It can be hard to know how to start a discussion about mental health, but the important part is that it gets started at all.
“The most important thing to realize is that it’s better to say something and be wrong than to not say anything and to wish you had,” said Gayle Robbins, director of Counseling and Psychiatric Services at the University Health Center. “If you see something, say something.”
According to the Centers for Disease Control and Prevention, 25 percent of all adults in the United States have struggled with mental illness at some point in their lives – whether they’ve been treated or not depends on if they or someone close to them spoke up about their situation.
“Think of a classroom of 20 – which is small on this campus – that’s five of those people in that classroom,” said Robbins. “So it is, sadly, not uncommon. What is unfortunate is that a number of people don’t get the help that they need.”
Many people don’t get treated because of the fear and stigma that surround mental illness, Robbins said. In other instances, they may not recognize the change in their own behavior, which is why it is important for friends, roommates and classmates to know how to approach someone they’re worried about.
“I think that we probably get a dozen or so if not more phone calls a week from a roommate or a friend or a peer in a class that is unsure about how to approach a student or unsure if what they’re seeing the other student doing may suggest the other person is at risk,” she said.
Step One: Say something to someone
How well you know the person might determine how far you go in getting involved, Robbins said. If it’s a classmate, you might speak to the teacher about the situation, or if it’s an acquaintance, you might speak to one of their closer friends.
If it’s a roommate you don’t know well, Resident Assistants might be able to offer advice as well.
“We have about 7,500 students in our 21 halls. It’s impossible for us to be in every room at every minute of the day, so we need everyone’s help,” said Rick Gibson, director of residential programs and services. “If they show that concern, unfortunately it may upset the roommate. That’s why you go talk to the RA. We’ll try to help mediate that conversation as well to say, ‘look this was out of concern for you and you should feel happy that that’s happening.’”
Step Two: Normalize the situation
If it’s someone you know better, like a friend or a roommate, a good way to start is to “normalize” what might be an overwhelming situation by letting them know many people face these sorts of challenges, Robbins said.
For example, the Jed Foundation – which promotes mental health and suicide prevention – says half of all college students say that at some point they have been so depressed they haven’t been able to function, do work or socialize. The foundation partners with mtvU on a program that features artists like Brittany Snow and Mary J. Blige discussing their own struggles with mental illness.
Step Three: Offer help getting help
“So once you’ve normalized it, say ‘I’m kind of worried about you and I’d like to get you some support. Would you be willing to go over to CAPS, would you be willing to call CAPS? I’ll help you with it. I’ll make the call and hand the phone off to you to make the appointment,’” Robbins said.
She said for many people who feel isolated by how they feel, just knowing that someone cares about them is enough to get them talking or willing to get help.
CAPS offers counseling sessions where you can role play a situation approaching someone you’re concerned about.
Step Four: What to do afterwards
How involved a roommate or friend should be after someone starts getting treated depends on the situation.
“It’s okay to ask, ‘Can I ask you how it went? And know that I’m here to talk to about it if you want. I’d love to know how I can support you,’” Robbins said. “Now, some people’s boundaries don’t want that level of support and in that case it’s okay to say ‘I’m glad that you went and I hope it went well.’”
It’s also important to understand how treatment works for different people. Robbins said diabetes is a good parallel.
“Some people with diabetes can control it through diet, other people need oral medication and other people need insulin,” she said.
With mental illness, some people need psychotherapy, some people need medication and some people need a combination of both.
"Psychotherapy still helps because it helps you understand and cope with the fact that you’ve got a chronic medical condition and that you’re going to need to be on medication,” Robbins said.
Friends should remember to be patient and encouraging as people start treatment because it may take a while to find the right one, said Jessica Parker, the chapter president of Active Minds – a student organization dedicated to the mental health discussion.
“Not everything works for everyone, so they may go through a period of trial where they try different medications, try different therapies and an important aspect for the friend in that part would be to remain in contact with them while they’re going through this,” Parker said.
Robbins said many students worry that, after they’ve been diagnosed with a mental health disorder, people will be afraid of them – a stigma perpetuated by the language used to describe the mentally ill in the news media, TV programming and movies. Many students feel ashamed.
“It’s biological and psychological and there are a ton of different factors that load into what causes mental illness, but that’s not the way people perceive it and that’s been the way for years that it’s been done,” Robbins said. “It goes all the way back to Descartes who said there’s a distinction between the mind and the body and the soul, and when it went into that realm and people believe because they couldn’t identify the gene or the medication that would solve it they put it into a different category of illness.”
Robbins said identification of mental health as a disorder in the same category as cancer or diabetes is becoming more common as more links are made between illness and genetics.
Parker said it may help the person to use people-first language, rather than defining them by their disease.
“You put the person first before the disorder,” she said. “They’re a person with schizophrenia or affected by schizophrenia. But they’re not a schizophrenic. And that’s an important aspect because they let themselves become defined as a schizophrenic in their own mind.”
Step Five: Remember you can’t be a doctor but you can be a friend
It’s important to remember that it’s not your job to provide a diagnosis or counseling to someone, Gibson said. The training undergraduate housing workers receive reflects that.
“I don’t want an RA to feel like we’re putting them in a situation that is going to get them in over their head,” he said. “So the reason we train them is to basically be aware of your environment. Know your residents, get comfortable with who everyone is and if you’re gut’s telling you that something’s not right, your job is to consult up. Not to go spend five hours with someone asking a series of questions that would be done during an intake session at CAPS."
Robbins said it was important to remember not to promise confidentiality when trying to help someone. As a professional psychologist, she said she is required to keep things both confidential and privileged, but students do not, and shouldn’t feel that it should keep them from getting help.
“But the bottom line,” she said “is to say something around, ‘I’m concerned about you, I care about you, I want to get you the support that I think you might need. I’m not sure what that is but I want you to know that I’m going to keep what you say private if I can. If I need some assistance I might call someone just to ask them what they would suggest I do.’”
Parker said while it was important to ask if there is anything you can do for the person to help them with getting to treatment, it shouldn’t be the only thing you talk about because it can make the other person feel disempowered.
“If you went to the movies occasionally, then you should continue to do that. If you are going to the store, then maybe invite them,” she said.
Step Six: Everyone’s physical safety comes first
If you every feel like you or the person in question is ever physically in danger, you should certainly call the police, Robbins said. But the police are not automatically involved in every case – which she said is a common assumption.
“We will only get the police involved if we’re worried about someone’s safety,” she said.
In short, the best thing to do – as with any ailment – is to speak up and get help.
“The best thing to do to is to get the condition treated early,” Robbins said. “And if you can prevent it by catching it when you’re still in that I feel yucky and irritable stage, that’s even better. Because that’s like the diabetic who realizes that their blood sugar’s going up and down and they just need to adjust their diet.”