While I sipped coffee and munched on a croissant, a supervisor approached me. I had just finished performing ‘Funny You Don’t Look Crazy’ (my story of mental illness and return to work) for a quiet but wonderfully engaged group of managers at a breakfast training event.

He confessed one of the biggest barriers he, the managers and staff face is being comfortable talking about mental health at the company. “We know how to discuss physical illnesses, but mental health issues? Not really.” It’s one of the most common remarks I hear. We don’t have an accepted vernacular and we’re not practiced at it.

Silence kills

This discomfort can lead people to say nothing, ranging from not intervening when they see someone in distress or not speaking up when they need help for themselves. Enter the deadly (literally) silence.

Results from a University of Oxford study found leaving serious mental illness untreated can shorten an individual’s life by as many as 10 to 20 years, similar to the mortality risk of tobacco smokers. 1

I started performing my one person shows about my experience with bipolar disorder and recovery back in 2001. At that time, other than Margot Kidder and Kay Redfield Jamison, there were few people divulging the personal secret of psychiatric disorder.  

Over the last 15 years though, we’ve made good strides in addressing mental health and making it more common place to discuss. We have the “Bell Let’s Talk” campaign, Mental Illness Awareness Week in October and Mental Health Week in May, to name just three.

However, even with these awareness initiatives, the discomfort of discussing mental illness in the office remains, and silence ensues. Silence breeds fear, drives myths and lets stereotypes remain unchallenged. These then reinforce reasons (though unfounded) for individuals who are struggling to refrain from getting help.

Using data collected from close to 500 university staff and students, a 2014 Australian study found the “silence surrounding mental health problems permeates … environment(s) and impacts on help seeking behaviours… (and the) recovery and well-being of affected individuals.” 2

According to another study out of Toronto, silence has negative implications for relationships and productivity in the workplace as well. 3

Programs that raise awareness and aim to reduce stigma are important. But if people’s discomfort of discussing mental illness is never addressed, these campaigns will be of little long term benefit.

4 steps to create comfortable conversations about mental health

Whatever role you hold in your company, the following are 4 strategies to increase your comfort and effectiveness when discussing mental health.

1. Find Company Mental Health Champions. Share Stories. Get Real.

Safe, inclusive and supportive environments will stop the silence on mental health.

Elio Luongo, Chief Executive Officer and senior partner, KPMG in Canada in a Special to The Globe and Mail agrees. How they went about that was a first in corporate Canada.

In 2017, they created the role of Chief Mental Health Officer (CMHO). They enlisted, Denis Trottier, an audit partner who has “lived through clinical depression while maintaining a successful career”. 4

Having an individual willing to disclose their own experience with mental illness and recovery can open up dialogue, change perceptions and create comfort faster than any other kind of educational program. Patrick Corrigan, one of the foremost experts in stigma research, found in study after study, the most effective method to change attitudes about mental health is what’s called contact-based behavioural health anti-stigma interventions. That is, “people with lived experience of mental illness or substance use disorders interact with the public describing their challenges and stories of success.” In fact, this kind of approach is twice as effective as an educational program alone. 5, 6

At Coast Capital Savings, then CEO Lloyd Craig, shared his devastating story of losing his son to suicide. Craig was a pioneer in workplace wellness initiatives and the Credit Union became a model for workplace mental wellness. In a short time, measures they took, which included Craig sharing his story, produced noticeable results. 7

Discomfort around mental health will only dissolve when people see it’s safe to share stories and ask for help. As Luongo puts it, it’s essential “we walk the talk, right from the C-suite level so that our people can be comfortable sharing their stories and talking openly about mental health at the firm.”

2. Be prepared for and accept the uncomfortable feelings.

Like difficult conversations that are…well…difficult. Uncomfortable topics are… well…uncomfortable. Paradoxically, knowing and accepting that something will be uncomfortable can make the experience easier to bear. Two studies out of Denver found accepting (versus avoiding) negative emotions was shown to be associated with reduced levels of anxiety and stress.8 Prior to talking about mental health, assume unpleasant emotions and sensations will rise within you. Your job is only to tolerate them, be mindful of those awkward feelings and continue the discussion. Preparing for them will make the conversation easier.

3. Practice talking about mental health.

Practice brings experience. Experience brings mastery and mastery brings confidence. 9, 10  Be intentional. Start with low risk situations. Take strategic opportunities to discuss mental health in casual conversation in positive terms. The more you do, the easier it will become. For example: decide that for each day over the next week, you will learn something about mental health and share it with others at work or on social media. Or choose to disclose something personal about how you stay mentally healthy. Let people know what you are doing and encourage them to join. Ask people what do they do to stay mentally well.

4. Make it fun and be curious.

This sounds counter intuitive, even improbable, maybe even insensitive. Make mental health fun? Yes. Even though mental illness can be a heavy subject that doesn’t mean learning about it, or creating a supportive environment, has to be. I consider myself to be an mental health icebreaker of sorts. I use a lot of humour as I share my personal experience with anxiety, depression and psychosis. Yes, I’ve managed to find something pretty funny about running down the street naked while in a psychosis – I think flirting with the ambulance guys has something to do with it.

Self-deprecating humour goes a long way to help people feel like they don’t have to walk on eggshells. A lighthearted and respectful approach opens dialogue up as well as people’s hearts and minds. The more serious we are about a subject, the more cautious we are asking questions and the more difficult it is to discuss.

Start simply. Hold short lunch n’ learns that explore well-being, host interactive workshops that offer strategies for mental wellness and self-care. Focusing on mental wellness first, can prime the pump for mental illness topics.

Silence is not golden. Speak up.

Michael Landsberg, former sports host of TSN’s Off the Record , lives with generalized anxiety disorder and depression and is a staunch mental health activist. He says: “When we talk openly, frankly and honestly about mental health, we’re one step closer to healing.” 11

The silence around mental health will only be broken if we take the risk to speak up. Every time we make a decision to talk about it, and not remain quiet, the more healing is possible. This means healthier companies, stronger communities and more vibrant families.  

How do you speak up about mental health at your work? Comment below and let me know.

For more Mental Health resources, tips & tools, sign up for my newsletter.

© Victoria Maxwell

References

1. University of Oxford. “Many mental illnesses reduce life expectancy more than heavy smoking.” ScienceDaily. ScienceDaily, 23 May 2014.

2. Curtin University. “The silence of mental health issues within university environments: a quantitative study.”: Archives of pychiatric nursing, Vol: 28, Issue: 5, Page: 339-44 Publication Year: 2014

3. University of Toronto. “Mental Health Issues and Work: Institutional Practices of Silence in a Mental Healthcare Organization” by Sandra Moll; Doctoral Thesis, 2010 

4. “Corporate Canada needs to help break the silence on mental health”  by Elio Luongo; Special to The Globe and Mail; January 31, 2018

5. Corrigan, P.W. (2012). Where is the evidence supporting public service announcements to eliminate mental illness stigma? Psychiatric Services, 63(1), 79-82.

6. National Academies of Sciences, Engineering, and Medicine. 2016. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. Washington, DC: The National Academies Press. 

7. “Employers Who Are Walking the Walk” by Donna Panitow; Reprinted from “Workplaces” issue of Visions Journal, 2009, 5 (3), p. 29-30

8. Let it be: Accepting negative emotional experiences predicts decreased negative affect and depressive symptoms. Shallcross AJ, Troy AS, Boland M, Mauss IB. Behav Res Ther. 2010 Sep;48(9):921-9. doi: 10.1016/j.brat.2010.05.025. Epub 2010 Jun 1.

9.  Conger KJ, Williams ST, Little WM, Masyn KE, Family Research Group B. Development of Mastery during Adolescence: The Role of Family Problem Solving. Journal of health and social behavior. 2009;50(1):99-114.

10. Why a Sense of Mastery is the Key to a Better Confidence?  by Evelyn Marinoff

11.  Michael Landsberg, quote: https://www.thelavinagency.com/speakers/michael-landsberg

When mental illness hits, it can hit hard. It hits the person who has it hard and it hits the family equally hard – though in very different ways.

One of the most common questions I get after my workshops and keynotes is, ‘How can I help my loved one when they don’t think they need help to begin with?’ So common in fact I’ve written two previous posts, one on my Psychology Today Blog: How to Help Your Adult Child if They Have a Mental Illness and another on my own: Families Falling Apart. There are many reasons for not wanting help. Denial, shame, anosognosia (the inability to be aware of one’s illness – a frequent symptom of psychosis itself ). 

Regardless of the reason, as a family member or friend, it can feel powerless. I’ve been on both sides of the path. I was that ‘someone’ with bipolar disorder, anxiety and psychosis who wouldn’t accept the diagnoses for years. I am also the daughter of a mom with bipolar disorder and severe anxiety, who has accepted the diagnosis, but does little more than take medication, which unfortunately succeeds in alleviating only a few of her symptoms. Good treatment involves more than just medicine.

But there are steps you, as a loved one, can take. Here are a few to help you help your family member or friend move forward on the journey to recovery and wellness. Take what you like and leave the rest.

1. Remember the journey to accept that there IS a problem, is theirs alone. You can help prep the ground, by having discussions and listening with an open heart, by setting clear boundaries, by offering information when appropriate. You can help create an environment that increases the chances of the person reaching out for help, but you can’t do it for them.

Anyone who’s been in this position knows, it takes more than one conversation. It takes many. It’s about opening the door of possibility. It’s about voicing your concerns with compassion and clarity and without judgement. Difficult, I know – especially when the struggle has been going on, in some instances, for years. But the rewards of avoiding power struggles, directives and arguments are great. A list of resources follows at the end of this post.

At the same time, it’s about setting boundaries for your own well-being and recognizing you are not responsible for their health and happiness. If you’re a parent of an adult child, this is one that is most heart breaking to learn and understand. Letting go is tough even when the adult child is well and thriving.

2. Rebuild trust and rapport. When family members ask me how to help their loved one, the issue has frequently been going on for quite some time. During that period, entrenched power struggles usually have developed and mistrust on both sides has been established. Your adult son or daughter, brother or parent, may continue to get angry when you suggest anything. The trick is for you to NOT get angry back. Easier said than done. Tools from Dr. Xavier Amador’s LEAP (Listen Empathize Agree Partner) method (below) may guide you how to listen without creating power struggles and rebuild trust essential for healing. Dr. Lloyd Sederer’s TEDx talk offers excellent tips and encouragement.

It was important that my treatment was a shared decision-making process; that those around me, both parents and professionals, didn’t try to convince me to do something. I needed to have people empathize, understand and reflect back my experience. The more I felt respected and heard, the more open to suggestions I became because I felt like I was being empowered not attacked.

3. Evaluate whether you really are the best person to talk to your loved one right now. Be honest. If conversations almost always end with tempers flying, another person who has his/her best interests at heart and can communicate more easily is a better option – at least for now.

4. Invite your loved one to go to the doctor together to address a legitimate physical issue. The problem could be poor sleep, or frequent headaches. You might feel that they stem from a mental health issue, but tending to a physical complaint is often easier to address first.

If mistrust and tension in your relationship is high, this may not be a good option. But, it’s surprising what sometimes works. The goal is to have them be willing to see someone for a general check-up. In that appointment have a mental health check-up too.

Resources:

  • Crisis Lines:  If you need help immediately, please search this list of crisis lines and centers and contact one of them right away.
  • Download this free Mental Health Resources and Tips e-guide I created from my website. It has many of the resources listed here and others for loved ones, individuals living with mental illness and employers and staff.
  • Dr. Lloyd Sederer’s TEDx talk ‘When Mental Illness Enters the Family offers excellent tips for parents, loved ones and others when supporting someone who is struggling with mental health issues but isn’t able to see they need help. In addition to his talk, he has a widely praised book “The Family Guide to Mental Health Care: Advice on Helping Your Loved Ones
  • Dr. Mark Komrad’s video has some good points. I wouldn’t watch the first part but from 49:30 minutes he describes when, how to talk to someone, some do’s and don’ts. Some of his approach is paternalistic, but some of the tips are useful. His book “You Need Help! A Step-by-Step Plan to Convince a Loved One to Get Counseling may be a helpful read. I can’t vouch for the info as I haven’t read it yet, but it comes recommended.
  • Dr. Xavier Amador’s book “I don’t need Help, I’m Not Sick describes his well-known LEAP (listen, empathize, agree, partner) approach. This post gives a concise summary of his LEAP programThis video illustrates a role play contrasting a traditional communication method and his LEAP method: Dr. Amador focuses heavily on anosognosia (when someone lacks the ability to be aware that they are ill). He makes a point to differentiate this from denial. You can find individuals who have been trained in his method on his referrals page.
  • Practical tips for family and friends on the “Living with Mental Illness: A Guide for Family and Friends” website.

I hope these resources help. Let me know if they do. If you have ones not listed here that are especially effective, please mention them in the comment box.

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© Victoria Maxwell