Peaks and Valleys

How to start a conversation with someone who may be struggling with mental health

What happens when someone in the “happy valley” finds themselves feeling sad or depressed? Despite living in a beautiful place, there are universal challenges that affect everyone, regardless of gender, age, religion, cultural or sexual orientation. Family, work, school, finances, health and relationships can all cause fear, anxiety and sadness. 

When people experience hardship, they sometimes feel like they’re the only ones struggling. Social media  can exacerbate the sense that everyone else is happier, thereby creating further isolation. A 2018 Pew Research Center study found that almost 25% of teens view social media as having a negative effect, with 15% of the respondents citing it creates unrealistic views of others’ lives.

Acknowledging and talking through challenging experiences can help people feel more connected and less vulnerable. It can also be profoundly healing. When someone is experiencing intense feelings, the brain’s amygdala goes into full gear to process emotions. This is the part of the brain that is responsible for the fight-or-flight response. A 2007 neuroimaging study from U.C.L.A. suggested that turning feelings into words–a process referred to as “affect labeling”—reduced the amygdala's response. By labeling feelings as sad, scary or confusing, for instance, the parts of the brain that control language and meaning are activated, and the person becomes less reactive and more mindful. 

“Talk therapy allows for a dialogue that identifies patterns in thought and behavior, creating an organic space for clinical rapport-building and trust,” explained Kala Bettis, a licensed professional counselor and the integrated behavioral health supervisor at Vail Health Behavioral Health. “People can then learn to understand how their experiences can be overcome by behavioral change.”

While licensed therapists, psychiatrists, psychologists and other mental health professionals are specially trained in assessing, diagnosing and treating mental health conditions, venting to a trusted friend or family member can also be helpful. 

Sometimes it’s difficult for people to reach out for help. Pride, fear or guilt can prevent people from talking to others about their feelings. Bettis warned, “Suppressing emotions can lead to manifestations that affect our health not just mentally, but physically. Stress, trauma and conflict can contribute to chronic pain, isolation and more, holding individuals back from experiencing their healthiest lives.”

Because it can be hard for people to open up, it’s often more effective when someone else starts the conversation. Everyone should be checking in with family members, friends, neighbors, co-workers. But how can you tell when someone is struggling? How do you ask what’s wrong? What do you say when someone shares difficult feelings? What if you say the wrong thing? What if talking to the person makes you sad too? 

Vail Health Behavioral Health empowers people to help each other through the inevitable ups and downs in life by providing conversation-starters, resources and tips at OurPeaksAndValleys.org. 

The Peaks and Valleys campaign’s visuals don the pages of the Vail Daily with comic strips that illustrate real-life situations in which a person is struggling, someone lends an ear and they both realize, “Talking to the right person at the right moment can make all the difference.” 

“People are struggling with their mental health here in Eagle County just as they are throughout the country,” explained Vail Health Behavioral Health Executive Director Chris Lindley. Social media addiction, 24/7 news cycles, a growing increase in sedentary lifestyles, combined with more highly processed foods infused with sugar additives, all negatively impact our mental health. Add an interpersonal stressor—the loss of a loved one or increased stress at work or school—and the fragile balance of our mental health changes. We are all struggling in one way or another, so why not take that struggle and use it to help someone else? That’s why our Peaks and Valleys campaign is so important.”

“We talk openly about our physical health,” said Lindley. “An orthopedic injury creates bragging rights, for instance. When someone is diagnosed with cancer, people bring food. But how often do we check in on a friend who is struggling with anxiety, depression or a child who’s abusing drugs?” 

Following are some suggestions for recognizing the signs that someone is struggling, starting the conversation and offering the right kind of support.

HOW TO RECOGNIZE WHEN SOMEONE NEEDS TO TALK
Staying connected with family and friends can help you recognize when they are sad, depressed or even suicidal. Get together regularly, schedule a weekly phone call or spark a conversation via text now and then. Signs that someone is struggling and needs to talk include anxiety, guilt or lack of interest; restlessness or agitation; anger or violent outbursts; avoidance of friends and social activities; risk-taking behavior, including the use of drugs or alcohol to cope; or struggle with focus on work, school or other tasks.

WHERE TO TALK
Talking in person is always the most effective way to engage. Seeing the person’s face and body language can help you identify when something is wrong. In addition to talking, being together allows you to hold the person’s hand, hug the person and—in extreme cases—make sure the person doesn’t resort to self-harm.

It’s important, especially for young people, to recognize that social media is not a safe space for confidential conversations. While texts or emails provide an opportunity to carefully craft a message, they are not as genuine as an in-person conversation. 

If you sense someone needs to talk, schedule a meeting in person. Find a coffee shop, invite someone to your home or stop by theirs. Talking outside can be even more therapeutic, as being in nature has been proven to boost mental health. Because sometimes it’s easier to talk side by side rather than face to face, plan a walk, get out on the mountain and talk on the chairlift or go for a slow bike ride and talk along the way.

HOW TO START THE CONVERSATION 
There is no right—or wrong—way to talk about mental health. Asking questions gives people the space to express their feelings or what they’re going through. 

“How are you?” is a simple question that typically elicits a simple response: “I’m fine.”  Instead, try asking open-ended questions and then provide the time to talk. “I’ve noticed you’ve been sad. Can we talk about it?” is an effective way to open the lines of communication. “It seems like you are going through a difficult time. How can I help?” acknowledges the person’s struggle and asks for specific direction to help you provide the right kind of support. If the person isn’t willing to open up to you, consider asking, “If you don’t want to talk to me, is there someone else you are comfortable talking to?” 

HOW TO LISTEN
When having difficult conversations about someone else’s emotions, remember that your time and presence are the most valuable gifts you can give them. 

“It is okay to not know the right words to say when someone is sharing their feelings,” explained Bettis. Being present and showing acceptance provides a safe space for vulnerability, without the need to respond to every disclosure. Acknowledging pain and experience is a main protective factor in someone’s behavioral health journey.”

Once the person you’re talking with opens up, reserve judgment. You may disagree, but it’s important to focus on being a good listener. Be empathetic—don’t try to fix the problem. Sometimes people just want to be heard and understood. Consider asking who or what has helped the person deal with similar issues in the past. Sometimes talking to someone who has dealt with a similar experience helps. Likewise, if you know of someone who has experienced these types of problems, you could suggest an introduction. 

WHAT TO SAY
In addition to showing the person you can be an active listener, it’s comforting to hear that you care. If appropriate, you could ask if they are in therapy, and if not, recommend it. Use empathetic phrases like, “I’m sorry you’re in pain, I can’t even imagine what you’re going through and I may not understand exactly how you feel, but I care about you and want to help.” Reassure the person, “You are not alone, and I’m here for you.” Offer help in other ways so the person has the time and capacity to work through their feelings: “Can I take care of any errands for you, do something around the house or bring you dinner?”

WHAT TO SAY OR DO IF THE SITUATION IS DIRE
“If you think someone is considering suicide, assume you are the only one who will reach out,” urged Erin Ivie, the executive director of SpeakUp ReachOut, a local nonprofit dedicated to providing suicide prevention, intervention and loss support services. “Have an honest conversation. Ask the person directly if they are thinking about suicide.”

While some fear that asking about suicidal intentions might increase suicidal tendencies, research published in the Cambridge University Press showed that acknowledging and talking about suicide may reduce suicidal ideation and may lead to improvements in mental health in treatment-seeking populations.

“If the answer is ‘yes,’ your first response should be, ‘thank you,’” said Ivie. “Expressing your gratitude in their trust shows how much you value your relationship with them. Next, tell them you’re on their team. Then, suggest calling Your Hope Center together.”

Your Hope Center’s 24/7 confidential support line is staffed with professionally trained clinicians  who respond in person to provide an evaluation and any needed referrals for a continuum of care. Call (970) 306-4673. 

If you suspect a threat to the person’s life, call 9-1-1 immediately. Stay with the person until an ambulance arrives. Assure the person you care about them and remove any lethal means. 

WHAT NOT TO SAY
To show your understanding and compassion, avoid expressions that might be perceived as dismissive, belittling or unhelpful. When someone is upset, avoid saying, “I know exactly how you feel.” While you might have gone through something similar, no two situations are the same. Don’t trivialize someone else’s emotions with statements like, “You have no reason to be sad, don’t be so negative, or think happy thoughts.” Let the person feel their feelings. 

HOW TO FOLLOW UP
To prevent your friend or family member from feeling vulnerable after opening up, check in often. Knowing you’re there on an ongoing basis can be extremely helpful. Likewise, invite the person to do something fun one-on-one or in a group setting. Don’t treat the person any differently than you did before. 

For more resources, visit OurPeaksAndValleys.org.