Free Books for World Bipolar Day

To mark World Bipolar Day 2023 Fran and I are offering our books for FREE on Kindle for five days between Wednesday March 29 and Sunday April 2, inclusive.

In High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder we share what we’ve learned about growing a supportive, mutually rewarding friendship between a “well one” and an “ill one.” With no-nonsense advice from the caring friend’s point of view, original approaches and practical tips, illustrated with real-life conversations and examples. Buy it here.

Friendship is a beautiful part of life and an important component of long-term wellness. No One Is Too Far Away: Notes from a Transatlantic Friendship is a collection of articles from our blog which shows that mental illness needn’t be a barrier to meaningful connection; indeed it can be the glue that holds people together. Buy it here.

Once the free offer is over the prices will go back to normal.

World Bipolar Day is celebrated each year on March 30, the birthday of Vincent Van Gogh, who is thought to have lived with a bipolar condition.

The vision of World Bipolar Day is to bring world awareness to bipolar conditions and to eliminate social stigma. Through international collaboration, the goal of World Bipolar Day is to bring the world population information about bipolar conditions that will educate and improve sensitivity towards the condition.

For more information check out the following websites.

• Bipolar UK
• bpHope
• International Bipolar Foundation
• Rethink Mental Illness

 

Please Wait Here Until You Are Useful

The inspiration for this article was a conversation I had with Fran a few weeks ago. We were discussing the nature of friendship, help, and support when she suggested that “the need to be useful is a sign of insecurity.” I knew exactly what she meant. Most of my life has been spent trying to satisfy a need within me to be of use, help, and value to other people. It’s not that this impulse is wrong or necessarily unhealthy, of course. Eleanor Roosevelt asserted that “[u]sefulness, whatever form it may take, is the price we should pay for the air we breathe and the food we eat and the privilege of being alive.” The Dalai Lama went further. “What is the meaning of life?” he asked. “To be happy and useful.”

With that in mind, it might seem surprising that the Nonviolent Communication (NVC, sometimes called compassionate communication) model doesn’t mention usefulness explicitly in its Needs Inventory. The closest need is support, listed in the Connection section alongside appreciation, cooperation, communication. Feeling that you matter (to others, to yourself, or to the world) is included in the NVC Feelings Inventory. NVC’s emphasis on cooperation and respecting one’s own needs no less than other people’s aligns with the belief Fran and I share in the importance of mutually supportive connections. It’s the constant thread that runs through our book and our almost twelve year transatlantic friendship. That mutuality is foundational. Our needs differ in nature and over time, but we respect those differences and attend to each other’s needs as best we’re able. I think Fran would agree we’re still useful to each other, though that’s not the sum of what we mean to one another. On reflection, this kind of mutual usefulness has been a feature of virtually all the most significant and meaningful relationships I’ve ever known.

That said, I believe there’s a role for what I might call nonmutual usefullness, or unrecipricated service. That is, offering help and support with no need or expectation that it will be repaid in any way. I discussed this aspect of supportive friendships in The Constant Gardener: How to Be Someone Your Friends Can Rely On.

What does steadfastness mean in practice? It means saying, as many times as your friend needs to hear it, I’m here for you. I’m not going anywhere. How can I help? — and not only meaning it at the time but following through. It means picking up when your friend calls or messages you, no matter what time it is, how your friendship stands at that moment, or how recently you were last in touch, even if it’s six months after the friendship broke down, because you promised you’d always be there and they believed you.

Where this becomes unhealthy, or in Fran’s words where the need to be useful becomes a sign of insecurity, is where we ignore or lose sight of our needs, setting them aside in order to meet the needs of others. Left unchecked, the consequences of putting other people’s needs before your own can be devastating, as they were for my mother. Her mental health deteriorated to the point where she was barely able to function. Ironically, she spent her final years depressed, anxious, and wracked with guilt for not having done more.

As I’ve written elsewhere, helping people helps you too, as long as you don’t lose sight of your needs. The insecurity aspect comes from placing too high a regard on how others see us, and imagining that we’ll only have value to other people if we’re useful to them. “No one will like me just for me,” the voice of insecurity asserts. “But if I’m useful they will like me, and need me.” This is something I’ve come to recognise in myself. I have trouble seeing myself as someone people will want to hang out with if I’m not making myself useful to them in some way.

There are three problems with this way of thinking. First, it opens us to exploitation by people predisposed to take advantage of others. I’ve not experienced this personally, but the danger is real. The second danger is codependency, which describes a situation of mutually toxic dependency. The best defense against codependency is honest communication, as Fran and I discuss in our book and have described elsewhere in How Much Help Is Too Much? Codependency in the Caregiving Relationship. The third problem is the fact that in relationships as in the workplace, no one is indispensable. If you base your sense of self-worth on your usefulness to others, you leave yourself open to disillusionment and loss of self-esteem when the situation changes. When this occurs — as it has for me on several occasions — it’s necessary to assess what has changed, what’s left, and what you want to do about it.

This insight first came to me several years ago. One friendship had become so imbalanced that it seemed the only thing keeping it going at all was my continued offer of help. For a long time I struggled to accept that what we had no longer met my definition of a mutually supportive friendship. I finally realised there was nothing wrong as such, it was simply that things had changed between us. In acknowledging that fact, I knew I had a decision to make. I could end the connection and walk away, or I could continue to offer the support I knew was very much needed and valued. I decided to continue, and felt almost instantly relieved and at peace with the situation. The connection might not meet my need for mutuality, but it did satisfy my need to be useful. In time, we reestablished the balance we’d known previously. Our connection remains strong to this day. Another friendship stalled under different circumstances. We reached a situation where my need to be useful was no longer being met, largely because my friend’s needs had changed or were being met elsewhere. Without that “Are you there?” / “I’m here” / “I need you” / “What to you need?” dynamic the connection lapsed naturally and gently. There is sadness, but neither blame nor acrimony.

Exploring our need to be useful can be immensely beneficial, both to our sense of self-worth and to our relationships. It’s helped me recognise the validity of offering help when that help is wanted and asked for, but resisting the impulse — all too common with me in the past — to push help in people’s faces in a desperate attempt to validate myself by “being useful” all the time. It hardly needs saying that such behaviour is annoying at best, and seriously toxic at worst. It’s also taught me a lot about boundaries; mine and other people’s. I’ve come to realise that I’m not responsible for other people’s choices or decisions, and needn’t contort myself to fulfill roles that are no longer relevant or needed. In short, I can be there when people need me, but I can’t insist on being there when they don’t.

The need to be useful isn’t unhealthy in and of itself; indeed, I’ve learned that helping others is an important part of my ethical makeup. I’ve recently been exploring aspects of moral philosophy, in particular the course on moral philosophy by Jeffrey Kaplan on YouTube. One video which left a lasting impression is Ordinary People Are Evil based on the idea of moral obligation propounded by Peter Singer. This is beyond the scope of this blog post but I may return to it in the future.

Likewise, it’s healthy to value the usefulness of other people in our lives, whether it’s someone with a car who can offer day trips or rides to appointments, or people with specific resources, skills, and experience they’re willing to share with us. Acknowledging this doesn't mean we’re manipulative or taking them for granted. My friend Aimee and I are both passionate about writing and blogging. We’re useful to one another because we understand the process, stresses, and excitements of blogging in the mental health arena. We often call on each other for advice and support. My friend Louise and I each have a good deal of experience supporting other people in various ways. It’s immensely valuable to have someone like that in my life. We’re able to draw on our experience to support each other when we need someone to listen to what we’re going through; someone who will understand without needing everything explained in detail. Mutual usefulness of this kind is a wonderful thing.

I’ll close with Fred Rogers’ famous quotation about looking for the helpers. It has its detractors, but for me it captures the essence of being useful.

When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping. (Fred Rogers)

I hope there are some people, whether still in my life or not, who would think of me in this light.

Over to You

In this article I’ve explored what being useful means to me. How do you feel about the topics I’ve covered? Do you have a need to be useful? Do you have useful people in your life? Whatever your thoughts and ideas on this topic, Fran and I would love to hear from you, either in the comments section below, or via our contact page.

 

Image by Ehimetalor Akhere Unuabona at Unsplash.

 

The Box on the Shelf: A Strategy for Handling Difficult Issues and Situations

In a recent article I discussed a number of models and analogies that help when I’m talking about mental health. One strategy which didn’t make it into that article is the box on the shelf. Fran and I find it a useful tool when handling things we’re concerned, frustrated, or anxious about. The idea is to imagine yourself putting your thoughts and worries into a box and setting the box on a shelf. It gives you a break from thinking about it all the time. When you’re ready, you can take the box down from the shelf, open it up and work on whatever it is that’s been worrying you. Once you’re done, you put it away again until next time.

What Goes in the Box?

The box can contain anything you’re hung up about. It might be an issue you’re having with a friend or family member. It might be a friendship or relationship breakup you’re struggling to navigate. It could be something at work that’s annoying or frustrating you. Whatever it is, you’ve likely been wrestling with it for some time. Maybe you can’t see a way through, or you’re waiting for something — or someone — to change so you can take the next step and move forward. The issue is playing away at the back of your mind almost all the time so that you find it difficult to focus on other things. That’s the time to put it in a box and set it aside for a while.

What Kind of Box?

It’s a virtual box and you get to decide what kind and size you find most appropriate. You might imagine it as an ornately carved wooden box, an enamelled tin box, a jewellery box, or treasure chest. You might equally image it as an antique suitcase or a battered cardboard box. Whatever feels right to you. Fran has occasionally used an actual box to help reinforce the imagery.

Opening the Box

When you’re ready to think about your issue, find some space and time where you can focus on it without being disturbed. Close your eyes and imagine yourself taking the box down from the shelf. Sit with the box in your lap. Remind yourself that there’s nothing to fear, then open the box and take out whatever it is you placed in there.

No matter how difficult or painful the issue may be, take a little time to observe it from the outside, as it were. Turn it over in your hands. How big is it? How heavy does it feel? Is it hot or cold? What shape and colour is it? Is it solid and rigid, or can you unfold or open it a little to examine it more closely? Sit with it as long as you feel comfortable, then return it to the box and close the lid. When you’re ready, return the box to the shelf.

You might not feel you’ve gained any new insights or made progress, but you’ve done enough for now. Give yourself permission to focus on other things for a while, knowing the box is safe on its shelf. You can take it down again at any time. As Fran expresses it, “You give it your attention. Then you put it away so you don’t have to obsess about it constantly.”

A Few Examples

You might be wondering how Fran and I use this in practice. It’s not something we use all the time but it came up in conversation recently. For several days we’d discussed a number of issues Fran was having. We seemed to be going round in circles without making much progress. I invited her to imagine herself turning the issues over in her hands, exploring them in whatever ways worked for her (for example, discussing them with me and other friends, or writing her thoughts down), then putting them back on the shelf for a time so she could focus on other things.

Fran thanked me, then asked if I was doing the same with some issues I’d been dealing with. I hadn’t, but I’ve used it since our conversation. I’ve also used it in the workplace. Just the other day I realised one particularly intractible technical issue was causing me to become frustrated and distracted. I messaged my co-workers: “I’m going to put this in a box on the shelf for now, because it’s really stressing me out!”

It can also bring a note of humour and relief to difficult situations. “You’re going to need a bigger shelf for all these boxes!” I joked with Fran on one occasion, reflecting how many things she had going on. Another time I observed, “Sometimes it’s not so much a case of putting the box on the shelf, as digging a hole, dropping the box in the hole, and setting the whole thing alight!”

Boxes Are Not Forever

The box on the shelf is a strategy for dealing with troublesome or persistent issues a little at a time, setting them aside in between so you can get on with other things. It’s not intended as a way of hiding things away or putting them off altogether. My friend Louise expressed it well. “I like the box idea as a way of dealing with things step-by-step,” she said. “As long as they’re not left in the box forever, never to be dealt with.” She shared a line she's found helpful in the past: “Shelving things has never worked out for us!!”

When the issue’s been dealt with, there’s no further need for the box. You might imagine yourself emptying it of anything that remains inside so you can use it again. Or you might want to throw it out altogether. It’s up to you. As Fran puts it, “[o]ne way or another, there comes a time to let the box go.”

Other Box Models and Analogies

Writing this article has reminded me of other box models and analogies. Continuing the idea of putting troublesome memories and thoughts out of reach, fellow mental health blogger Aimee Wilson suggested the idea of a trauma box, “[b]ecause people can put their traumas into a box in their mind.”

Schrödinger’s Cat is a well-known thought experiment in the field of quantum mechanics, involving a cat and a box. Less well-known is Schrödinger’s fishing tackle box, an idea which helped me explore a number of issues relating to my family and childhood. Pandora’s box also springs to mind, although in its original form the container opened by Pandora was a large storage jar rather than a box. Whatever its nature, the item had been left in the keeping of Pandora’s husband. The story can be interpreted as a cautionary tale about the dangers of delving into things not meant for us. The 1995 movie Jumanji starring Robin Williams is play on the Pandora theme, albeit with a decidedly happier ending.

I’ve focused on putting troublesome thoughts, ideas, and issues into boxes, but sometimes we may choose to pack loving, caring feelings away, against a time when they may more readily be expressed. I’ll close with the opening lines of a poem written many years ago.

my love, come quickly,
For a while we must put aside desire
In a little box, labelled: “Passion. With care.
Do not open until we are both sure what to do with it”.
We must hide it underneath the bed with your copies of New Society and my hopes of tomorrow.

— From “Lovepoem (6)”

You’ll find that poem and many more in my anthology Collected Poems: 1977–1984.

Over to You

In this article I’ve explored the box on the shelf, a strategy Fran and I employ when processing difficult situations and feelings, especially those which seem intractable or likely to persist for some time. What strategies do you use when dealing with such feelings and situations? What works for you? We’d love to hear from you, either in the comments below or via our contact page.

 

Photo by Erda Estremera at Unsplash.

 

The Stress Bucket and Other Models That Help Me Talk about Mental Health

Talking about mental health can be difficult and I wrote recently about some of the reasons we may not want to. Part of the problem can be that we lack the words to adequately describe what’s going on for us when we’re struggling. I was reminded of this a few weeks ago when I completed a Mental Health First Aid Refresher course. The training covered several models of mental health and wellbeing, including the mental health continuum and stress container (or stress bucket). Models such as these can never completely describe the personal and often subtle details of what we’re going through, but they can provide a starting point and some common language with which to explore and share our feelings. In this article I’ll cover a number of models I find helpful when talking about mental health, plus two relating to supportive friendships.

The Stress Bucket

Also known as the stress container this model was originally developed in 2002 by Professor Alison Brabban and Dr Douglas Turkington. There’s a useful overview in this article on managing stress published by Lincoln University.

When we’re stressed it’s natural to focus on the events, situations, and triggers that led us into that state. These stressors can be difficult to avoid or eliminate, however, leaving us feeling hopeless or overwhelmed, with no option but struggle through as best we can until — hopefully — things ease up. The stress bucket model reminds us we have other options.

The model invites us to imagine we each have a stress container or bucket. The size of the bucket varies from person to person, and can also vary from time to time throughout our lives. Stressful events and situations flow into the bucket, starting to fill it up. These stressors might include problems with our relationships, friendships, work, or money; anything that adds to our feeling stressed and anxious. If we have a relatively large bucket, it might take a while before it starts to overflow, but no matter how small or large it is, our bucket will fill up unless we do something about it.

The most obvious approach is to address the source of the stress. If we can resolve the issues then the flow of stress into our bucket will reduce or stop altogether. That’s not always possible, though, at least in the short term. And even if we resolve one stressful situation, there’s likely to be another potentially stressful situation not too far behind. It’s possible to become more resilient, which we can think of as increasing the size of our stress bucket. Without being able to let stress out, though, any size bucket will fill up eventually.

We can let stress out in various ways. Think of this as making holes in the bottom of the bucket, or opening taps to let the stress out. Healthy taps include exercise, meditation, journaling, listening to music, or spending quality time with friends; anything that helps you relax, de-stress, and regain a sense of balance. Less helpful strategies include excessive use of alcohol or drugs, or attempting to ignore or avoid the issues. These may provide temporary relief but tend to feed additional stresses back into our bucket.

I like this model because it helps me focus on what I can change, and how I can best manage stressful situations without becoming overwhelmed or resorting to unhealthy coping strategies. I particularly like the taps imagery. It reminds me I can choose which taps I want to open, how much, and for how long. My taps include journaling, blogging, and spending time with friends.

Spoon Theory

Spoon theory was coined by Christine Miserandino in an article first published in 2003 at But You Don’t Look Sick. The article recounts a conversation with a friend in which Christine shares her experience living with lupus. She passes her friend a handful of teaspoons and explains that each spoon represents one unit of energy which must be relinquished as she goes through her day-to-day activities. The limited — and fixed — number of spoons reflects her need to continuously monitor her resources and manage her activities accordingly.

Although originally devised to explain what it’s like to live with the autoimmune disease lupus, spoon theory has been adopted by people living with a wide range of chronic physical and mental health conditions, characterised by limited resources of energy and focus.

It reminds me that activities that require little advance thought or planning for me, such as cooking a meal or taking a shower, might place major demands on someone who lives with illness or disability. It’s more than simply feeling tired. Someone with few remaining spoons for that day has to mete out their resources with extreme care. They might need to forsake activities or cancel arrangements in order to accomplish tasks that are more important or essential.

Although I wasn’t aware of spoon theory at the time, I recall Fran describing what it was like for her to try and make a sandwich when in the midst of a crushing depressive episode. “Oftentimes,” she said, “I would only get as far as opening a can of tuna and eating it from the can rather than bothering with getting mayonnaise and bread, to save the energy needed to wash the dishes. All energy had to be minutely calculated.”

Sine Curves of Mood, Pain, and Energy

Fran and I describe several models in our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder. One I’ve found especially helpful originated in an interview Fran gave on TV before we met. In conversation with Jennifer Rooks on MPBN, she described the ever-changing nature of her illnesses.

My chronic fatigue syndrome operates like this . . . [Fran draws an up and down sine wave in the air.] My bipolar depression operates like this . . . [She draws a second wave.] And sometimes they go like this . . . [She draws two synchronised waves.] And sometimes they go like this . . . [Fran draws two waves out of phase, so that one peaks while the other bottoms out.] It’s really quite a bizarre experience.

We’d been friends no more than a few weeks when I first watched the interview. Fran’s simple analogy of interwoven waves of pain, fatigue, depression, and mania helped me grasp what it’s like for her to live with multiple, independent yet overlapping, illnesses.

Waves on the Shore

Waves of a different kind feature in the model another friend uses to explore her relationship with depression. As she described for our book:

My analogy is a sunny beach. The sea represents my depression. If I’m in the water out of my depth I’m not feeling so good. If I’m knee deep I am getting better. If I’m walking on the beach with waves lapping at my feet it’s much better. If I’m on the dunes looking back at the sea view at sunset I am happy and content, at peace for a while.

The imagery reminds me of King Canute who demonstrated to his fawning couriers that he had no power over the incoming tide. Like Canute, our friend knows she cannot hold back the tide of depression by willpower alone. Her model nonetheless shows how important it is to take responsibility for what she can influence. She can alter her situation by swimming for shore or stepping onto dry land. In practical terms, this might mean changing aspects of her lifestyle and behaviour, taking prescribed medication, or employing therapies or other coping strategies.

Relentless Army Model of Suicidal Thinking

It can be difficult to convey what we’re going through to someone with no equivalent experience. I’ve never been suicidal but Fran described one aspect of her suicidal ideation in ways that I could understand.

Fran once described these [suicidal] thoughts as a relentless marching army. Each thought must be acknowledged individually, picked up, and set aside before she can take on the next. The assault repeats again and again, sometimes for hours. It is exhausting, and the danger is that weariness and desperation may lead Fran to harm herself, if only to stem the onslaught.

On other occasions she likened her experience to playing the video game Space Invaders, where the goal is to shoot down wave after wave of advancing aliens. It’s a powerful analogy, the difference being that failing to defeat the army of dangerous thoughts could cost Fran far more than a lost game.

Return to Down: My Baseline Mood Model

So far, I’ve described models which help me appreciate what it’s like for other people. What about when I want to talk about how things are for me? I’ve shared a few personal models and analogies here on our blog. One of the most helpful arose from an insight I had about my baseline mood slipping from positive to low.

I’ve always believed my emotional and mental health baseline to be essentially positive and healthy. Things might happen at times to upset my equilibrium, but after a shorter or longer period I return to my place of stability and wholeness. Lately, though, this model has been turned on its head. Instead of events and situations disturbing me from an essentially healthy baseline, it feels as though my baseline itself has shifted downwards. Positive events and situations such as meeting up with a friend, or feedback on one of my blog posts — essentially any of the things I was grateful for last week — can lift me up, lighten my mood, or provide an alternative focus for a while. But, once the distraction has passed, I’m pulled back to this low mood baseline.

There’s a parallel here with the rubber band analogy Fran uses to describe the “rebound crash of pain and fatigue” she experiences with her fibromyalgia if she exercises or exerts herself too much. I’ve yet to fully work through what it means for me, but it helps me navigate some of the (occasional) ups and (more persistent) downs I experience. It’s also helped in describing how I’m feeling to other people.

Two Models of Friendship

Our books and blog focus on mental health and supportive friendships. It’s no surprise, then, that I’m interested in models that relate to personal relationships. I’ll close with two I find helpful when working through issues with friends or exploring my need for connection and support.

In Dissolving the Circle I described my former model of friendship: an inner circle of close friends but almost no one outside of that circle. This served me for many years but led to a situation where I found it difficult to make new friends or handle the loss of people from within the circle. It took time but I eventually managed to dismantle that model and arrive at something much healthier.

In my world now there is no Inner Circle: just me and — everybody else! Of course, some people are closer to me than others, some relationships are stronger than others, but there is no circle, no event horizon. It’s been a revelation. Everything is dynamic, rich, colourful. And I feel free. I am free. I’m free to strike up a conversation one day with someone at the next table to me in a cafe, who seems to be having a rough time. I’m free to chat holiday plans with a couple I bump into most weekends. I’m free to sign up for a course without stressing that I won’t know anyone or whether I will be able to engage. I’m free to meet a new friend for coffee, to enjoy her company and the conversation, and for us to part without needing to know when we will next get together.

I explored supportive friendships in more detail in Spokesfriends and Insular Groups: What Kind of Support Network Do You Have? The distinction is between having a network of people who mostly know one another (one or more insular groups) and having friends who do not know one another well or socialise together (spokesfriends).

If I drew my network out on paper there’d be a dot in the middle representing me, with lines radiating out to each of my supportive friends, like the spokes of a wheel. [...] This kind of network is more likely if your friends live far apart, as mine do, although that’s not necessarily the case. A few of my “spokesfriends” have met, in person or online, but none of them know each other well or socialise.

In contrast, Fran has several small groups of friends, most of whom live locally to her. Within each group, people know one another and call or meet up more or less regularly. Fran’s support network could be drawn as a number of overlapping circles, plus me and a couple of others who aren’t in any of her groups of mutual friends.

It’s not a question of one type of network being better than the other, and in practice most people will have a combination of the two types. Exploring the two types of network, though, helps me grasp the different dynamics that can arise within and between friends. It’s a model I’ve used when discussing friendship and support with Fran and other friends.

Over to You

In this article I’ve described a number of models relating to mental health and supportive friendships. Do any of them resonate with you? Which ones and why? What models or analogies have helped you understand your health situation, or that of friends and loved ones? Fran and I would love to hear your thoughts, either in the comments below or via our contact page.

 

Photo by Lubomirkin at Unsplash.

 

Our Top Posts of the Month (February 2023)

Check out our top posts for the past month. Posts are listed by the number of page views they attracted during the month, most popular first.

1. Exploring Bipolar Disorder and the Sister Diagnosis of Schizoaffective Disorder. Is My Friend or Sibling Underdiagnosed?
2. The Fog Has Lifted: My Journey With Bipolar Disorder
3. It’s Time to Talk. But What If You Don’t Want To?
4. We Are All Made of Stories
5. Where There’s Hope There’s Life
6. How to Educate Yourself about Your Friend’s Mental Health Condition
7. Our Top Posts of the Month (January 2023)
8. What Does Having a Conversation about Mental Health Look Like? #TimeToTalkDay
9. Effective Strategies to Manage Paranoia in Bipolar Disorder and Schizoaffective Disorder
10. Call for Submissions: Hope for Troubled Minds: Letters Between Those With Brain Illnesses and Our Loved Ones

Our most visited pages were:

1. Contact Us
2. Our books
3. About Us
4. Resources
5. News and Appearances
6. Testimonials

 

Photo by Martin Baker.

 

How to Give Mental Health Help and Advice to People You Don't Know

Awareness campaigns such as Time to Talk Day encourage us to reach out for help if we’re struggling, and to be there for others who reach out to us. I’ve discussed some of the reasons people may not want to talk, but what about when they do? You might feel confident talking with a friend or loved one about their mental health, but what about someone you hardly know at all? In this post I share how I approach such requests, because it can be very different from talking about mental health with people I know.

Little or No Backstory

The most obvious difference is that I only know what the person has chosen to share with me. With a friend or loved one there’s a history and a relationship to draw on. A friend will choose to talk to me based on their trust in our relationship and in me personally. When someone approaches me out of the blue there’s very little to provide that broader context.

In the workplace I might be contacted in my role as a Mental Health First Aider. The person is necessarily a colleague but rarely someone I’ve worked with previously or closely. They work for the same organisation but could be based anywhere in the country. They may have heard my name mentioned by others, seen my e-mail signature which mentions my role as a Mental Health First Aider, or chosen me from the organisation’s list of MHFAs.

Outside work, the person might have found me through social media, our book, or this blog. Occasionally, I might have been suggested by a mutual friend. However it happens, they are approaching me based on their perception of my personality, knowledge, and experience. It helps if I know how or why they chose me, but that’s less important than the fact that they did, and their belief that I can help in some way.

ALGEE: The Mental Health First Aid Framework

Workplace conversations are conducted within the Mental Health First Aid framework, but I also find it useful when responding to other requests for help and advice. Known by its acronym ALGEE, the MHFA action plan has five steps which can be used in any order.

• A: Approach, assess for risk of suicide or harm.
• L: Listen nonjudgmentally.
• G: Give reassurance and information.
• E: Encourage appropriate professional help.
• E: Encourage self-help and other support strategies.

You can find more detail about the ALGEE action plan on the Mental Health First Aid website. The MHFA framework reminds me to pay attention to my responsibilities regarding safeguarding and escalation in the case of suspected crisis situations, and to maintain healthy boundaries.

The Initial Approach

With friends, mental health topics tend to arise naturally during regular conversation, whether that’s face-to-face, in chat, or on a voice or video call. If it’s more urgent, a text or message along the lines of “Something’s happened, can we talk?” will be enough.

It’s different with people I don’t know personally. In the workplace, the request is usually by e-mail or Teams chat, asking if I’m free to have a Mental Health First Aid conversation. The initial approach might be from the person concerned or their colleague or manager. There may be a little context or background, but that’s not always the case. We’ll decide a mutually convenient time, and meet face-to-face or via Teams depending on our location and availability. More often than not, I arrive for the meeting or open the call with little idea of what is about to be shared or asked of me.

Outside work, requests from people I don’t know arrive by e-mail or instant message. These tend to be longer and more detailed than workplace approaches. They generally describe the situation the person is in and what kind of help or advice they’re looking for.

Assessing the Urgency of the Request

No matter how it arrives, the first and most important priority is to take the request for assistance seriously. I may not be able to respond immediately but I’ll read the message at the earliest opportunity and assess how urgent it seems to be. If the situation appears urgent or critical, I respond straight away, signposting to relevant services, crisis or support lines.

If it doesn’t appear urgent, I think about when I’ll have time to give it the care and attention it deserves. The person will be looking for a response but it’s better for them to wait a little longer than receive something from me that appears rushed, or dismissive of their situation and concerns. If necessary, I might reply to say I’ll get back to them within the next day or so. That way, they know I’ve received their request and that I’m not going to ignore it.

Responsibility and Respect

I begin by reminding myself it’s both a responsibility and a privilege to be asked for help, advice, or support. I treat the person and their request with respect, recognising the courage it takes to reach out to someone you’ve never met and don’t know at all. Whether I can help them or not, they deserve to feel I’ve taken them and their request seriously.

What Am I Being Asked?

It’s important to assess what I’m being asked to provide. Does this person want someone to hear their story, or are they asking for practical help or advice? I was reminded of this distinction during one workplace Mental Health First Aid conversation. The person told me they were happy to talk about their situation all day, but they were looking for practical help and suggestions, not just someone to listen.

Advice, Information, and Signposting

I’m wary about giving advice, especially on the basis of limited information. Where possible I want to offer something practical, helpful, and positive. That often includes signposting to relevant resources, or suggesting next steps they might take. I’ve written previously about taking and offering advice, including whether I am good at taking my own advice.

If I feel an online resource would be helpful, I’ll take the time to find direct links to the websites or pages. This makes it as simple as possible for the person to check them out and decide if they’re relevant to their situation. Wherever feasible, I suggest support links and resources that are geographically relevant. Hub of Hope is a great starting point for anyone in the UK, offering crisis and support links based on your home location.

Clarity and Focus

It’s important to respond concisely and clearly to the points or questions the person raised, without rambling or going into too much detail. It’s natural to try and fill in the gaps but I resist the temptation to make assumptions or draw conclusions about the person’s situation. I find it helps to focus on the actual words they’ve used in their message or e-mail and proceed on the basis they meant precisely what they said: no more and no less.

In a face-to-face conversation it’s easy to check my understanding or ask them to expand a little on what they’ve said. This is harder where I’ve been approached in an e-mail. Where necessary, I might ask for further information or clarification, or simply state in my reply any conclusions I’ve drawn. This gives them the opportunity to consider my suggestions in context, and where necessary to correct any misundersandings.

Never Diagnose or Suggest Treatment

It might seem obvious but I make no attempt to diagnose the person’s mental health condition or suggest specific treatments. If they disclose that they or the person they’re concerned about has received a clinical diagnosis, it’s reasonable to take that into account, but it’s no part of my role to diagnose or recommend treatment. That’s solely the responsibility of the person’s doctor or clinician, and I would always advise they seek relevant professional advice.

Thank Yous and Follow Ups

I close by thanking them for approaching me, and invite them to follow up with me if they’d like to. I generally receive a reply thanking me for taking time to reply to their request. They sometimes expand a little based on what I said or suggested. On occasion, it’s clear that my suggestions were not as relevant or useful as I’d hoped, but that’s inevitable when working with limited information.

Self-care and Confidentiality

An important lesson from my MHFA training is the importance of considering my own boundaries and wellbeing. It’s rare for me to need support following a mental health conversation but I can draw on the network of Mental Health First Aiders at work, and the wider MHFA community. If necessary, I’d turn to my circle of friends for support. In either case, I take the privacy of the person who approached me for help, and the details of what they shared with me, very seriously. I would only divulge details if I felt the person was at risk.

Links and Resources

If you’re interested in finding out more about becoming a Mental Health First Aider, the websites of Mental Health First Aid England and Mental Health First Aid (US) are a great place to start. For international crisis lines and support organisations, check out our resources page. If you are in the UK, the Hub of Hope website and app can signpost relevant resources local to you.

Over to You

In this article I’ve described how I approach requests for mental health help and support from people I don’t know. Have you ever approached someone you didn’t know for help or advice? How did it go? Have you offered help and support to someone you didn’t previously know? Did you feel confident about being able to help them? Fran and I would love to hear from you, either in the comments below or via our contact page.

 

Photo by Timon Studler at Unsplash.