How to start a conversation about Mental Health

Over the past few years, we have come a long way in how we talk about and address mental health. Mental Health has been a cause for concern in Sri Lanka for some time. Having endured a Civil War for 30 years, a Tsunami in 2004, Easter Sunday attacks in 2019, and the present economic crisis have undoubtedly had repercussions on the mental health of the population.

Poor funding, a lack of understanding of mental illness, a dearth of skilled professionals, and a reliance on tertiary care have affected the treatment of mental health in Sri Lanka, especially in the rural parts of the country. This issue has only been exacerbated by the social and cultural stigma associated with mental illness. Research conducted on the stigma of mental illness in Sri Lanka indicates a link between the community’s view of the person with mental illness and their view of the family ( Samarasekare, Davies & Siribaddana, 2012 ). These concerns inadvertently affect the future and ability of family members to find suitable partners for marriage and contribute financially in a low-income household. There is also a lack of understanding about the causes of mental illness as people are led to believe in supernatural phenomena of evil spirits and accept the wrongdoings from a past life.

Starting a conversation around mental health plays a key part in challenging the stigma, and helps to remove one of the many barriers to treatment and recovery. There is no right way to talk about mental health but here are a few tips:

• Ask how they are doing or feeling – I like to phrase this question in several ways so that the receiver of the question understands that it is an open-ended question that is focused on them and their wellbeing. This question might be phrased like ‘’How are you feeling these days? How are you doing in your personal life? How are you doing in the other areas of your life?’’ Open-ended questions help someone to open up and show that you care about their well-being.
  

• Ask twice – It’s common to sometimes provide a meaningless exchange of an answer to a question such as ‘’How are you?’’, but the simple act of asking again with genuine interest, can prompt a more meaningful answer. The next time someone says ‘’I am fine’’, try following this up with a question like ‘’Are you sure?’’ or ‘’How are you really?’’.
  

• Don’t wait for the perfect moment – Sometimes when we imagine ourselves having a conversation about mental health, we may imagine a quiet place, sitting facing each other like a therapy session. But this is not always the realistic scenario, so it’s important that conversations around mental health happen in places that are neutral. Perhaps this might be while one of you is driving while going for a walk together or having coffee at a café. People might find it easier to open up when they have something to do in parallel so that there are no awkward silences or eye contact.
  

• Talk about yourself and your own experiences – I have often found that human beings open up more when they feel like they can relate to another person. This does not mean that you have to share your own experiences, but perhaps it might help to talk a little bit about the struggles you’ve been facing recently. It can make the other person think that having problems is only human and that they won’t be judged for sharing their feelings with you.
  

• Avoid the urge to fix things – just listen – While it comes naturally to fix someone, especially if it is someone dear to you, resist this urge as it may make people feel dismissed. Often what people want is a safe space to talk about their feelings and someone that will listen to them while they make sense of their feelings and experiences. Also, it might be that we think we know what’s best for someone based on our unique experiences, without taking the time to understand the context of their feelings/problems. Pay attention to the words, their tone of voice, and body language which will give you clues into how they are feeling.
  

• Close the conversation of mental health effectively – When it’s time to end the conversation around mental health, ensure that you end it in such a way that the person feels that they can come to you when they need to. Make sure to summarise the conversation and identify any practical steps they might want to take. If the next steps are not identified, ending the conversation by inviting them to reflect on what was spoken about, and to consider what they might want to do next, could be the best way to end the conversation. However, if you notice an increase in any risk-taking behaviour, loss of interest in day-to-day life, or substance use, helping them to get in touch with a local GP or mental health professional would be the best course of action.