And I would have stayed up with you all night
Had I known how to save a life
When I felt suicidal recently, I cut my wrist. I’m sorry to say it so bluntly but there’s really no way to sugar coat something like that! Anyway, I’ve never done anything like that, so I got scared and when I saw all of the blood, I rang an Ambulance. They told me I needed stitches and took me to A&E but I got scared and I just couldn’t stay there so I left, the Police were called and they found me, told me I didn’t have capacity and took me back to A&E. A very cold Consultant came along and said I did have capacity before discharging me. When I got home, I took some Diazepam (a very mild sedative) and fell asleep. In the morning, I felt better and took myself to Minor Injuries for the stitches. Unfortunately, though, because the wound had been open for so long, they said it wouldn’t close and has had to remain open and be redressed every few days. When I spoke to my Mum, she asked why I hadn’t taken the Diazepam before cutting because it might’ve helped me and maybe I wouldn’t have done it. I told her that I hadn’t thought of it and she suggested that I write a list on the whiteboard in my Kitchen so that if I have another crisis, I can look at the list and try all of the coping skills that the crisis makes me forget. And then I thought, wouldn’t be good to come up with a list of things that I think everyone could know/use to support someone in a mental health crisis.
The most important thing to know, before you read this list, is that reading this and being prepared to use it doesn’t make you a professional because I’m not a professional. This list is just things that I’ve found helpful for both myself and others and it won’t work for everyone but there’s some really broad tips and some that could easily be adapted to fit the person’s crisis/personality/type of mental health problem. I mean, a mental health crisis will mean something different to different people. For someone with anxiety, a mental health crisis could be a panic attack. For someone with Borderline Personality Disorder (like me) a crisis could be feeling suicidal. No crisis is any more or less severe than another. But that does mean these tips might not even be relevant for some people!
I also wanted to say that if someone you know does have a mental health crisis and doesn’t reach out to you; don’t feel offended or useless. Other people aren’t usually the first place I turn in a mental health crisis – for many reasons – but I appreciate that there are a number of people in my life who could be so helpful at those times and I just don’t give them the chance. This isn’t anything against them.
1. Get medical advice/assistance
I guess this was the obvious one, so I put it first (although the others are in no particular order!)! It might seem realistic to say that it doesn’t matter how much emotional support you offer someone, if they’re in need of medical assistance there’s only so much you can do to help the person. But actually, the two are very interlinked. Sometimes, emotional support and advice can help convince or support a person to seek medical help. If a person isn’t getting medical help because they feel suicidal or perhaps their hallucinations are telling them not to or maybe they’re scared of what will happen if they do go to Hospital; sometimes talking their rationale through and reasoning with them will support them to get medical help. Of course, there may be times – in a mental health crisis – where medical assistance has to be the priority.
2. Listen to them
There’s a difference between sitting there with your ears open and sitting there and actually listening to a person. The first, means that you’re providing someone with the opportunity to talk. The second, means that you’re providing someone with the opportunity to get support for what they need to talk about. Remember saying this to a Nurse in a Psychiatric Hospital one time after she’d sat through me pouring my heart out and had only contributed the odd ‘mmm.’ It’s difficult to get a balance though, because it’s so important to show that you’re listening but without interrupting or sidetracking the person who’s talking. And if you hear something you ‘don’t like’ or want to speak up about, it’s so important that you stay quiet to allow the person the chance to process those things themselves.
3. Don’t judge them
I’m not ashamed to say that I’m hugely guilty of ‘judging a book by its cover.’ I used to think that it was natural and that everyone does it to a degree and just doesn’t admit to it because deep down, they know it’s wrong. Then I admit some amazing, kind, caring people in the mental health industry and was proven wrong. I learnt that there’s good people out there who don’t pass judgement on others and I learnt why passing judgement is important in a mental health crisis. The biggest factor in my refusal to report the abuse was fear of judgement. I worried that if someone heard what had been done to me then maybe they would think all of the worst things I thought about myself. Maybe they’d think it was my fault. Maybe they’d think I’d asked for it. Maybe they’d think I had deserved it. And if I hadn’t had that fear of judgement then maybe my mental health wouldn’t have deteriorated to the point it did two years after the abuse physically ended.
4. Don’t patronize them
Having someone be patronizing or condescending towards me is one of my biggest pet hates because I find it so demeaning. Because of this, I think I’m very cautious of coming across as either of those things when talking to other people and I regularly say; ‘I don’t mean to be condescending…’ or ‘I hope you don’t think I’m being patronizing...’ I think that there’s two schools of thinking here: one is that people with mental health problems are unintelligent and need to have things explained in more detail than others. The second thought process is that you need to walk on eggshells around people with a mental health problem because they’re more emotional than others.
5. Remind them of other coping strategies
A while ago my Mum and I had a similar conversation to the one about my forgetting to take Diazepam in my most recent crisis. We talked about the fact that I’d forgotten to ring the Crisis Team before self-harming so I’d come to realize that when I’m in a mental health crisis (and I realize it is different for everyone) I find myself in a tunnel and in that tunnel, the light at the end of it is actually self-harming and not hope, or recovery. All I could see in my future was more self-harm, so suicide felt like the only option; not Diazepam or ringing the Crisis Team. My tunnel vision didn’t offer an alternative to killing myself so how could I possibly think to use my healthy and safe coping strategies?!
6. Recall happy memories
It’s incredibly straightforward (I think that ‘easy’ would be the wrong word) to use bad memories as motivation and rationale to self-harm or attempt suicide and in doing so, all the good memories that make you laugh, or smile are delinquent. Sometimes they just aren’t powerful enough to counteract all of the very negative memories that are so overwhelmingly horrific they make you wish you weren’t here to remember them all. It’s important not to use reminders of positive and happy times in a condescending and patronizing way – the person knows these things happened but it’s almost as though they happened to someone else.
7. Don’t judge their priorities
A lot of people often say to me “think of your pets” when I’m struggling or “imagine how your Mum would feel if you killed yourself!” The thing is either 1, I’ve considered these things and they’ve been no match for the darkness; in which case I feel even more negative and suicidal that these things weren’t good enough to keep me alive and they really should’ve been. Or 2, these priorities are actually a motivation for my struggle e.g. I believe friends and family would be better off without me; in which case talking to me about them only reminds me of that. Or, finally, 3, I was struggling so much that I haven’t even thought of those things; which means mentioning them leads to me feeling leaves me feeling even more like a terrible person. The thing is, if there was anything in a person’s life that was ‘good enough’ to stop the person from self-harming or attempting suicide then they wouldn’t do it so don’t assume that the person must have their priorities wrong in order to be doing these things. A person is never saying that self-harm is more important that anything else… it’s the only thing!
8. Give them time
If you’re helping someone in a mental health crisis, there’s no deadline on that crisis. Neither for them nor for you. There has to be a level of commitment in your support and that support needs to be unconditional. You can’t say you’ll help someone and then look at your watch when it’s time to pick your kids up! I appreciate that supporters will have their own lives and priorities but it’s equally important to recognize that once someone steps into a crisis to offer their support, it can be very difficult for the person in crisis to find that same level of support in someone else. Your support is unique. Don’t make the person feel hurried to explain themselves or to make a decision as to whether or not they’re going to self-harm or do something else.
9. Show them respect
A person in a mental health crisis isn’t looking for your sympathy. Often, the last thing they needed is for someone to say they feel sorry for them because it could be interpreted as condescending. Instead, show respect for that person by not treating them as though they are weak or defenseless for being in a mental health crisis.
10. Validate their feelings
This is probably one of the hardest steps in helping someone because there’s a line between validation and encouragement. And it’s a thin line. It’s a grey area because it can be interpreted differently depending on the mental state the person is in. For example, if a person is struggling because they’re feeling lonely then validation might be the perfect tool to helping them through the crisis. If a person is feeling angry at something that has happened to them then that person is especially vulnerable to validation and perhaps it will be misinterpreted as being encouraging in that they could view as the supporter is saying they’re right for feeling that way and so self-harm or suicide is the right way to cope with that. Of course, no one wants to encourage a person in that way; but there can be a lot of misinterpretations in a mental health crisis with emotions all over place and high-risk factors.