Mental Health Part 1: Helping Conversationally
Over the past 20 years or so public awareness and acceptance of ill mental health has grown enormously. There is vastly improved knowledge of its prevalence and treatment. But there is still much improvement needed. In the context of the Covid pandemic, there is a secondary contagion of mental ill health that to varying degrees affects us all. We are all in this together and together we’ll have to find our way through it. The key is to be proactive and to focus on preventing distress turning into serious mental ill health.
Today’s discussion is about being able to recognise mental health concerns in the workplace early and to help each other. We’ll cover how to conduct what I call a ‘helping conversation’, including options for referral, confidentiality issues and self-care. In Part 2 we’ll explore a couple of practical ideas for managing people with mental health issues at work.
But first, what is mental health? According to the WHO Mental health is ‘a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.’ Clearly, this defines mental health as not only about ill health, but as including thriving, as well as mild to moderate ill health and severe mental health illness.
How prevalent is poor mental health? The global rates are pretty steady. Around 1-in-7 people globally have one or more mental health or substance use disorders each year. So mental ill health at some time in life is pretty normal, with about half of us experiencing it. Most common are the anxiety disorders, but Major Depression is thought to be the second leading cause of disability worldwide. Despite our advances still nearly two-thirds of people with a mental health disorder never seek help that’s available from a health professional.
Overall, there are three main interacting causes of poor mental health: Genetics and Personality, Life History and Psychosocial Factors – the latter being the physical and social environments that impact on our mental health. Obviously, the global pandemic is a very significant and pervasive psychosocial factor impacting us all.
Given we cannot change genetics, nor the past, our emphasis should be on increasing personal resilience and coping strategies, as well as addressing psychosocial risk factors by promoting positive cultures and environments for good mental health, and by helping others who are struggling.
One more thing. It is also important to remember that mental health is complex. The fact that someone doesn’t have a diagnosed mental health condition doesn’t necessarily mean their mental health is positive. Likewise, it’s common that people with diagnoses that are well-treated can have high levels of wellbeing. This uncoupling of diagnoses from good and bad health helps us keep our eye on the ball: if a person is suffering, they warrant our help.
So, what are we on the lookout for? The key is to notice negative changes in a person across a range of observable factors. This might include a drop in work performance; withdrawal; a decline in cognitive functions like memory, problem solving or concentration etc. They may be obviously upset or just not themselves. The key thing is that you if you have made these observations and have a feeling that something is wrong, you probably should talk with them about it. You conduct a helping conversation.
Why? Well, we know that being able to talk about one’s stresses or struggles with someone who genuinely cares and who is not judgmental, is incredibly helpful for them. Both kindness and compassion reduce their bodily stress, inflammation, heart rate and blood pressure and opens their mind to more positive coping strategies.
So, having the conversation is the single most important thing to do. You are not diagnosing but telling a person you are concerned and want to help. And you base it on observables which keeps bringing things back to tangible realities. You are not doing therapy or counselling but are primarily listening.
One of the best ways to do this is to use a technique called OARS, where you ask Open questions (and then shut up) and whatever they say you Affirm that this is their reality, perception, experience or understanding. We primarily do this by Reflecting and paraphrasing what they say without judgment or challenge, and when they seem to have told us the most important things, we Summarise so they experience being understood.
Why is this so effective? There is then a natural move (in both people) at this point towards action; towards problem-solving. The most common error is trying to move here too fast before people have had this very validating experience of articulating their reality.
Once that is in place, the conversation becomes much more natural and two-way, and you discuss together action steps. The key here is to mobilise the person towards getting help, whether that is counselling, a GP, a financial adviser, a personal trainer or having conversations about adjustments to one’s work for a period of time.
It is also rarely a single conversation. Often people are not ready to talk straight away. It takes them by surprise and they say they are fine (even if they are not). So don’t try to kick in their door, so to speak, but do persistently tap on their window. Touch base again if you are still concerned. If you have spoken to them, follow up.
Sometimes, especially down the more severe end of the mental health continuum, helping someone can be taxing on us. It’s always a good idea to debrief with someone – of course protecting confidentiality. And speaking of which: never promises absolute confidentiality. If they ask you to tell no-one let them know you agree except if they are at risk to self or others. And let them know you’ll always consult with them about who you’ll talk to and about what.