How to talk mental health after asking today

The aim of R U OK? Day is to encourage Australians to have open, honest conversations with one another to help reduce the country’s suicide rate. On average, more than 2,800 Australians commit suicide every year according to the World Health Organization.

“We want all Australians to take a moment to check in with someone and ask them, ‘Are you okay?’” says Janina Nearn, R U OK? co-founder and CEO. “A conversation could change a life.”

Saying you’re not okay

While Australians may have a “she’ll be right” attitude to life, it’s important to remember that it’s okay to admit if things are getting you down.

Some of the most vulnerable groups in our society include men over 55, who often need to be encouraged to speak up if something is wrong. Young people are also at risk, with a report from the Australian Bureau of Statistics finding suicide is one of the biggest killers of young people aged 15 to 24 years.

“It’s very common to feel alone when going through difficult times, but helping someone to admit they’re not okay is the first step to getting support,” says Professor Graham Martin, suicide prevention expert and chair of the R U OK? Scientific Advisory Group.

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Asking for help

Discussing a problem can help you feel less overwhelmed. If you don’t feel comfortable talking about it with a loved one, speak to your doctor or another trusted health professional.

Professor Martin says regularly checking in with each other can help build stronger relationships and communities. “You don’t have to be an expert to support someone going through a tough time, you just need to be able to listen without judgment and take the time to follow up.”

Davies says that two years after losing her brother, she has moments where she must “find the courage to say I’m not okay”.

“My advice is to first of all honour your feelings and emotions, realise you are not alone, and remember that your family and friends are the ones who have the ability – so long as you allow them – to carry you through to brighter days in the future,” Davies says.

“Without the support of those I allowed into my life in this way I doubt I would have come through this as well as I have. Please, please reach out – you’ll be surprised at how many of those around you really care about your wellbeing.”

How to ask “Are you okay?”

If you are concerned about a friend, family member or colleague, here’s how you can make a difference.

  • Start the conversation somewhere intimate and be relaxed and open.
  • Listen to them without judgment and give them time to talk.
  • Encourage action by suggesting they seek advice from a GP or caregiver.
  • Follow up by asking them how they are doing and reminding them that help and support is available.
  • If they are in denial, accept that they are not ready to talk yet and ask them if you can enquire about how they are sometime in the future.
  • “It is never too late to turn your life around”

For many of us, the hardest part about discussing depression is simply starting the conversation. But once you’ve made the initial step to raise the topic with a loved one, working out how to respond is often just as daunting.

Worrying about saying the wrong thing is totally normal, says psychologist Jocelyn Brewer, but it doesn’t have to stop you from reaching out. “Much of the time, actively listening without judging, interrupting or avoiding is a big part of what people are seeking – the sense of being heard,” she explains.

While there’s no such thing as the perfect script, there are some common responses that are universally unhelpful.

“It sounds like you’re having a really rough time… I’m here for you”

As much as you might want to ease your friend’s suffering, the most helpful thing you can do is show up. “Helping someone through depression often means sitting with our own discomfort and helplessness,” says Ash. “We don’t need to have all of the answers, we just need to show that we see that person, we see how much pain they’re in and we’re there to listen and support them.”

“That sounds really tough. You’ve been coping pretty well but I wonder if talking to someone would help you work on these issues?”

Reframing therapy as an opportunity to grow and improve rather than an indication of a personal deficiency is key, says Brewer. “[This phrase] includes a reflection of what you’ve heard, a compliment or recognition of their abilities, then encouragement to take further steps,” she explains.

Be aware that you might need to revisit this suggestion a few times before it lands. “Sometimes people need to sit with this idea for a while before accepting and acting on it,” adds Ash. “If you foster gentle encouragement and openness to continue the conversation about depression, and check in daily with how they’re feeling, they may slowly open up and consider this option.”

“I had an experience that sounds similar. Would you like to hear what worked for me?”

Sharing your own struggles with mental health can be a really powerful move if it’s handled with care – it shows your loved one that they’re not alone and there’s hope. A sensitive way to do this, says Brewer, is to ask permission to tell your story. “Just keep in mind that what worked for you might not work for someone else,” she adds.

“I’m going for a walk this afternoon. Would you like to come with me?”

Rather than presenting what Brewer calls a “wellbeing shopping list”, take the pressure off with a gently collaborative approach.

“To help someone feel in control of their recovery, it’s good to get them as involved as possible – for example, going for a walk or making dinner together,” Ash says. If they’re not up for it, don’t push the point – give them another opportunity later.

“I just want to check in to see if you’re thinking of hurting yourself?”

“You’re not going to do any damage by asking this question,” Ash explains. “If the person has been thinking about it, asking this can be quite relieving for them. If they say they’re not thinking about it, you may want to say something like, ‘If this ever changes, I’m here for you to talk to about it.’ It’s important to keep this conversation open.”

If they admit to having suicidal or self-harming thoughts, the key is not to panic but to keep the conversation flowing so you’re able to gather more information. “A rough guide is that if a person is having suicidal thoughts but doesn’t have a plan, give them a space to talk about their thoughts and let you know if it changes,” Ash explains, adding that if the person is having these thoughts quite often and has thought about a concrete plan, they’ll need more support and monitoring, and are “best linked in with a mental health professional”.

What you SHOULDN’T say to someone after asking “Are you okay?”

“You need to think more positively”

When you’re supporting someone with depression, it’s natural to slip into fix-it mode. Positive thinking might seem like good advice, but it can leave your loved one feeling misunderstood – if it were that easy, they’d have done it already. “It really invalidates the power that depression has over someone,” explains April Ash, a clinical psychologist at Sydney practice The Indigo Project. “Although changing our mindset is a big part of therapy for depression, this isn’t something we can just turn on and off. People need a lot of help in shifting their mindset.”

“You should see a psychologist”

While attitudes to mental illness are changing, it still carries a lot of stigma, which is why this well-meaning suggestion can sting. “Often people are worried about being perceived as too weak; that they’ve failed in some way or let people down; that they should be able to do it alone; that there are people worse off than them and by asking for help they’re burdening others,” Ash explains.

“I know exactly how you feel”

Relationships are built on common ground, so it’s natural to want to empathise with your friend in this way. But no-one can truly understand what’s going on in someone else’s mind, so this response can end up pushing your loved one further away. “It’s important to acknowledge that everyone’s journey is very different,” explains Ash. “The best way to avoid assumptions is to be curious about the person’s experience and to ask open questions.”

“Why don’t you try exercising?”

Yes, exercise is a proven mood-booster but when you’re in the grips of depression, going for a walk around the block can feel as monumental as a marathon.

“Many people with depression will struggle to activate goal behaviours, and making them seem simple and easy can distance you from them because they might feel incompetent or hopeless,” explains Brewer.

“You’re not going to hurt yourself, are you?”

It’s important to openly talk about suicide and self-harm with your friend, as these thoughts are really common when people are feeling low, says Ash. One of the mistakes people make when broaching this topic is to ask closed questions. “We generally do this because of our own fears,” Ash says. “We don’t want to hear the answer or we want the answer to be ‘no’ so we inadvertently show that we’re not OK with the answer being ‘yes’.”

But, if you’ve said the wrong thing…

Don’t beat yourself up – just apologise and start over. “We’re all trying our best and sometimes we get it wrong,” says Ash. “This can be an opportunity to have an honest conversation and work out what can be done differently.”

1. Talk to them

This might not be easy and can be an incredibly hard topic to address for both you and your partner, however, it can definitely be done. Remember that talking also involves a high degree of listening; make sure you have the conversation in a safe environment and keep the dialogue open. Avoid using “you” language, which can often come across as “blaming” language and can make your partner or loved one feel isolated and alone in their journey. Instead, offer compassion and an open mind free of judgement, and try to understand what it’s like to walk in their shoes. During this conversation let your partner know you support his or her journey and explore avenues of help such as online therapy sessions that can be available to them in their own time.

2. Choose your timing

It is important to choose timing wisely when discussing your partner’s mental health with them. Do not bring it up during or straight after an argument or when either of you are emotionally charged. Choose a time when you’re both seemingly calm and can have an open conversation without any anger or frustration already involved. And always remember, although bedtime seems like a great opportunity to open heavy conversations, this isn’t the time nor the place. Ensure you are both as rested as possible and present. Talk about it when you both have time, are available emotionally and don’t have a lot stress on your plates.

3. Look after yourself

Often when we deal with our partners issues, it can be very easy to take on their emotional condition. It is extremely important to look after yourself so you don’t burn out. Emotions can be transferable so try to maintain your normal level of emotion, stay calm, and engage in self-care. Make sure you set some time aside just for yourself through this difficult time and use your support system. Remember, we can’t pour from empty cups so rest and relaxation for you is equally important.

4. Be aware of the options

When talking to your partner about what they are going through, make sure you have reliable information that can support them. Whatever the issue, be sure to let them know that there are many options that can support them through their journey. They do not need to suffer in silence or without any help. Offer some support suggestions such as seeing a psychologist or partaking in activities that might help to improve their mood such as exercise. It is important to let them know that there are experts as well as social supports available to help them through their issue.

5. Seek out the expert advice

Even if your partner doesn’t feel ready to talk to someone, do your own research around things that could potentially help them. Expert advice can also help you in coping with the situation and provide you both with healthier alternatives to get through this trying time. Assist your partner to seek help from their GP to get a referral to a psychologist that could be the right fit for them. It’s important to be aware that experts are equipped to deal with these issues and to not try to take on all the responsibilities yourself. A professional can provide a fresh perspective without emotional baggage, which can be quite valuable. The aim is for you to support your partner and not try to fix them.

1. Improve your diet and start moving

Wholefoods such as leafy green vegetables, legumes, wholegrains, lean red meat and seafood, provide nutrients that are important for optimal brain function. These foods contain magnesium, folate, zinc and essential fatty acids.

Foods rich in polyphenols, such as berries, tea, dark chocolate, wine and certain herbs, also play an important role in brain function.

In terms exercise, many types of fitness activities are potentially beneficial – from swimming, to jogging, to lifting weights, or playing sports. Even just getting the body moving by taking a brisk walk or doing active housework is a positive step.

Activities which also involve social interaction and exposure to nature can potentially increase mental well-being even further.

General exercise guidelines recommend getting at least 30 minutes of moderate activity on most days during the week (about 150 minutes total over the week). But even short bouts of activity can provide an immediate elevation of mood.

2. Reduce your vices

Managing problem-drinking or substance misuse is an obvious health recommendation. People with alcohol and drug problems have a greater likelihood than average of having a mental illness, and have far poorer health outcomes.

Some research has shown that a little alcohol consumption (in particular wine) may have beneficial effects on preventing depression. Other recent data, however, has revealed that light alcohol consumption does not provide any beneficial effects on brain function.

Stopping smoking is also an important step, as nicotine-addicted people are constantly at the mercy of a withdrawal-craving cycle, which profoundly affects mood. It may take time to address the initial symptoms of stopping nicotine, but the brain chemistry will adapt in time.

Quitting smoking is associated with better mood and reduced anxiety.

3. Prioritise rest and sleep

Sleep hygiene techniques aim to improve sleep quality and help treat insomnia. They including adjusting caffeine use, limiting exposure to the bed (regulating your sleep time and having a limited time to sleep), and making sure you get up at a similar time in the morning.

Some people are genetically wired towards being more of a morning or evening person, so we need to ideally have some flexibility in this regard (especially with work schedules).

It’s also important not to force sleep – if you can’t get to sleep within around 20 minutes, it may be best to get up and focus the mind on an activity (with minimal light and stimulation) until you feel tired.

The other mainstay of better sleep is to reduce exposure to light – especially blue light from laptops and smartphones – prior to sleep. This will increase the secretion of melatonin, which helps you get to sleep.

Getting enough time for relaxation and leisure activities is important for regulating stress. Hobbies can also enhance mental health, particularly if they involve physical activity.

4. Get a dose of nature

When the sun is shining, many of us seem to feel happier. Adequate exposure to sunshine helps levels of the mood-maintaining chemical serotonin. It also boosts vitamin D levels, which also has an effect on mental health, and helps at the appropriate time to regulate our sleep-wake cycle.

The benefits of sun exposure need to be balanced with the risk of skin cancer, so take into account the recommendations for sun exposure based on the time of day/year and your skin colour.

You might also consider limiting your exposure to environmental toxins, chemicals and pollutants, including “noise” pollution, and cutting down on your mobile phone, computer and TV use if they’re excessive.

An antidote to this can be simply spending time in nature. Studies show time in the wilderness can improve self-esteem and mood. In some parts of Asia, spending time in a forest (known as forest bathing) is considered a mental health prescription.

A natural extension of spending time in flora is also the positive effect that animals have on us. Research suggests having a pet has many positive effects, and animal-assisted therapy (with horses, cats, dogs, and even dolphins) may also boost feelings of well-being.

5. Reach out when you need help

Positive lifestyle changes aren’t a replacement for medication or psychological therapy but, rather, as something people can undertake themselves on top of their treatment.

While many lifestyle changes can be positive, some changes (such as avoiding junk foods, alcohol, or giving up smoking) may be challenging if being used as a psychological crutch. They might need to be handled delicately, and with professional support.

Strict advice promoting abstinence, or a demanding diet or exercise regime, may cause added suffering, potentially provoking guilt if you can’t meet these expectations. So go easy on yourself.

That said, take a moment to reflect how you feel mentally after a nutritious wholefood meal, a good night’s sleep (free of alcohol), or a walk in nature with a friend.

Headspace (Free for 10 days, then about $18.57 a month, iOS and Android)

Learn to meditate with this app’s guided sessions and mindfulness exercises. Scientific studies have shown Headspace helps to reduce stress, and increase mindfulness and sense of wellbeing. Plus, the first 10 sessions are free.

Mood Coach (Free, iOS)

This app aims to boost your mood through ‘behavioural activation’, a popular CBT technique. Created by the US Department of Veterans Affairs, it helps you set goals, schedule positive activities in your day plus track your mood and progress. It also includes information about depression.

MindShift CBT (Free, iOS and Android)

Developed by Anxiety Canada, this app provides CBT–based tools to help you take charge of your anxiety. It includes guided meditations, coping cards, a thought journal, goal setting, belief experiments, and tips for creating healthy habits to set you up to manage anxiety better.

HeadGear (Free, iOS and Android)

HeadGear was developed by researchers at the Black Dog Institute, the University of Sydney and UNSW. It’s been designed particularly for men, and guides you through a 30–day mental fitness challenge using behavioural activation and mindfulness.

MoodMission (Free, iOS and Android)

Elegantly designed and colourful, MoodMission was created by two psychologists with support from Monash and Swinburne Universities. Simply tell the app how you’re feeling and it provides you with five ‘missions’ to improve your mood, based on cognitive behavioural therapy.

To mark R U OK Day? today, remember to check in with a loved one. For more info, visit ruok.org.au. If you or someone you know needs help, call Lifeline on 131 114 or Beyond Blue on 1300 224 636.