Tips to communicate with someone with mental illness

woman puts arm around troubled young man to communicate with him
Have you ever had a friend or a family member struggling with mental illness, and you’re not sure how to help? You may be surprised to learn that nearly one in five U.S. adults are living with a mental illness. That’s more than 46 million Americans dealing with conditions that vary in degree of severity, with up to 9 million experiencing severe mental illness characterized by psychosis.
Maybe you’ve encountered a stranger in a public area who’s in the throes of psychosis and you didn’t know what to say or do, for fear of making the person feel worse?
When someone has a psychotic illness (a variety of brain illnesses such as schizophrenia or bipolar disorder in which psychosis is a common symptom), their perception of reality may be disrupted.
They may think other people are trying to hurt them. They may not make sense when they talk.
Psychotic symptoms distort their thinking; they may suffer from hallucinations (hearing or seeing things that others don’t), delusions (beliefs that aren’t based in reality or truth) or trouble organizing thoughts and seemingly purposeless movements.
They may also seem depressed and withdrawn, and may have trouble using information, making decisions and paying attention.
What can I do to help?
Here are suggestions of what you can do when you encounter someone who’s struggling with mental illness:
  • Stay calm and be patient. Many people who’re actively psychotic find others threatening, which can lead to agitation, and being calm and kind can go a long way to temper hostility and create an alliance.
  • Listen but respect personal space and be cautious. People with psychosis can be somewhat unpredictable at times and, if you feel unsafe or threatened, don’t feel obligated to continue in the conversation.
  • Offer assistance if feasible. If someone seems distressed, offer to help them find a police officer or get to an emergency department if they’re willing, but only go so far as you feel comfortable and safe.
  • Don’t try to counter their symptoms. If someone is hearing voices or has delusional beliefs (paranoid beliefs are most common), don’t tell them these voices or beliefs aren’t reality. This will generally cause the person to become upset and hostile, and will quickly escalate the situation.
  • Recognize your own limits. People with psychosis need kindness and support but, in addition, very likely need treatment with a psychiatric team. Your goal is to help facilitate that linkage, but realize that you aren’t the final answer and can’t do it alone.
  • Recognize the limitations of the illness. Psychotic illnesses have multi-fold effects on the brain, potentially including cognitive impairment and also insight issues. Many people with a psychotic illness don’t think they need treatment and many don’t want it. Be mindful of this fact at all times and recognize that, when trying to talk to the person, it isn’t as simple as just telling someone they have a mental illness, they have symptoms and they need treatment.  That approach generally won’t work, and a more general and ‘softer’ approach tends to work better.
As a society, we’re working to change the conversation surrounding mental health, including depression and suicide prevention. We’re encouraged by efforts of national organizations such as the National Alliance on Mental Illness and Mental Health America to help reduce the stigma that surrounds mental illness.
You can also play a part in this by something as simple as focusing on the language you use. Don’t call someone “crazy.” Remember, someone isn’t defined by their illness: They aren’t schizophrenic, they have schizophrenia. And just like everyone else with an illness, they need kindness and understanding to help them, along with appropriate medical care.
Walter Stearns is a psychiatrist and Craig Parris is a nurse practitioner, both in the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center.