and determined the reason for doing so,” says Johnson.
“It is important to identify that this person isn’t simply having an off day and are their symptoms persisting and becoming more serious. Where appropriate, observe over a period of a couple of weeks to determine repetition and accumulation of various symptoms.”
Adds Rules, “it can be useful to discuss with them your worry and desire to involve a professional by saying something like ‘I’m really worried about you — would it be okay if we call some mental health services together to get some advice?’.”
Meanwhile, Givens advises that there is no definitive answer to the question, but can often come down to the person initiating the conversation to trust their instincts.
“If you feel they are a danger to themselves or others, then do not leave them alone and get professional help,” she says. “You should also tell them when you are first having the conversation(s) with them that the only circumstances in which you would break your agreement of confidentiality is if at any time you feel they are a danger to themselves or others. Of course, if they are having psychotic experiences (hearing, seeing or feeling things that aren’t real), I believe it is best to get professional help.”
What are follow up actions you should take after your conversation?
Keep in mind that starting a conversation about someone’s mental health is a great place to begin, but it is likely that it will need to be ongoing in order to be effective.
“Keep checking in on them, preferably with their agreement,” says Givens. “Remain non-judgemental (don’t tell them what they ‘should do’). Without breaching confidentiality, consider if there are other people close to them that might have a chat with them at your suggestion.”
Rules also offers that consistency and reliability are important and advises you to follow through with anything you say you are going to do.
“Be sure to ask how you can be most supportive, and then keep checking in,” she says. “Supporting someone who is struggling with mental distress can be hard and sometimes awkward, but it’s important to stay connected and push through awkward conversations in a respectful way. You should also remember to look after yourself and get support if you need it.”
Johnson encourages making the time to meet up with the person again and check that they’re on track while encouraging them to make the most of the support available.
“In the workplace, help the person to uphold any workplace adjustments that have been put in place to support their recovery,” she says. “Discourage rushing the person’s recovery process, as not being sensitive to this will risk relapse.”
What should you do if someone insists they are fine but you don’t believe them?
It’s no secret that it’s become almost a reflex to say you’re fine when someone asks how you are, even if that could not be further from the truth. Likewise, if you initiate a chat around mental health with a loved one, they might thank you for being concerned but remain adamant there is nothing to worry about.
In this case, Givens suggests giving them examples of the changes in them you have noticed that are the reasons for your concern while acknowledging that it can be difficult to open up but assuring them you will keep anything they say confidential.
“If they still insist they are fine, ask their permission to check in with them again in a day or two, as you are still concerned about their wellbeing,” she says.
Rules, meanwhile, acknowledges the trickiness of this situation and also suggests continuing to check in with them in a supportive way, but try not to make them feel harassed.
“If you are genuinely concerned for their safety, you can call an ambulance or your local area mental health team,” she says. “You can also talk to other people in their life about your concerns, and make a plan to support them together.”
If you or someone you know needs help, please contact BeyondBlue on 1300 224 636 or Lifeline on 13 11 14. Family and friends can also call upon these services for advice and
assistance on how to support someone who is struggling with life. You can also find advice and resources at www.ruok.org.au
If you are in immediate danger, call 000.
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