Ideas for talking about your mental health: Starting the conversation

Author: Milena Glasbeek Paul Chaudhuri

Having a conversation about your mental health with another person can be challenging. Currently, physical health and mental health are not treated the same, especially in Western society. The existing stigma regarding mental health and the discrimination which often occurs, has created a significant barrier for people to seek help. Opening up to someone about your mental health struggles can lead to anxiety, feelings of shame, and uncertainty. You may wonder what the consequences of your disclosure will be, and how you will be perceived from that moment forward. Maybe you have already been speaking with a mental health professional and received a diagnosis, but have been keeping this a secret until now. Whether you have already spoken to a counselor, or if you will be speaking to someone about your mental health for the first time, taking the time to prepare for this delicate conversation can be an important first step. 

You can ask yourself the following questions in order to take charge of the conversation:
 
1. Why do I want to talk about my mental health? 
There could be various reasons why you have decided to speak about your mental illness or about seeing a mental health professional. People in your environment may have noticed a change in your mood or behavior. They might be asking questions and this could be the right time for you to answer them on your own terms. Sometimes it can be a relief to be able to share what you are going through with people close to you or with others in a similar situation who may be able to provide support. 
 
2. What are my expectations?
It is important to become aware of your expectations from the conversation. It is possible that the person you decide to talk to does not understand what you are going through, or reacts in a way that is not helpful to you. It may be tempting to stop talking about your mental health entirely if your expectations are not met. However, just because one person is not supportive does not mean that there may not be other people who could be of more help to you.
 
3. Who do I tell? How much do I tell?
Since details regarding your mental health are private information, it is fully up to you to decide who you feel comfortable talking with and how much you would like to disclose. Think about who you trust, who would be understanding, and able to help you.  When we have boundaries, we decide who we let in, and who we keep at an arm's distance.  Ideally, those we let in should be people we trust, and have given us reason to feel safe with them.  It may be useful to write down in advance what you would like to say. This could include:

• Received diagnosis 
• How you are feeling
• What you are struggling with
• What kind of help you would like to receive 
• Optional: share a pamphlet or website with accurate information about your mental health issue

Depending on the person you are speaking with, the conversation may look different. Here are some examples:

1. Sharing with a parent
Not all parents are equally informed about mental health issues. The range of reactions that can be expected is guilt, concern, fear, relief, confusion, and more. They may need some time to process and could have many questions.
 
2. Sharing with a colleague or boss
This situation can be complicated. You may want to keep the information you share limited. It could be enough to say: “I am experiencing some personal struggles, I would appreciate some flexibility/time-off/extra time, etc.”  Or, if you need to get time off to go to therapy, you can say, "I've got a health issue where I'll need to go to a weekly meeting.  I'll make up the time missed by coming in early that day".  You don't have to discuss what is going on if you are concerned that it will lead to a negative perspective on your work performance.  On the other hand, most everyone has struggled in their life, so explaining that you're going through a difficult time and getting help can help your boss make sense of recent work mistakes, as well as be assured you're addressing the issue. 
 
3. Sharing with a friend
Think about the pros and cons of speaking with a close friend versus a less close friend. Some people worry that their friendship will change, and that they will be perceived as a burden if they speak about their mental health struggles. On the other side, a friend who knows you well may be more compassionate, supportive, and ready to help. It is important to note that despite good intentions, friends might respond in ways that are insensitive or give unwanted advice. Therefore, take some time to consider which friend would be most able to give you the help you need and what the consequences could be for your friendship.
 
4. Sharing with a teacher or school counselor
Many schools and colleges provide students with a counselor or contact person. Teachers and school counselors may have limited capability to give you long-term help, however, they may be a good point of contact for further resources and guidance on how to connect with a mental health care provider. 
 
5. Sharing with a physician
When people experience mental health-related issues, they often reach out to their primary care physician instead of contacting a mental health professional directly. PCP’s provide mental health care services such as diagnosis and (medical) treatment. Although primary care physicians have a general capability to provide mental health services, their consultation sessions are shorter compared to a psychotherapy session. Furthermore, PCP’s do not have the extensive training that mental health professionals have. Therefore, your primary care physician can help direct you to a mental health care professional if you decide to seek specialized care. 
 
6. Sharing with a helpline
Consider calling or texting a mental health helpline for free and confidential support. Crisis hotlines do not only provide suicide prevention services, they also provide support for people who are experiencing mental health struggles or going through a difficult time. Furthermore, they can provide you with information on resources through referrals to mental health care providers. 
 
Finally, consider preparing for this conversation with the help of a counselor or therapist. If you have been going to therapy you could ask your counselor to dedicate a therapy session to prepare for having the conversation about your mental health. Have you not yet spoken to a mental health professional? Therapy can be a safe space for you to share your experience without being judged and with a trained counselor who is willing to help. 

It is important to not be alone with your struggles, and whether talking to a therapist, a family member, a friend, or even calling a helpline to speak with an anonymous stranger, not being alone in your head with your difficulties is important.  We are social creatures by nature and seek connection.  Research has found that loneliness is one of the number one factors for not living a long life.  When we can share our vulnerable parts with loved ones, often it signals empathy and for them to connect with us.  For many it might lead them to worry, and feel like they have to fix it.  Letting the person know you're having a hard time, but dealing with it through therapy, or working with a doctor can relieve the other person of feeling overwhelmed with wanting to help, and provide space for them to be supportive of you. 
 
Additional resources:
National Suicide Prevention Lifeline: https://suicidepreventionlifeline.org  
 
Sources:
Mental Illness Stigma and Disclosure: Consequences of Coming out of the Closet
Understanding the impact of stigma on people with mental illness

About the Author:
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Milena Glasbeek Paul Chaudhuri is Non-Clinical Intern with BACC and IAP. She is an MFT student at the University of San Francisco. She received her Bachelor of Science degree from KU Leuven (Belgium) in Psychology and Educational Sciences. Her previous experiences include a research assistantship at UC Berkeley’s Golden Bear Sleep & Mood Research Center for a depression treatment study aiming to support CBT therapy outcomes, and a volunteer position as a Behavioral Aid at an elementary school in Oakland, CA. She’s also actively engaged as a Crisis Counselor for a 24-hour suicide prevention line.