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Tough to talk : 100 Reflections

Today is ‘time to talk’ day, a day set as an annual reminder to the nation, over now the last decade, to start a conversation on Mental Health. A hopeful marker to a shift in societal focus, the title equally highlights the shadow of how Mental Health can be tough to talk about. Certainly, many of us don’t know how to start a conversation, how far to explore what we hear/say, and fear what next- the expectation that falls to fix whatever we discuss.


This topic is one I am passionate about having worked supporting those with mental illness and taking considerable focus to the import of communication in all that I do, from mental health education to therapy and coaching. In exploring this topic, I wanted to take a different approach to some of my other posts in reflecting on a list of themes. I start with focussing in on some of the many ways it may feel tough to talk, and then continue to a list of approaches that can support, all from the position of the person with a mental illness.


This list is not specific to any person I have provided therapeutic or clinical care and retains all the bounds of confidentiality at the heart of therapeutic practice. There may be many more themes others have heard and experienced, but the power of this list is to highlight both the commonalities and uniqueness of every encounter and I hope to provide some practical reflections of how to talk when the time comes.


Why I’m struggling to talk...


1.’I don’t understand how I am feeling’


2.‘It’s too painful to talk about right now’


3.’I am numb and I can’t go there’


4.’I don’t feel how that was just described, perhaps it’s not easy for anyone to understand’


5.’I was told to stay positive, and I now find it hard to express how I feel when I’m upset’


6.‘I was told it’s not ok to get angry, so now I can’t talk about it/ don’t feel it’


7.’I was told to have courage and keep going and now it feels hard to admit my fear’


8.’I was told to be prepared, so how can I admit my shock?’


9.‘It doesn’t feel a quiet space I can talk’


10.‘I could be overheard here’


11.‘The room is too bright or overstimulating and I can’t concentrate’


12.‘The room is too clinical it feels intimidating’


13.‘I don’t feel I have enough physical space in this room’


14.‘I feel anxious being away from home’


15.‘There are too many people here, I only want to sit with one person’


16.‘I feel fearful of your size/location/posture’


17.‘Talking online I’m getting tired looking at the screen’


18.‘Talking over the phone I can’t see how you’re responding’


19.‘I can’t speak to you when my parent/ sibling/ partner is in the room…as they won’t understand’


20….as they have a different opinion’

21....as they will judge my opinion’

22….as they will want to fix this and not listen in to it’

23….as they will get angry/anxious/upset’


24.’I can’t speak to you alone as you won’t understand’..


25….may have a different opinion’

26….may judge my opinion’

27….may want to fix this and not listen in to it’

28….may get angry/anxious/upset’


29.‘My mental health journey is so long I don’t want to talk about it again’


30.‘My mental health journey is so short, I don’t think it counts’


31.‘When I talked about x before to y they said z and that didn’t help me- what’s the point of me talking about it now’


32.’I don’t understand why I am doing this’


33.’If I told you how I really feel…you couldn’t hear it so perhaps it’s better not to say’


34.…you couldn’t do anything about it so perhaps it’s better not to say’


35.‘Compared to my previous actions this doesn’t count to me as risk, so why mention it’


36.‘Other’s have harmed themselves more, comparatively there’s no point in saying it’


37.‘I won’t be able to continue in my job if I let them know I struggle with my mental health’


38.‘I will be penalised if I tell others’ about my mental illness’


39.‘People are afraid of others who have mental illness’


40.‘I can talk about my current low mood, but not about my personality disorder/ bipolar disorder/ schizophrenia- no one understands the label or how I feel’


41.’I shouldn’t feel this, I don’t want to think about it’


42.‘I shouldn’t feel this, I don’t want to talk about it’


43.‘If you know how I feel you won’t be able to care about me anymore, let’s ignore it’


44.‘I am just not a good enough person to deserve any support or you sitting with me to listen’


45.‘I like to be referred to by my full name/ middle name/ other name…


46.‘My first name was mispronounced…

47.‘My pronouns were not used / I was misgendered…

…and if I can’t introduce myself I don’t see that there is any point in continuing.’


48.‘The Diagnosis/ Label/ Term…I don’t understand it’


49.…it doesn’t describe my experience’

50.…I feel judged by it’


51.‘How is talking about x relevant to y?’


52.‘That aspect of my sexuality/ gender/ relationship/ religion/ culture/ family/ race/ ethnicity/ age/ education/ working class background/ disability/ physical health contributes to how I am feeling yet no one has asked…perhaps it’s best not to discuss this or other things’


53.‘That aspect of my sexuality/ gender/ relationship/ religion/ culture/ family/ race/ ethnicity/ age/ education/ working class background/ disability/ physical health does not contribute to how I am feeling yet everyone is asking only about that.. perhaps it’s best not to discuss anything’


54.’I feel out of control and it doesn’t feel safe to talk about this’


55.‘I don’t feel I have any say in what’s being discussed’


56.‘I was told what to do last time and I feel less inclined to talk into decisions now’


57.‘There are too many options and I can’t make a choice’


58.‘I am having a panic attack…


59.‘I am currently having a flashback…


60.‘Talking about that event made me zone out'

....and I am currently unable to think, speak or hear you’


What may help me when talking..


61.'Don’t rush…to ask too many questions’


62…to ask about my most challenging area’

63....my answer’


64.'Ask me…my name,’


65.…how I’d like to introduce myself,’

66....my pronouns’


67.'Introduce…yourself’


68...,permission to discuss’

69....bounds of confidentiality’

70....the reason to exploring sensitive topics’


71.’Acknowledge…my side looks’


72....tears’

73.…the things I tell you it’s hard to talk about’

74.+++with compassion and helpful curiosity’


75.'Enable pauses...Just be, you don’t need to say anything; just sit with me for a minute’


76.'Validate…my emotions’


77.…the things I tell you it’s been hard to manage’

78....that I have strengths’


79.’Change or offer other opportunities for.. where we are talking..


80....who is talking to me so that I feel most empowered to speak’


81.’Lean in to the elephant in the room, it will be there either way…ask me about my mental illness.’


82....ask me about risk, self harm and thoughts of ending my life’

83....ask if I feel safe or at risk from others’

84....ask me of my concerns for others risk’

85....for each please let me describe the elephant first- it may actually be a rhino’


86.’Check that you understand.. paraphrase back and ask me directly.’


87.’Apologise when you ..made a mistake or interpreted something in a way that doesn’t fit’


88....said something that I didn’t hear as it was intended’


89.’Admit you...don’t know things you don’t know’


90.'Don’t offer promises you can’t offer’


91.’Invite me…to think about next steps and options.’


92....to suggest other options you are aware of’


93.’Name your…concern for my mental illness’


94.…reasons for why I need to get additional support’


95.'Explore options you know and signpost me to other resources.’


96.’Name your boundary for support…and when others need to step in.’


97.'Remind me on anything I missed, on bounds of confidentiality’


98.’Pause when I can’t hear you, when I seem to freeze…focus on my breathing for a moment again...


99....'Invite me to speak when I am ready.’


100.’Let me know it’s ok not to be ok


On this last point with the intention of support it's also ok not to be ok in a conversation. This list is to bring us a bit closer to reflecting on lived experience and is in no way prescriptive. We are all unique and need different things at different times. Whether you are a family member, a friend, or someone directly involved in supporting an individual's mental healthcare talking about mental health and illness has many layers. We all make mistakes and trip up and need a village to support us rather than one pair of hands. The conversation deserves more than one time and one person. Remember risk, reflect on what you may want to come back to and signpost to involve others from the GP, wider community mental health team, and through charities such as mind, and helplines such as the Samaritans.


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