Although no one is immune from mental health issues, it can be hard to admit when life isn’t all rainbows and unicorns. So, if your bullshit detector pings because a loved one insists they’re “fine” when their actions say otherwise, what do you do?
“It's a tough spot,” clinical psychologist and psychoanalyst Suzanne Klein, Ph.D., tells SELF. You might feel tempted to dig until you uncover the truth so you can help, but at the same time, you want to respect their privacy and autonomy. The good news is that there are ways to do both and also to increase the likelihood of this conversation going as smoothly as possible. Here are expert-approved tips for having a caring, respectful mental health check-in with a loved one who doesn’t seem “fine” at all.
1. First, ask yourself, “Am I approaching this from a place of concern or judgment?”
Before you begin to think about what you're going to say, do some self-reflection, clinical psychologist Ryan Howes, Ph.D., tells SELF. If you’re nervous about having this conversation, ask yourself why. Are you scared to talk about something so intimate? (This is a completely legit worry.) Are you worried about their safety and wellbeing? Or are you mainly worried about what it will mean (for them or for you) if they are in fact struggling with a mental health issue?
If it’s the latter, that might point to you having internalized some societal stigma about mental health. Many people grow up learning that mental illness should be a secret, but try to remind yourself that there’s absolutely nothing wrong with it, and it’s not a choice. Feeling deep down that mental illness is shameful will make it that much harder to have a supportive conversation with your loved one.
2. Decide if you’re going with a blunt conversation opener or if you’re going to be more delicate about it.
The best way to broach the subject depends on the person. If they typically prefer a straight shooter, Howes suggests something like, “Hey, it looks like you’ve been pretty down lately. You’re avoiding my calls and always seem withdrawn when we’re with friends. I know you’ve said you’re fine, but really, is anything going on? How can I help?” That might open the floodgates.
If they usually shy away from confrontation, Howes suggests something more general, like, “Things are so stressful these days. How have you been dealing with life?”
3. Use observations about their behavior to explain why you’re worried.
During your conversation, Howes recommends gently pointing out observations about your loved one’s behavior rather than outright saying something like, “I think you have depression.” Although there’s nothing wrong with having depression, diagnosing and labeling someone isn’t your job.
Instead, mention whatever it is that you’ve noticed—it seems like they are seeing friends less often, drinking way more, skipping out on a hobby they used to love, or other possible signs of anxiety, depression, or other mental health issues. Then ask, “What do you think that's about?”
4. Bring this up when you’re both feeling relatively relaxed.
It may seem obvious that you shouldn’t start this conversation when tensions are running high, but those can be the hardest times to make level-headed decisions.
For example, if you’re mad because your friend texted to bail on your housewarming party—as they have every other time you’ve tried to see them lately—you might feel angry and annoyed but also have a deeper worry that something is going on. As long as your friend doesn’t seem in danger of harming themselves or others, consider taking a beat and starting the conversation after the anger and annoyance have receded, ideally in person. (We’ll explain what to do if they are a risk to themselves or others below.) “If it's in heat of the moment … and you load on top of that, that could be overwhelming, and you'll get resistance,” Howes says.
5. Tell them you’re coming from a place of care, not judgment.
“Let them know you love them … and you're worried about them, but not in a 'holier than thou way' or like you know what's best for them,” says Klein. She suggests something like, “You're really important to me. I see that you are suffering, and you don’t need to suffer alone or in silence. You can get help with this.” You can even straight up tell them that you’re not judging them, you just want to make sure they’re as happy and healthy as possible.
6. Share your own experience, those of celebrities, or even statistics to let them know they’re not alone.
If you have ever had tough times with mental health, been in therapy, or thought about seeing a mental health professional, share that information if you’re comfortable doing so. “You are telling them it's OK to feel this way,” Howes says. This can help allay some of their fears and concerns about being judged, Klein adds.
If you’ve never dealt with mental health issues, maybe you can remind your loved one of all the celebrities sharing stories about their mental illnesses. You can even look for statistics from resources like the National Institute of Mental Health to reassure them that other people are on similar journeys.
7. Offer to help in their search for a mental health professional, but let them take control of actually reaching out.
It is your loved one’s choice to seek professional help, and keeping that in mind will allow you to respect their autonomy. However, you can offer to help them look up therapists or to ask for referrals from your own psychologist if you're seeing someone. “Finding a therapist can feel like too much and interfere with getting treatment,” Klein explains. “Legwork can be helpful, but don't make the calls for them—that could be infantilizing.”
8. Don't stage a full-on intervention by gathering a worried group of friends and family to discuss this.
It can feel nerve-racking to approach your loved one about this on your own, so you might feel more comfortable teaming up with others who are concerned. Don’t do this. “They can feel betrayed, judged, or ganged up on,” Howes says. “They may not see you have the best intentions.” The person you love may become angry, particularly if you bring in people that they didn't want to know their problems, and they may also pull away from you, Klein cautions.
This advice also applies to your one-on-one conversation with them. Even if other people have told you that your loved one has been acting differently, it might be best to avoid broadcasting that to them.
9. If they’re insisting they really, truly are fine, don’t push it.
Unless they are a risk to themselves or others, the choice to seek treatment is really up to them. So, if they still say nothing is wrong after you’ve brought up changes in their behavior in a kind, non-judgmental way, move on. You can say something like, “OK, I’m glad you’re doing well. You can always come to me if that changes.” Things you might see as red flags, like no longer going out all the time with friends, could be a result of your loved one already working on their own mental health, being more true to who they are, or making decisions about who they want in their life. Or they may simply not be ready to talk about their mental health yet.
“Prying would damage the relationship, and [the loved one] should feel empowered to handle their own problems,” Howes says. “You can make observations, you can be there for support, you can make recommendations, but in the end, it's their life. Not meddling in their business is the best option.”
10. Follow your gut when it comes to bringing up this topic again.
If time passes and you notice that something still seems off, you might want to revisit the conversation. Maybe it seemed like your loved one was right on the precipice of sharing but not quite ready. “You are planting seeds. They might come back to you one day,” Klein says. Or maybe you know your loved one would just retreat from you further, in which case the best option might be to support them with only your actions until they’re ready to bring this up on their own (if ever). This is one spot where your past relationship with the person really informs what you do.
11. Remind yourself that you can step away from the relationship if it’s necessary for your own mental health.
This is of course not a free pass to avoid your loved one because you want to be there for them but don’t know how. If that’s your situation, ask them.
Otherwise, let’s say your loved one does open up to you about their mental health, and you really step up to the plate to support them. That might be a huge help. Remember, though, that it’s OK to continue your own life as you sustain your relationship. Depending on how much it is impacting you—if you consistently rush to their side when they’re struggling, for example—you may need to step back at some point for the sake of your mental health.
“In general, you can offer help until that help drains your own wellbeing. When you feel like giving is draining your own life, it’s probably way too much,” Howes says. In that case, talk to your loved one, reinforce how much they mean to you, and also set their expectations going forward.
Be careful not to frame this conversation as though your loved one is a burden or like the sole reason you’re stepping back is their mental illness. With that in mind, it’s best to avoid generalities like, “I always feel exhausted after we talk.” Instead, when they’re in a relatively good spot, focus on setting specific boundaries. You can try something like, “I love you so much and am committed to being there for you, but I won’t be able to come over as much as I have been lately. I want to help you get a handle on your anxiety, but I don’t think I’m enough on my own. Have you talked about this with your therapist?” (If they don’t have one, this can be a good time to ask their opinion of therapy and share any stories about how it may have helped you.)
12. Watch out for signs of deep depression or suicidal thoughts so you can get emergency help for your loved one.
If your loved one talks about taking their own life, acquires the means to do so, changes their normal routine in a way that worries you, begins behaving recklessly, or gives away belongings, they may be considering suicide. (Here are more signs to look out for.) Now is the time to speak up.
“Don’t be afraid to ask the person if they are feeling suicidal,” Klein says. If they say yes, help them contact their physician or get in touch with their family. Get them to the emergency room if you can, or call the National Suicide Prevention Lifeline at 1-800-273-8255 for guidance. Life-and-death matters are not a time when you need to worry about “intruding”—there is no such thing when it comes to trying to prevent someone’s suicide.
If your loved one says they don’t have depression or experience suicidal thoughts but you don’t believe them, you may need to make a judgment call, Howes says. If you really are worried, you can try to take the above measures. If it comes to it, you may need to call 911 and tell them the whole story, Howes says. If they’re going to dispatch the police, ask if it’s possible to send those who have crisis intervention team training.
Bear in mind that this might wind up with your loved one being held against their will in a psychiatric facility. “This seems harsh and potentially excessive,” Howes says, but for people who are in true danger, it may be the best option.