According to the National Opinion Research Center at the University of Chicago in Chicago, Illinois, 1 in 5 Americans is experiencing feelings of loneliness, anxiety, and irritability. Unlike a physical injury like a sprained ankle, these symptoms are invisible. With the help of Psychologist Jerry Walker, III, PhD, ABPP, MSCP, we put together four ways to help a loved one struggling with a mental illness. 

Watch

Be mindful of signs showing a person is struggling. It’s possible to only see a person a few times a day and be unaware of their inner strife. According to Dr. Walker, unless you know a person well and know what their “normal” is, it can be difficult to see if someone is struggling.

Some signs to watch out for if a person is struggling:

Changes in behavior

• Eating more/eating less
• Drinking more alcohol/smoke more
• Neglecting basic hygiene like showering
• Sleeping more

Mood

• Irritability
• Anger
• Becoming distant
• Losing interest

Reach out

After we notice these changes in behavior, attempt to reach out and create a space to allow your loved one to discuss their emotions. “The ways we reach out really matter; it does make a difference,” states Dr. Walker. This conversation may be uncomfortable, but it is very important to be the beacon of light for your loved one struggling in the dark.

Start the conversation with open-ended questions to foster a safe space for your loved one to be vulnerable. Instead of asking, “How are you?” try asking:

• What's been going on lately?
• How are you feeling?
• What kind of things has been running through your head?
• Do you feel like you've been different lately?

These types of open-ended questions allow your loved one to really explore their emotions and recognize if their behavior has changed. If your loved one regularly struggles with their mental health, they are most likely to be more attuned to their emotions. 

Don’t end the conversation there. Ask follow-up questions to allow your loved one to think of their own behavior.

• What has that been like?
• What does that look like?
• How has this impacted you?
• How long has it been going on?

Listening

While listening to your loved one discuss their struggles, keep an open mind and do not interject yourself into their narrative. The stigma around mental health already creates a difficult environment to be vulnerable. Listening without judgment provides such an essential role in helping your loved one.

This conversation may be uncomfortable. If you don’t normally experience these thoughts or emotions, it can be easy to say things like “You’ll get over it” or “It’s all in your head.”

Do not do this.

Responding in this fashion continues to make a person feel worse about their emotions, and the last thing we want to do is to hurt our loved one.

If your loved one is expressing thoughts of suicide such as: “I want it all to end” or “I might be better off dead.” Ask them, point blank: “Are you thinking about killing yourself?”

“In my experience, as a psychologist and as a friend,” says Dr. Walker, “when people are having those thoughts [of suicide] they’ll actually say yes.” From here, follow up with the question, “Do you feel like you’re going to act on these thoughts?”

If the answer is yes, intervene with professional medical or mental help. 

Thoughts of suicide are more common than we think. The intrusive thoughts are truly distressing even when a person does not want to act on these ideas.

Connect

Now that you’ve fostered a safe and open environment for your loved one, it’s time to act. Dr. Walker recommends breaking the cycle of negative thoughts by behavioral activation. This process of activation shifts attention from thoughts to behavior and environment.

Some things to do with your loved one:

• Go for a walk
• Do the dishes together
• Water your plants
• Help them take a shower
• Work on a puzzle
• Sit outside 
• Take them for a drive
• Play a board game
• Draw self portraits
• Put on some music and dance

If these things don’t work, experiment with different activities. One shoe never fits all. If your loved one loved running and no longer wants to run, find other ways of exercise. If your loved one enjoys reading, consider going to a bookstore for a new book. Breaking a person out of these spirals of thought can begin the process of healing.

These actions don’t have to be monumental. Taking these small steps helps your loved one recognize someone cares about them and wants to see them get better.

Finding mental health services can be challenging. The Nebraska Medicine Behavioral Health Connection is a free, confidential service to help adults with mental illness identify and connect with local mental health and social service resources. This is a telephone referral line, not a crisis service. It is staffed Monday through Friday, 8 a.m. to 5 p.m. The number is 402.836.9292.  

Consider reaching out to a primary care provider to connect your loved one with a behavioral specialist. With the use of telehealth options, it’s possible to have same-day appointments. 

Having a loved one with a mental illness can be stressful, and families often don’t know where to turn when looking for help. Psychologist David Cates, PhD, suggests reaching out to the local chapter of the National Alliance on Mental Illness. NAMI has a variety of resources for families, including support groups and family education.