Your suggestion could be invaluable, and it doesn’t need to be perfect. These steps will help you get a caring message across
It’s Sunday evening. I’m listening to music and planning out the week ahead. But my mind keeps going back to a text exchange I had with my friend Diana the day before. Diana has struggled with mental health problems over the years, mostly anxiety related. Through it all, she’s maintained an admirable ability to share how she’s feeling – always punctuated with a fierce sense of humour that she admits is her go-to coping mechanism. When we texted on Saturday, neither of these qualities – her candour, her humour – were evident. Her responses were vague and lacking her usual pointed jokes. When I asked if she wanted to meet up or call, she declined. Diana said she hadn’t been sleeping well and didn’t feel up to it.
Normally, I wouldn’t give too much thought to texts like these. We all have days when we’re feeling down, stressed, or just need time to ourselves. However, it’s become a pattern with Diana over the past several weeks. A few of our mutual friends have reached out to me to share their concerns. They’re also worried about her withdrawal, sad mood and low energy. Most of all, we just miss Diana, notice she’s not herself, and wonder how to effectively support her. Our usual friendly attempts to connect and cheer her up don’t seem to be enough. This time, she may need formal help from a mental health professional.
Can you relate to this experience? My story about Diana is a composite inspired by multiple real experiences I’ve had. Most of us have people in our lives who struggle with their mental health at one time or another. In fact, these struggles are common; in the United States, for example, an estimated 23 per cent of adults had a mental illness in the past year. We all do our best to support the people in our lives as much as we can, even as we face our own challenges. However, once mental health problems reach a certain level of severity, it may be time to recommend professional help.
If someone you know is suffering from a mental health issue – whether it’s related to anxiety or fear, low mood, disordered eating, drug use, or something else – you might feel uncertain about how to bring it up to the person in a caring, effective manner. You may not know how to say it in a way that maximises the likelihood they will listen to your suggestion. Perhaps you’re worried they’ll feel judged, hurt, embarrassed, or pull away from you even more. The risk is that you then say nothing at all. Without your suggestion to seek therapy, your loved one might be further away from getting help. And you might feel helpless, without any concrete actions to take.
Don’t recommend therapy to someone if you fear it will harm you or your own mental health to do so
Even as a therapist, I find it challenging to recommend treatment to someone I know in my personal life. I don’t want to sound like I’m fitting a stereotype by ‘psychoanalysing’ them when I’m really just acting as a concerned friend or family member. With some trial and error, I’ve found that certain approaches tend to work better than others. They largely have to do with being direct, authentic, empathic, and supporting the person in a way that’s specifically tailored to their needs.
Before diving into the specific strategies, take a moment to consider if you want to have a conversation where you suggest therapy to someone. Reflect on your relationship. If it’s someone you’re not close to, who makes you fear for your emotional or physical safety, or whom you know in a professional rather than a personal capacity, then suggesting therapy might be out of bounds. Don’t feel that you have to recommend therapy to someone if you fear it will harm you or your own mental health to do so. However, if the person is a friend or other loved one who has confided in you about their mental health struggles, then suggesting therapy could be welcome and appropriate.
If you decide that recommending therapy is the right way to go, I hope you’ll find these tips useful. Showing up for people with loving, positive intentions goes a long way. You don’t have to say something perfectly (if that’s even possible!) to help people in your life. The fact that you’re concerned about them and expressing it can be deeply meaningful to people who are suffering. Don’t let a fear of imperfection stop you from reaching out.
Carefully consider the setting of the conversation
When you’re worried about someone’s mental health, you might understandably feel a sense of urgency to address it quickly. This immediacy is appropriate in emergency situations; if the person has expressed suicidal thoughts or intentions, you should contact a helpline for guidance (such as 988 in the US). However, for non-emergency mental health situations, it is usually worth waiting for a good time to talk.
The best time and place will vary by person and situation. But, generally, I’ve found it useful to prioritise talking in person, or at least by video call if possible. Waiting until you can speak in person or by video allows for important elements of nonverbal communication – such as tone, eye contact, facial expressions and body language – to convey compassion. That can be more challenging via text message or chat. Real-time conversations also create space for timely clarification and communication about sensitive issues.
Plan to talk either one-on-one or with a few mutually trusted people. I like to ask the person if they have a time coming up when they can connect. For example, I might say: ‘Diana, I know you haven’t felt up to talking lately, but I’m wondering if we can find some time in the next couple of days to meet up or have a call. What would work best for you?’ This gesture shows your consideration for their time, and minimises the chances of interruption during the discussion. You don’t want to feel rushed during this important conversation.
‘I know you’ve been tired, and I don’t want to push you, but I also miss seeing you’
Share your observations and ask about their reaction
Once you’ve identified a time that works for both of you, you can open the conversation by directly sharing what you noticed and expressing concern. Avoid being general (‘We were all talking and noticed that you’re acting differently’) or making assumptions (‘You’re depressed’). It’s important to begin with the fact that you care about them – and then follow up by stating your specific observations, without expressing any judgment. After you’ve done that, continue the conversation by asking for their reactions.
For example, you might say something like:
Diana, I’m concerned about you. I feel worried that you haven’t seemed like yourself the past few weeks. Specifically, when I ask how you’re doing, you don’t really say much. I’m used to you sharing more of your thoughts and feelings. You also haven’t wanted to hang out in a while. I know you’ve been tired, and I don’t want to push you, but I also miss seeing you. I noticed that we haven’t been joking around as much as we used to. That’s OK – you don’t need to be any specific way around me or be funny when you’re not doing well. But it does make me curious about whether you’re struggling right now in a way that’s different from the past. How have you been feeling? What do you think?
If you have already discussed your concerns with the person previously, you can refer to past conversations; you might start by saying: ‘Like I mentioned last time we met up, I’ve noticed…’
Listen to their response, try to understand, and express empathy
Once you’ve shared your concerns and observations, create space for the other person to express how they feel. They might respond in a variety of ways, including by opening up about their struggles, denying that there are any problems, or something in between. This is a good time for you to deeply listen and seek to understand them better. You can do this by asking open-ended, clarifying questions, such as: ‘What has that been like for you?’ or ‘What’s the hardest part for you right now?’ Then you can patiently use some reflective statements to show that you are listening and that you care about what they’re saying. For example, you might say: ‘It sounds like things have been really hard for you lately. I can only imagine how difficult that’s been. I want you to know that I care about you. I want to help you through this.’
Introduce the idea as something that would be useful and they should not feel bad about
Ask what they think would help – and propose therapy as an option
Rather than jump right into suggesting therapy, it can be helpful to ask someone what they think would be best for the situation. Sometimes, they’ll say that they need to seek professional help. When this happens, it’s an opportunity for them to experience a sense of autonomy and self-determination in their own mental health journey, without you being the first to recommend it. Alternatively, they might ask you what you think would be helpful. That can open the door for you to suggest therapy in a natural way. However, if the person responds by saying they don’t know what they need, or that they just need ‘to try harder to get better’, for example, you still have a chance to suggest that they pursue professional help.
The goal is to introduce the idea as something that you think would be useful, and that they should not feel bad about it. You can note the fact that many people (even therapists) have had mental health treatment. If you are in therapy currently or have been in the past, you may want to share that or remind them about it. For example: ‘When I’ve struggled with my mental health, I have found therapy helpful. Do you think that’s something you might find helpful?’ Or: ‘I know people who have found going to therapists helpful. It’s pretty common for people to seek therapy for their struggles and it’s nothing to be ashamed of. What would you think about doing that for yourself?’
Explore hurdles and ask how you can help
There are various reasons why your loved one may not be ready to seek therapy. Perhaps they don’t know how to find a therapist, don’t feel ready for change, worry about costs, or had negative past experiences with therapy. Remain curious about these thoughts and feelings, rather than immediately challenging their reluctance. As you listen, take time to validate their concerns. This could include simple statements such as: ‘I can see why you’re hesitant to try therapy again’, or ‘I get why it’s hard to think about seeking professional help, given what you’ve been through in the past.’ If the person has not found therapy helpful in the past, it’s possible that they did not receive a research-supported treatment, did not have an affirming therapist who understood their culture, or that there were other reasons specific to previous attempts.
After validating their concerns, you have an opportunity to get curious with them again about potential ways to address hurdles. For example, you could offer to help them identify a therapist who is better suited to their needs, such as a clinician who explicitly identifies as culturally humble and affirming. For some of the people I’ve encouraged to go to therapy, they just want someone with them when they make phone calls or emails to potential therapists. For other people, I offer to go with them to their first appointment. Or I’ll try to help them find options that are affordable or ‘sliding scale’ (ie, with a flexible fee based on one’s ability to pay). Some people might feel more open to being evaluated for medications or talking to their primary care physician instead of a therapist; these can be useful starting points as well. Your availability to help will also depend on your own mental health and bandwidth for supporting them.
They will know that you care enough to tell them and be there for them
What if they feel like they should be able to resolve the problem themselves? You can encourage self-compassion and let them know that many competent, skilled people seek mental health treatment. Therapy is not a sign of failure or deficiency. They may feel comforted if you can point to people you know who are similar to them in certain ways (eg, age, gender) who sought and benefitted from treatment. If the process of finding a therapist feels overwhelming to them, you can talk to them about breaking it down into smaller steps. Convey that they don’t need to fully commit to therapy, but you wonder if they’ll consider looking into potential options.
Accept their autonomy
Ultimately, the person you care about will make their own decision. You have done a lot by expressing that you care, trying to understand them better, and making the suggestion that they seek professional help. Remember: if they do not take your advice right away, it does not mean you were wrong for making it. It also doesn’t mean that they won’t take your advice at some future point. Importantly, they have heard that what they’re going through has reached a level that you’re worried about. That could help them to realise how much they’re being impacted by their mental health problems. They will also know that you care enough to tell them and be there for them. If they do become ready to seek professional help, they’ll know that you’ll be available for more conversations in the future.
Take care of yourself
When you’re worried about a loved one, it can take a toll on you too. Please take the time to seek your own support, whether it comes from other friends or a mental health professional. Know that it is OK for you to set limits on how much support you’re able to provide at any given time, so that you can also tend to your own mental health. One of the hard parts about seeing a loved one struggle is feeling that you haven’t done enough. If you keep showing up, expressing that you care, and modelling the importance of taking care of your own mental health, you are actually doing quite a bit already.
Mental illness can be so cruel. It can drive people to behaviours, such as isolation and avoidance, that are the exact opposite of what would help them feel better. On the other hand, small gestures and consistent support from well-meaning loved ones can be just what a person needs to push back against those tendencies and pursue the help they need to recover. You can make a difference just by expressing how much you care and by taking their mental health seriously.
