CN: mental health crisis’, mental health management; brief mention of a variety of mental health based issues and abuse.
The fifth and final installment of Lucy Merriman’s guide to offering mental health support when you yourself are not a trained mental health worker, is possibly the most universally helpful of all the parts. It includes some extremely useful problem solving techniques, basic guidelines to finding the info you need to help you move forward, and an amazing list of mental health related media that you should check out regardless of whether you are the one offering help or the one in need of help. I will definitely be adding a number of those resources to my “to read” list!
Hi everyone. Welcome to Part 5, the last entry in our five-part series dealing with the mental-health crisis in America. If you’re just joining us, my name’s Lucy, and I’m a trained volunteer at the crisis hotline in my home county in Ohio. I live in one of the geographic areas that has a severe shortage of mental health professionals, according to The United States Department of Health and Human Services.
In Part 1, I talked about my personal story dealing with a mental health crisis, and my experiences on both sides of the phone.
In Part 2, I went over the first elements of helping someone in your own life work through a mental health crisis: embracing a calm, compassionate mindset, setting boundaries, and assessing danger.
In Part 3, I started talking about processing. Processing is the key to helping someone through a crisis state and out the other side into calmer waters. Processing is a big, well, process! So, I ended up breaking these steps up into two articles. Part 3, covered reflecting, validating, and asking.
In Part 4, I walked us through the winding-down part of a mental health crisis; I explained how to use educating, normalizing, and comforting to guide your friend in crisis into a more mentally peaceful place.
In this final post, I want to talk about how to find resources so you can help your friend develop a short-term, medium-term, and long-term plan on the road to healing. I’ve also included a resources list at the end of the article. Let’s jump into it.
So, usually, when listening to someone process, you can hear what problems are bothering someone the most. It’s important to let the person in crisis take the lead on what issue is the most pressing; your friend will feel empowered when they hear you respect their judgment by supporting their own choices.
That said, your friend might need help focusing and sorting out which of their problems to work on first. One way to help someone prioritize their problems, (so they can focus on just one at a time) is to reflect one of their problems back to them. “It seems like everything you’ve talked about today leads back to your struggle with depression. Is that right, or am I off base?”
Another option is to ask them directly which of their problems feels most urgent. You can say something like, “What do you want to try to solve today?” or “What would be the biggest relief to have resolved?”
You might not even have to do this. Often, after processing, it’s clear to both the person in crisis and the counselor what the most urgent issue is. Sometimes the person in crisis will even ask, “What should I do?” or “what are my options?”
At that point, you can break down the problem into small, concrete steps.
Break Down the Most Urgent Problem Into Solve-able Steps
Breaking down a problem often involves “telescoping.” Telescoping is a problem-solving strategy that involves envisioning an idea, far-off solution, then working backward until you get to a step you can take today.
Once your friend has an end goal in mind, even if it’s vague, you can ask, “So, what’s a step you think you’ll need to take to reach that goal?” Usually, they’ll identify a step somewhere in the middle. They’ll also talk about a barrier preventing them from taking that step, which is where you can begin unpacking the barrier.
If the person in crisis identifies a step but they seem stuck as to how to get there, you can say something like, “that’s definitely an important step. I know there are a lot of options people have tried to get there. For example, some people _______.”
It’s also helpful to model researching, and to extend emotional support while they do their own research, in order to find resources and intermediate steps that can get them closer to their ultimate end goal.
What telescoping might look like for you
Here’s an example of what telescoping might look like if your friend is depressed. Their far-off solution might be something as vague as “feeling happy and enjoying life again.” This is a good starting point but to get there you’ve got to make a plan. So, if “enjoy life again,” is your depressed friend’s goal, you can build a plan backward from there, starting with any step they already know they'll need to take to get to that goal. Let’s say they know they may need therapy and medication, for example.
In order to get therapy and medication, they need to connect with a psychologist and psychiatrist.
In order to connect with mental health professionals, they need to know where they are, which ones take their insurance, figure out how to pay their co-pays (if there are co-pays), and find a reliable way to get themselves there.
In order to figure out a reliable transportation method, they may need emotional and technical support while they research public transportation options, non-profit patient-transport services, or how to budget for a weekly Lyft or Uber trip. They may need to practice conversational scripts to ask trusted friends for rides, if necessary.
And so on.
You don’t have to go through every single step; in fact, you probably shouldn’t. It’s just helpful to have the working-backward method in mind because the optimistic end goal can be a powerful, encouraging factor for someone in crisis.
What if They’re Feeling Overwhelmed?
If the person in crisis begins to feel overwhelmed at a particular barrier, validate their feelings. Reflect how the barrier makes them feel. Then, offer to either lead them back to tackling the barrier with different strategies or suggest taking a break. That is to say, either way, bring the focus back to an immediate, short-term solution. The short-term solution is something that they can choose right now, in the moment, that can alleviate their stress.
Remind your friend that everything about this conversation is their choice; doing something like going to sleep and calling back tomorrow (or, asking you to call them back tomorrow) is a valid option if they feel too overwhelmed to make any decisions at the moment. It’s not uncommon for the short-term plan to simply be “go to sleep,” and for taking other steps to all be medium-term or long-term plans.
In other circumstances, after working backward and unpacking barriers, the short-term solution may be, “Identify ten potential therapists in my area who take my insurance, using the Psychology Today website and my insurance’s network guidebook.”
Or, it could be, “come up with a short, three-sentence script to say when I call to make a therapy appointment and practice.”
Or, it could even be, “ask a trusted friend to provide moral support when I contact Legal Aid services tomorrow.”
A short-term solution is something that will ultimately connect up to a medium-term and long-term plan, but it doesn’t have to be anything more complex than finding a resource or asking for emotional support.
Just having that concrete, specific thing accomplished can fuel the optimism your friend needs to take the second step; that success can then empower the third step, and so on.
How to Find Resources
Now that your friend has a plan, it’s time to seek out resources that can help your friend carry that plan out. Resources are essentially the tools a person needs to solve a problem. These can be anything from housing and food to therapy and medicine, to transportation, legal aid, or safety from violence. Once you have a solid plan, the tools you need to enact that plan often become clear.
There are three primary methods of finding resources: talk to your social circle, go online, and call information lines or hotlines on the phone.
Asking your friends for help
The first resource to think about are the people in your friend’s personal social circle.
It’s important to consider who the person in crisis trusts; if there’s someone they name as trustworthy, great! But if they don’t, it’s important to make no assumptions. Asking open-ended questions is key here: “Who do you trust to help you out?” and “Who do you count on in other areas of your life?” are better questions than “Do you have any family nearby?” or “Do you attend a church that can help you?”
People can be embarrassed if they aren’t religious, or if their family is abusive or long gone, which can lead to dishonest answers that won’t solve the problem. Open-ended questions evade potential shame-points and keep people’s focus on the potential solutions.
After talking about trustworthy people in your friend’s social circle, you can ask your friend which of their friends they think might be best able to meet a specific need. In some circumstances, it can also help to encourage them to seek out different friends to solve different problems because it emphasizes just how many different people care about them.
If your friend’s social circle can’t meet their needs, if they want to explore more options, or if they find themselves socially isolated, it can be good to explore phone-based resources. You’ll want to find resources specific to your own community.
Using Phone Directories
Way back in Part 1, I mentioned a webpage that can be helpful to have on-hand which has a wide variety of national, problem-specific crisis lines and helplines. I can also now vouch for the Crisis Text Line, which has the same training and certification process as the National Suicide Hotline; it currently has enough staff that texts are answered quickly (usually within five minutes), which wasn’t the case when it first launched.
While these national lines are helpful, local directories might be able to help you more quickly--especially if you know what you’re looking for (things like the food bank’s address and hours of operation, or a list of free services in your neighborhood for low-income people). If you’re in the United States or Canada, you can call 211, or 411 to get relevant local information.
Calling 211 connects you with a free, confidential directory of “essential community services.” According to FCC.gov:
“Dialing ‘211’ provides individuals and families in need with a shortcut through what can be a bewildering maze of health and human service agency phone numbers. By simply dialing 211, those in need of assistance can be referred, and sometimes connected, to appropriate agencies and community organizations.”
Dialing 211 connects you to an actual, live, trained services director, who can be a helpful facilitator when there are multiple options. The FCC has more information on 211 on their website.
Calling 411 will get you a directory search, similar to using Yellow Pages back when phone books were more commonplace. 411 can give a caller a list of relevant phone numbers based on the topic (for example, “food charities,” “Medicaid advocate” or “free legal aid services”). 411 directors can look up numbers locally, regionally, and even nationally. Here is Verizon’s FAQ on 411 for more information.
Using Search Engines
Sometimes these directories might not have the resources you're looking for, or talking on the phone isn't your friends’ jam. In that case, use search engines.
To maximize the odds that you'll find useful information, try using different keywords to get different results on Google. So, for example, you may want to search for “housing services [my county]” and also “low-income housing [my city].” They might get you slightly different results.
When using Google, make sure to check if the results are genuine results or ads. The results at the very top of the page are frequently ads. There will be a small rounded box with the word “ad” next to them. They look like this:
Scroll past the ads to see the top results from your search. Once you start seeing results, check the domains (that is, the actual website address). These are displayed in lowercase, green font on the results page. Usually, government websites will have a .gov URL (web address), and non-profit sites will have a .org URL. So, .gov and .org sites are more likely to have accurate, up-to-date information.
Psychology Today has a therapist-specific search engine that many people find helpful.
And DrugRehab.com is full of valuable mental health resources for those who are affected by alcohol and drug dependence.
A Directory for Marginalized Groups
Finding mental health resources that are specific to the needs of people of color, LGBTQ folks, disabled people, and other marginalizations can be particularly tricky. Jeff Baker just published this article on Teen Vogue with an incredible list of mental health directories and search engines specific to different minorities.
Resources I Recommend: ‘Zines, Books, Blogs and Vlogs
There are a lot of resources out there designed to help people figure out how to solve their problems and access the help they need. This is by no means a comprehensive list; instead, these are just the resources that I, or someone I care about, have personally found helpful.
The best mental health resource I can vouch for is Kati Morton, a professional therapist who specializes in eating disorders, addictions, borderline personality disorders, and marriage and family counseling. She’s friendly, encouraging, and has a lot of concrete strategies for combating anxiety and compulsions.
Her videos on learned helplessness and asking, “Is it okay to just give up?” were especially helpful to me.
Do It Yourself: DBT (and CBT) for anxiety, depression, ADHD and trauma
Cognitive Behavioral Therapy (CBT) and the “spinoff” treatment, Dialectical Behavioral Therapy (DBT), are the two most effective types of therapeutic treatments for anxiety and depressive disorders, according to meta-data analyses.
In order to carry out these treatments with maximum effectiveness, a patient should work with a therapist. However, there are helpful resources out there if someone wants to get started on their own. These “DIY” websites and workbooks can be hugely helpful if someone finds themselves stuck on a waiting list or faces other barriers to therapy.
The options I can vouch for are:
This website has worksheets, videos, games, and other resources designed by professional therapists to use during CBT therapy, to help people make cause-and-effect connections between their past, their present thoughts and beliefs, their actions, and their moods. Understanding how these things are connected is a key part of empowering people to make choices that improve their mood overall.
This website helps people take some of the lessons of DBT therapy home to practice on their own. The concept of distress tolerance in particular (that is, the idea that everybody has the ability to develop healthy methods to recognize, tolerate and cope with distress, and can increase their tolerance over time) has proven amazingly helpful to people struggling with eating disorders, substance use disorders, codependent relationships (or “love addiction”), other behavioral addictions, and borderline personality disorders.
While it’s easiest to practice distress tolerance by role-playing with a partner or in a group therapy setting, DBT Self-Help provides strategies, insightful questions, and possible scripts so people can practice at home, on their own or with a friend.
The Mindfulness Prescription for Adult ADHD
This book applies a meditative technique known as mindfulness to help adults with ADHD cope with their condition. Mindfulness is sometimes part of CBT or DBT therapy. This is the Amazon link (not an affiliate link), but it’s a popular enough book that you might be able to find it at your local library.
Rejection Sensitive Dysphoria and ADHD
This short, explanatory article in ADDitude Magazine (an online magazine for adults with ADD and ADHD) has been worldview-shifting for many of my friends. It explains the most distressing symptom of ADHD-- rejection-sensitive dysphoria--what causes it, and what some common treatments are.
‘Zines and Blogs
There are a lot of ‘zines, especially on Etsy and Redbubble, oriented around helping people struggling with mental illnesses or other crisis issues. I haven’t read most of them, but I do love:
Printed Zines by dogsnotdiets
Hattie Porters’ brightly colored ‘zines are less than $3 apiece. They’re good to read and keep in your pocket. She has ‘zines encouraging people who, like her, are battling depression, anxiety, and eating disorders. They feature a helpful cartoon dog who loves you and wants you to get better.
As far as blogs and forums go, one of my favorites is:
Jennifer Peepas, aka Captain Awkward, is a film professor in Chicago who became an advice columnist, specializing in giving hard-won advice on triumphing over depression, setting boundaries, and recognizing the red flags of abuse. She wrote this great post about being a beginner, not a failure, and this excellent guide to trying to find free and low-cost mental health resources in USA and Canada.
She’s written over 1000 posts, and so many of them clearly articulate things I’d only seen talked-around before. Her community also has its own forum, Friends of Captain Awkward.
Chronic Babe Forum
Chronic Babe is a website for people with chronic physical and mental illnesses. It’s a place to find both emotional support and factual, evidence-based articles on improving the quality of your life when you’re chronically ill.
Alright, so, I already mentioned a book up in the DIY Therapy section, but I’ve got more. There are a lot of books out there! In addition to the books listed below, I also recommend going to your local library and asking the librarian if there are any books available for people dealing with the specific subject your friend in crisis is dealing with. Librarians love helping; sometimes I get the impression that they wish they were asked for book recommendations more often.
In the meantime, here are seven excellent books that deal with some of the struggles people in crisis may be facing. Plus bonus material! In no particular order, I recommend:
1. Mindset by Carol Dweck.
This book is all about how to approach challenges with the mindset that we have the potential to learn almost anything, so long as we practice. It’s about viewing a failed attempt not as failure but as practice-- a necessary, and even empowering, first step to success.
2. Resilience by Mark McGuiness
This book helps people learn to build resilience to setbacks. While the intended audience is artists and writers dealing with rejection of their creative work, much of it can be applied to rejection in other fields or dealing with social or romantic rejection.
3. Why Does He Do That? By Lundy Bancroft
This book has helped many of my friends who have been in abusive relationships learn that the abuse really, truly wasn’t their fault. It helped them unpack the motives and manipulations of abusers, and see for themselves that abuse is not something they encouraged or deserved.
Unfortunately, this book is somewhat old, and it uses dated heteronormative contexts. It is entirely about understanding the ways men abuse their wives and girlfriends, to the exclusion of other kinds of relationships. For people in abusive same-sex relationships, or men struggling in abusive relationships with women or non-binary people, I recommend Love Is Respect, an LGBT-supportive website geared toward helping people understand and escape abuse.
For people escaping abusive parents, Will I Ever Be Good Enough? and Toxic Parents have helped people I care about to leave that legacy behind them.
4. Too Good to Leave, Too Bad to Stay by Mira Kirshenbaum
This book is for anyone who’s unhappy in their relationship but isn’t sure if it’s abusive or if it’s worth sticking around for. It’s written in guide format and helps the reader think through questions about their relationship, without judgment about whichever path they choose.
5. Rising by Joon Madriga
Joon Madriga grew up in poverty and eventually became middle class. Along the way, she was homeless, diagnosed with a learning disability, and stuck in an abusive relationship.
In this book, she unpacks the psychological, emotional, and cultural aspects that trap people in poverty, and talks through things like grieving for things lost to injustice, unlearning beliefs that hold you back, and finding the courage and allies to help you use the resources in your community. It’s an honest, moving, powerful book. While some of her advice is Canada-specific, much of it applies to impoverished people anywhere.
6. Daring Greatly and The Gifts of Imperfection by Brene Brown
This one’s a two-for-one because I love them both!
Brene Brown’s research on the importance of vulnerability to human connection can empower many people to take reasonable risks in their relationships. She also has a compelling TED Talk.
7. Boundaries by Henry Cloud
Exactly what it says on the cover! This is a great book for anyone who struggles with setting and enforcing boundaries. It helps people practice by setting and enforcing small boundaries, then “leveling up.”
(Resource list last updated 10/13/19)
One of the toughest things about being in a crisis situation is that when you start making progress, you take some steps forward, and then you hit an unexpected obstacle. Sometimes it can feel like you used up all your hope and energy to pursue one solution, only to hit a dead end. The discouragement can become deeply demoralizing.
That’s why my last section here is on how to stay courageous. When someone is in crisis, one of the most vital things is to make sure they have a one-step plan if they find themselves deeply discouraged. The plan should be something like, “Call me,” or “call your local crisis line.” Or, “Go to so-and-so’s house; you know they’re a safe person.”
Again and again, friends and allies are the best way for a distressed person to find encouragement.
I have found it helpful for some people to have emergency Uber cards stashed-- at least enough to get to a bus station or to a safe friend’s home. If a person doesn’t have a smartphone, they can pay $10 to use ArriveRides, which will contact Uber or Lyft on their behalf.
People also find the courage to try again in their favorite music, books, or tv shows. When someone in crisis seems to be feeling better, they may want to make a list of songs, favorite quotes, or episodes from tv series that they can go over if they feel down again later.
Finally, people find courage in concrete evidence of their own skills. It can be empowering to encourage someone to list their successes-- even if they think they’re too small, or happened too long ago. Opening up to you may very well count as a success.
Creating a list of their successes reminds someone that they aren’t inherently a failure; they’re able to learn things, solve problems, and get themselves to a better place and away from toxic people. If if they feel overwhelmed and feel like they can’t, the list of successes is evidence that, in fact, they genuinely can.
When someone remembers that they have the power to solve problems, it can be just enough of a booster shot to their confidence that they can take the next step-- whether that’s calling a crisis line, eating their lunch, or showing up at their therapy appointment. Succeeding in that can give their confidence another boost, turning a downward spiral into positive, forward-looking momentum.
I hope this series has been helpful to you.
In a surprising way, writing it all out and organizing it has been helpful to me. Even though I’ve been a certified, volunteer crisis counselor for over a year, creating this series has clarified a complex process even further than my training and practice already has. For that reason alone, I’m grateful for the opportunity to create this series.
Thank you to everyone who’s read it so far, and thanks to Yopp! for hosting and editing these pieces. If you’ve found this at all helpful, please spread the word! The more people who have these tools in their toolkits, the better.
About the guest blogger: Lucy Merriman is a poet and artist living with her friends in Ohio. Her poetry has been printed in Pif Magazine, and her personal blog, Welcome to Tree City, is a fun place where she interviews artists, posts contemporary art criticism, and is generally trying to figure the big stuff out. You can also find her on Instagram on @merriman_lucy. She likes people! She probably thinks you're pretty neat.