Mental health communication challenges

Communicating with someone who struggles with a mental illness can be challenging, but there are a number of suggestions you can utilise that will help all people involved.

Establish rapport

Try to establish rapport with the person to help them trust and open up to you and confide in you what problem they are experiencing. They may be frightened, especially if they are experiencing paranoia, and may appreciate additional personal space.

Be respectful

Always be respectful to the person and really listen to what they are saying. When someone feels like they are being respected and heard they are more likely to extend the same courtesy to you, giving you a better chance of understanding the problem and how you can help. Additionally, do not assume that they are not intelligent and will believe anything you tell them, mental illness has nothing to do with intelligence level and lying to them will often break your rapport.

Adjust your language and tone

Some people with mental illnesses have difficulty concentrating, so using short, clear and direct sentences will give them clarity and make it easier for them to understand and respond. Remain pleasant and use reassuring language, acknowledge what they are saying and ask for clarification if you don't understand to avoid misinterpretations. Be patient and remain calm to try and diffuse stressful situations.

Body language is also important, try to maintain eye contact, show empathy in your facial expressions and keep your voice low and steady.

Stay with them

Passing people around unnecessarily just to get rid of them could create further problems and lead to added upset, anger or even violence. Setting limits such as 'I can only talk with you for 10 minutes' or 'if you lash out I will not be able to talk to you' may be helpful. If you do refer them to someone else, make sure it is an appropriate referral and try to ensure that they understand why you are referring them.

Respond to delusions or unexpected behaviour

People who are experiencing delusions or hallucinations believe that they are real and you will not be able to talk them out of their reality. Communicate that you understand that they are experiencing those events but do not pretend that you are also experiencing them. If you need assistance in de-escalating the person or feel physically threatened, call for help (police, security, or colleagues)

Offer further help

Suggest options for further help (if they need it) including community resources such as shelters, food programs and mental health services. Not everyone will accept the suggestion, but some will.

Anticipating triggers and recognising warning signs

Contrary to what is often reported in the media, people with a mental illness do not just 'snap', but proceed along a progression of behaviours that may worsen their condition or possibly lead to violence (against themselves or others). It is important to learn how to recognise behavioural warning signs and communicate concerns to others who may be more equipped to help.

Anticipating triggers

People with severe mental health conditions usually have times when they feel good and strong and can manage their symptoms effectively. However, they will also experience setbacks or 'relapses' when symptoms worsen and can lead to serious consequences or even hospitalisation. External circumstances, events or behaviours may act as triggers that produce uncomfortable emotional or psychiatric symptoms and trigger a relapse including:

• Stopping medication, or not taking medication as prescribed – these are the most common causes of relapse
• Using drugs or alcohol
• Experiencing stress or being overwhelmed
• Personal problems such as relationship conflict or the illness or loss of a loved one
• Anniversary dates of traumatic events
• Frightening current news events
• Physical illness

Recognising warning signs

Reacting to triggers in normal, but recognising and responding to them appropriately is essential to prevent a downward spiral. Although some relapses happen quickly, most occur gradually over time and recognising the warning signs can help you get help early and avoid a more serious crisis. Possible warning signs include:

• Stopping medication, taking it less regularly or not as prescribed
• Changes in sleep patterns (too little or too much)
• Social withdrawal and isolation
• Decline in personal hygiene/appearance
• Changes in performance at school/work
• Nervous, tense or hostile feelings
• False beliefs, paranoia, delusions or hallucinations
• Increased risk-taking behaviours (often involving money, alcohol, drugs or sex)

If you identify signs of a possible relapse it is important to talk about your concerns and contact your doctor or mental health service provider as soon as possible.