Matching Good Intentions with Good Outcomes--Ways to Engage in Discussions about Therapy and Psychiatric Hospitalization

About. While well-intentioned, our approach to conversations about therapy and psychiatric hospitalization can also unintentionally undermine other’s experiences and promote harmful values about mental health. Below we offer a few common, well-intentioned sentiments, language and actions to consider. For each, we then offer a alternative ways to engage.

Well-Intentioned Sentiments

Sentiment	Implicit Implication
"I'm glad you decided to seek help." "I'm glad you were willing to receive help."	(a) While it's important to acknowledge someone's efforts to seek help, this statement can minimize their prior struggles; it might imply that their previous difficulties were their fault, that they haven't been trying, and that they haven't been seeking help or trying new things. (b) While therapy provides structured help, the statement inappropriately centers the help, making it seem like the person is passive in the process. Therapy is not like breaking an arm (you get your cast on and your body does the rest); it requires constant effort and grit from the individual to overcome significant challenges.
"You're so strong / brave."	(a) Though intended as a compliment, it implies that seeking therapy is an extraordinary, rather than normal act. This can reinforce the stigma that therapy is appropriate only in "extreme" cases. (b) This statement can also come across as having pity, imply that the person needs therapy / hospitalization because they are "weak." Mental health challenges and disabilities are experiences that can affect anyone, regardless of their background. While some people may never face marginalization related to race, gender, or sexual orientation, they can still encounter circumstances that lead to disability and/or significant mental health challenges. It's crucial to understand that we all exist on a spectrum of mental health, rather than viewing individuals as inherently "strong" or "weak." This statement endorses the concept of "strong" vs. "weak" instead of promoting empathy, recognizing the shared potential for facing such challenges.
"Why don't you do something nice for yourself?"	It's important to do nice things for ourselves and practice self-care. At the same time, this may come across as trivialising significant mental health challenges that require more intense and structured interventions from healthcare professionals and supportive communities.

Reframing. After reading this, you might feel like you can’t say anything. Instead, we offer one key way of engaging: instead of making value-statements about the individual or the experience, consider asking them value-neutral questions about their experience to express your interest and to learn more. For example, you can ask questions like:

• What’s it been like for you?
• What have you found challenging?
• How has this experience affected you?
• How did people close to you react when you told them? And how did that make you feel?

Well-Intentioned Actions

Actions	Implicit Implication
Offering solutions	Oftentimes, your well-intentioned offer of support can overlook the complexity of the individual's experiences, inadvertently minimizing them.
Providing support without consent, or without problem solving together.	Your support can inadvertently cause harm. For example: "You seem overwhelmed—let me take this off your plate." ← You may be right that taking away responsibilities may help, or, taking away responsibilities may take away structure and sources of meaning in their life, causing significant harm. "You have a lot you're dealing with—I won't talk to you about my own life / mental health / work challenges." ← You may be right that talking with you about these topics is a burden, or, it may be that in talking about these, you make the person feel valued and needed. It's best not to make unilateral changes to your behavior to accommodate someone else—ask what will be helpful.
Tip-toeing around the subject of mental health or things you think might be "triggers."	Tip-toeing can reinforce stigma, make the person feel perceived as weak, and contribute to misunderstandings that can be more harmful. If you're not sure what's ok to talk about, it's best to ask the person directly. Additionally, being open about mental health can actually serve as a protective factor. For example, an open and constructive conversation about suicide may offer relief and mitigate the isolation that offen comes with suicidal ideation.
Thinking "it's not ok to make mistakes."	It's likely you're not the cause of someone else's mental health challenges, but it's also possible that certain actions, words, or environments you've been a part of have contributed in some way to those challenges. This is normal, and it's important you don't blame yourself. Instead, consider maintaining open communication, soliciting feedback, and helping to mitigate any unintended negative effects of your actions to contribute to a more supportive community.

Reframing. As before, it’s best not to assume you know what someone’s experiencing and what they need. Instead, it’s bask to ask them if you can be supportive, and if so, how. For example you can ask:

• “If there’s a way for me to be a part of your mental health journey, please let me know–I realize that there might not be anything I can do, but if there is, I’d like to be a part of it.”
• “I felt like when I _____, it had a negative effect on you. If you’re open to it, I’d love to learn more about your experience and what I might do differently.”

Commonly-Used Language

Language	Implicit Implication
"Committing" suicide. "Successful" / "failed" suicide attempt.	The word "commit" criminalizes suicide: it implicitly compares suicide to a crime—something done selfishly, recklessly, without concern for others. "Success" attribute positivety to suicide-deaths, and "failure" associates negativity with non-fatal suicide attempts. Most current theories of suicide cernter "psychache"--intense psychological pain, so strong that it elicits a desire to escape it, like being trapped in hell. Oftentimes, for their life as it is, death seems like the only source of relief. Using language that criminalizes suicide centers "harm to society" instead of the unbearable pain someone's, that no one should be asked to endure. Consider using the following language instead: "Committing suicide" → making a suicide attempt "Successful suicide attempt" → fatal suicide attempt "Failred suicide attempt" → non-fatal suicide attempt
"People who are depressed / suicidal" "Depressed / suicidal people"	This language equates the individual with the mental health challenge. Instead consider using "person first language:" e.g. People with depression People experiencing suicidal ideation
"Mental health illness / disorder"	The words "illness" and "disorder" suggest something is inherently wrong with a person. Instead, consider using the terms "mental health journey" or "mental health challenge," implying that it is a normal and common human experience, and that it's something that can be overcome (i.e. not an inherent flaw in the person). Moreover, using this language implies that there's value that comes from the experience, as opposed to treating it as a misfortune that shouldn't be talked about.
"Suicide is a cry for help"	The idea that suicide is simply a "cry for help" is a misconception that can oversimplify and misrepresent the complex realities of suicidal thoughts and behaviors. It can: Contribute to stigma by implying attention-seeking behavior, which can discourage individuals from speaking openly about their thoughts and seeking necessary support. Downplay imminent risk and need for professional help and intervention.

You may find the following readings helpful in addition:

• Words matter. Learning how to talk about suicide in a hopeful, respectful way has the power to save lives. [link]
• Language matters: how should we talk about suicide? [link]