When Felicia Gould, Ph.D., a clinical neuropsychologist with the University of Miami Health System, thinks about mental health, she likes to quote her former department chair: “There is no health without mental health.”
Maybe you’ve seen a friend or family member’s emotional state suffer during the pandemic. Perhaps mental illness runs in your family, and you worry about certain behaviors in your child, spouse, or sibling. How do you voice your concerns kindly and clearly?
“I encourage people to do their best to have those potentially uncomfortable conversations on any aspect of mental or physical health,” Dr. Gould says. Her techniques, developed over years of working with patients, can guide you to discuss sensitive topics with those you love.
Conversations about mental health should be an ongoing process. An intense, one-time intervention is unlikely to resolve an issue. Before any discussion, check yourself first.
Make sure you’re calm and collected before speaking. “More than 80% of communication is non-verbal. If you’re upset, nervous, or angry, the other person will pick up on your body language,” Dr. Gould says.
Have a plan – jot down your concerns, suggestions, and any positives so everything is clear in your mind. Pick a time when you’re less likely to be interrupted. Dr. Gould recommends starting with education, especially when speaking to a young person or teen. If you think someone is depressed, for example, know the symptoms and causes.
Delivering your message
Some basic rules can help steer your conversation in a positive direction:
- Be a good listener
- Practice empathy
- Avoid giving advice
- Don’t label or judge
- Don’t pressure the person to take medication
- Steer clear of blame
- Offer perspective
The sandwich technique
Try easing into difficult conversations using Dr. Gould’s “sandwich” technique. “You ‘sandwich’ the negative topic between two positives. You might start by saying, ‘You’re so valuable to me and this family. You’re a great provider. On the other hand, I see you isolating, angry and pulling away. Am I wrong? I want you to fully enjoy life, and I appreciate you listening to me,’” Dr. Gould says. This technique may open the door to future discussions and potential solutions.
Make sure you rule out any underlying health problems. “Suggest that the person see their primary care doctor,” Dr. Gould says. Self-care is next. “Are they eating three healthy meals a day, getting enough sleep, activity, and socialization?” Dr. Gould asks, adding, “Self-care starts young; even children can learn self-care. If your child or teen doesn’t understand how to practice self-care, teach them.”
Remember, however, as children mature, they are increasingly responsible for their self-care.
Talk therapy helps many people regain emotional health. Consider starting with family therapy; counseling may feel more approachable when the spotlight isn’t focused on one person. Eventually, people can “work their way up” to one-on-one sessions with a therapist. What if your loved one doesn’t take action or accept help? “Whether it’s addiction, depression, anxiety, or another issue, it’s ultimately their journey. Plenty of people seek supportive counseling because their significant other refuses to seek help.”
Mental health concerns like bipolar disorder and depression often run in families.
“When you discuss this concern, mention someone who successfully dealt with their problem. For example, ‘Your uncle struggled with depression, and he’s doing better now.’ You could also talk about a famous person who successfully dealt with their mental health issue. Sometimes, you may need to bring up people who’ve succumbed to their illness: ‘I’ve seen this happen in others, and I don’t want to lose you.’”
Helping vs. enabling
It’s harder to practice tough love during a pandemic when many families are together 24/7, regardless of behavior. Dr. Gould says there is a significant difference between financially enabling someone using drugs and asking them to leave the family. Again, it comes back to self-care. From setting boundaries to making time and space for yourself and seeking counseling support, safeguarding your mental health is paramount.
Here’s a recap of Dr. Gould’s step-by-step approach for having tough talks:
- Start with a compliment or positive comment
- Express your concerns
- Present possible options and solutions
- End on a positive note: “I care about you and want you to enjoy life. I’m here for you if you need to talk.”
- Follow-up: “We discussed this a while back, but I haven’t seen any changes.” Or, “I’m checking in. How are you doing?”
While you’re at it, check in with yourself, too. “If anything, our mental health is more important now than ever,” says Dr. Gould.
If you or someone close to you has suicidal thoughts, call 9-1-1 or the 24-hour National Suicide Prevention Hotline at 800-273-8255. The hotline is available in English and Spanish.
Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the Centers for Disease Control and Prevention. Her writing also appears in the Chicago Tribune and U.S. News & World Report.
Depending on the individual, ADHD can present itself as inattentiveness (traditionally called ADD), hyperactivity and impulsiveness (traditionally called ADHD), or a combination of all three. Read more.