Why It's Difficult For People To Talk About Mental Health Concerns, And How We Can Make It Better

Experts tell us how we can be better allies to friends and family who experience mental health concerns.

I was in my early 20s when I first felt the need to get help for my mental health. As I began to learn more about why I felt how I felt, and how to help myself, I realised that my journey was going to be a lonely one because those closest to me did not understand what it meant to have a mental health concern.

Almost a decade later, much has changed and much hasn’t. There are more conversations surrounding mental health and more empathy, but a lot of us still don’t know how to reach out to and truly be there for people who have certain mental health concerns or psychological vulnerabilities.

As a consequence, those with mental health concerns still face stigma and find themselves isolated, being unable to speak about their feelings to even closest friends or family. This sense of isolation has only increased with the social distancing enforced by the coronavirus pandemic.

Huffpost India spoke to experts to find out what makes it so difficult for people to speak out, and how we can, in these dark times, help those who could do with a good heart-to-heart with a friend.

No space for vulnerability?

For those of us who experience mental health concerns, it’s often even difficult to explain to our closest friends about how we’re feeling. Mumbai-based psychotherapist and counsellor Rhea Gandhi told Huffpost India, that often, most relationships don’t give space to vulnerable conversations.

“People are unable to generally talk about it because the feelings are so overwhelming, there is a lot of stigma, and friendship groups don’t necessarily allow for vulnerable conversations, they allow for fun and gossip but not necessarily vulnerability,” Gandhi said.

Even in 2020, those with mental health concerns are perceived as being “weak” or “dramatic” by some. Often, when someone says they are feeling anxious, the general advice is “don’t worry” or “everything will be fine”.

But that’s not how psychological distress works. Having their feelings dismissed constantly or not having a safe space to share their thoughts and feelings can compel people to stop talking about their concerns at all.

“Clients do feel hesitant to talk about their mental health condition. But the trend is changing.”

Delhi-based psychologist Ruchika Kanwal said that scepticism from family and friends stops people from speaking up.

“Most people still think alcohol dependence is about poor self-control and moral weakness rather than seeing it as a disease,” Kanwal said. “Some clients have mentioned their families think depression can be dealt with by having positive thoughts and doing things that make you happy. In my experience, taking mental illness symptoms lightly especially by the family, makes the conversation around it difficult.”

Not only a dismissive attitude, but rationalising mental health concerns as just a “passing phase” can also be discouraging. Many are made to believe that how they feel likely isn’t even a symptom of a mental health concern.

Tanya Vasunia, a Mumbai-based psychologist told Huffpost India over email that minimising people’s experiences can do more harm than good.

“Symptoms of anxiety and depression are over-simplified and labelled as stress and highly sensitive. It continues to surprise me as how many individuals truly believed or hoped that their low mood was due to a thyroid concern or low vitamin D,” Vasunia said.

To be sure, thyroid problems have a role to play in one’s mental health and wellness, but seeking medical help for a thyroid condition is not a substitute for therapy.

Such circumstances make it difficult for one to speak about the complex feelings — like suicidal thoughts or self-harm — when sometimes we ourselves do not understand the full extent of what we’re feeling. However, Kanwal said that things are changing and people are opening up more and more.

“Clients do feel hesitant to talk about their mental health condition. But the trend is changing. People are opening up about their mental health condition. Even adolescents are coming out and talking about things they are concerned about,” Kanwal said.

‘Burdening’ others

There are times when we share our emotional pain with our loved ones, they too become overwhelmed. Vasunia said, “No one likes being the person who isn’t doing great.”

Shame, guilt and the fear of hurting others can also cause much stress and anxiety.

Anxiety around socialising

Society, families and friends groups have varied and difficult benchmarks for what it means to be “social” or “functional” or what is acceptable for them to maintain relationships with you. Anyone who doesn’t live up to that is considered “not normal” or even “dysfunctional”. If you’re not constantly upbeat or chirpy, or up for every plan that is made, people are often excluded from such plans, further socially isolating them.

Just the thought of going to large gatherings like family functions can be extremely emotionally challenging.

Shaina Vasundhara Bhatia, psychotherapist and counselling psychologist said, “Sometimes relationships meant to be supportive can feel exhausting and draining. The mere thought of pretending to be ‘functional’ for events and relationships can often feel very overwhelming. Unfortunately, often there is also a stigma attached to wanting to take some mental health time off for oneself.” So, when people are shamed for wanting to take such time off, they’re further pushed into isolation.

An unreturned phone call or a cancelled plan can have friends feeling upset, triggering discord in the relationship, creating a situation that is difficult to navigate for someone who is already in trying to cope with their own emotional pain. The empathy that is extended to someone who is physically sick, isn’t extended to those who are feeling unwell emotionally.

“What is normal functioning anyway? When you’re experiencing a physical distress, no one is going to fault you because you couldn’t make it out, or you couldn’t attend a function or return a call or if you said I was in too much pain,” Gandhi said. “So why does it have to be different for emotional pain? Why can’t we extend the same amount of empathy for emotional distress.”

Gandhi said that she did not subscribe to the polarising ideas of “normal and dysfunctional or abnormal” because “what is normal anyway?”

“In order to truly understand how to help those struggling with mental health concerns we need a buy in from all stakeholders such as family, society and the government.”

Social media chatter, but no real understanding

Social media has become a space where people consistently speak about mental health and caring for others and being there for each other, especially in light of Suhsant Singh Rajput’s death – yet, often without knowing that this means or entails.

Kanwal said that most people still don’t understand the nuances. “There are still people who do not know the difference between a psychiatrist and a clinical psychologist and a counsellor. In addition to that a lot of people still think that treatment includes ECT whereas it isn’t practiced now. Then there are people who feel until they don’t take medicine, they would never be cured.”

Vasunia said, “In a country where the divide between rich and poor continues to grow, surviving and thriving will remain the focus, this leaves no room for the differently abled and vulnerable. In order to truly understand how to help those struggling with mental health concerns we need a buy in from all stakeholders such as family, society and the government. It is only then a tectonic shift will manifest. Awareness is the catalyst for change.”

Like we know what kind of doctor to go to for a physical illness, there is a need to educate ourselves on what it means to experience psychological distress or mental health concerns. And we need to begin educating people when they are young.

Other than that Vasunia said we needed to let go of our preoccupation with keeping up appearances. “We as a society place far too much emphasis on success and keeping up appearances, this makes the inability to perform extremely difficult and embarrassing. We need to start being more honest and open, we are human, we all struggle and it is okay to do so. This change in narrative will help society in general.”

Why now?

The pandemic has completely changed the way we live, causing stress for not just those who already experience mental health concerns, but for others too. For many the little things they did for their own healing — stepping out for a run or meeting a friend over coffee — are options that aren’t available anymore. For those living alone and experiencing psychological distress, being physically unable to meet their loved ones can also feel isolating or overwhelming. For others, being stuck in spaces where they feel unsafe means that they are taking many steps back in their mental health journey.

“For anyone struggling with their mental health, sudden big shifts in their routines, their lifestyles and their support system can feel like a massive transition and can be an enormous challenge,” Bhatia explained.

The last few months have been marked by loss and grieving — of losing jobs, life goals and plans and most importantly loved ones. While in any other scenario people grieve in collective, the scope of doing so has been lost because of social distancing. Bhatia said, “The absence of the space and people to experience these milestones in life has also taken a huge toll on people. Not being able to say goodbye to a loved one, being able to perform the last rites and rituals together as a family, is going to change the fabric of how one grieves.”

As most of us grieve the loss of life as we know it, perhaps there isn’t a better time than to learn to take care of ourselves and our loved ones emotionally than now.

Here’s what all the experts said we could do to be there for a loved one who was experiencing mental health concerns:

Guide them into professional help

Remember that the best solution to any mental health concern is to seek professional help. All of us can listen and be there as a friend, but nothing can replace going to a counsellor or psychologist. Bhatia said that it was important to recognise when professional help is needed. “If your loved one is refusing to go see a therapist or counsellor, you can begin by simply enquiring them about what’s holding them back. Help them see that they will do well with help coming from a professional space.”

Educate yourself

Much of the stigma around talking about mental health has to do with friends and family being unaware. So, the first and most important step would be to use all the resources available to us and learn. “Sometimes it is better to not take charge of the problem and providing solution, but be the person who can mediate the therapy process,” said Kanwal.

Human hand holds mobile smartphone with smiling young woman on display. Speech bubble above. Vector cartoon illustration of phone conversation
Human hand holds mobile smartphone with smiling young woman on display. Speech bubble above. Vector cartoon illustration of phone conversation

Check in on them

It is always good to know that someone is thinking of you. So, checking in on your friend or loved one every now and then can help them know that you are there. Bhatia said, ”

A call, heartfelt text, notes on some favourite shows you may have been enjoying, books and songs recommendations or exchanged pictures of meals cooked are some helpful ways to see where the person is at, emotionally. Keeping your questions open-ended is very helpful.”

To care to avoid questions that may make them feel like they are being scrutinised. “Avoid direct questions that can be inadvertently viewed as pressurising. For example ‘Hey how are you doing today are you feeling better?’ while the sentiment of care is present your hope of their improved mood is also present and if the person is still low they can feel like they are letting you down or being unsuccessful in recovery. Instead a healthier text might say “Hey, just checking in, hope today is better, let me know if you would like to chat,” Vasunia said.

Don’t give advice, just listen

What works for you may not work for them. Gandhi said, “If somebody is experiencing psychological distress, it’s not about advice, it’s actually trying to have empathy and listen to a person. Also being aware of how much is your capacity to listen — how many hours in a day can you offer, and how many minutes in a day can you offer, being very clear about that.”

Making people feel heard can help. According to Kanwal the best way is to “keep questions open ended”, to not get into arguments or make them feel guilty about their feelings or compulsions.

Go back to basics

Bhatia said that basic everyday chores like eating, exercising and getting enough sleep can help us feel healthier. So asking questions about their daily lives may help. “Ask questions around the pillars of our lives, is the person eating regularly, are they eating healthy food once in a while, are they using any substances to cope with how they are feeling, if yes then how often, how much sleep are they getting, are they getting any movement through the day, are they exercising, are they drinking enough water,” Bhatia said.

“I think the best way to ask others to go to therapy is to go to therapy yourself.”

Don’t focus on the solution

Vasunia said, “When we are trying to be supportive, we can be solution focused and as a result have tunnel vision in conversations. Being open to communication involves communicating in the medium that the person who is struggling is most comfortable in and not constantly focusing on the person’s mental health.”

Don’t be pushy

The experts said the key is to give space and ask them how they want to be helped. Kanwal said, “You want to come across as encouraging but not too pushy.”

Keep an open mind and really listen in

A part of making the other person feel heard is to really listen in, something that we don’t often do. And to also listen with an open mind. “Set aside some non-distracted time and hear them out. If something seems very hard for you to accept, remember that this isn’t your experience. The idea is to not always agree to everything,” Bhatia said.

Get help yourself

Supporting and caregiving for someone with a psychological distress can take a toll on you. So Vasunia said it is also good to get professional help for yourself. ” Being there for someone who is going through a mental health concern is not emotionally taxing but also involves a lot of patience and understanding. If you don’t take care of yourself your ability to support/care for the vulnerable individual will eventually be impaired and inadvertently you might end up being doing harm,” Vasunia said.

One can also set an example and break the stigma around therapy by getting help. Gandhi said, “I think the best way to ask others to go to therapy is to go to therapy yourself. If you’ve been to therapy and you’ve experienced it yourself, then you’re a much better ally.”