The quick answer: It depends. It depends on the struggle. The enormity of this question paired with the spectrum of mental health issues, possibilities and struggles, makes this answer near impossible to tackle in a mere 1,000 words. My experiences as an A Place to Talk (APTT) trainer, QPR-certified member, Sexual Assault Resource Unit (SARU) hotline respondent, psychology major and hospice volunteer will hopefully prove useful, though. I am going to break all the rules here and give advice (which is usually the worst thing you can do in supporting someone struggling with mental health).
In very broad strokes, most mental illnesses can be divided into two categories: ego-syntonic, like anorexia nervosa or narcissistic personality disorder, and ego-dystonic, like obsessive compulsive disorder (OCD) or major depressive disorder. A person with the former believes it is a good thing to have the disease; a person with the latter does not.
For example, people with anorexia — an ego-syntonic disorder — truly believe that they are fat and that restricting their diet is healthy. There is no one correct way to talk to people with eating disorders since it is such a broad spectrum; but, usually supporting them in eating (offering to eat together or cook for them) and exercising (telling them it’s okay to take a rest day) is helpful. Only in recovery can someone even say the words “I have an eating disorder,” and recovery alone can take years. Once they are in recovery, though, directly asking them what would be most helpful is best. Being the person that they can call in tears if they feel fat or just ate, to reassure them that food is good and they are not fat, is incredibly helpful. Make it known to them that you are there for them. If you are close to them, telling them that you love them, that you are here for them and giving them a big hug can go a long way.
If they are a survivor of trauma (intimate partner violence, rape, abuse and other trauma), then providing support is key. Tell them that it is not their fault; that they are in control of their steps moving forward,; that they are not alone; that you believe them; and that it took a lot of courage for them to tell you and that telling you is a big step. Reassure them of your willingness to help and check in with them. Be respectful by asking for permission before giving them a hug and reaffirm that whatever happened should not have. Finally, support whatever decision they make regarding reporting. Their power was taken away from them, so give it back: Ask them if they want to report, but understand that both options — reporting or not reporting — are 100 percent valid. If they need help in reporting or just want someone’s hand to hold, offer them your support upfront.
If they have made suicidal jokes or said “I wish I hadn’t been born,” “I’m a burden to everyone” or even “I’m going to kill myself,” then questioning is key. Ask them if they’ve ever thought of suicide. Yes, it is a extremely difficult question to ask, but it could save a life. It will not make them contemplate suicide if they have not already. If they have, ask them if they have a plan. Again, this will not put ideas into their head. This is the best thing you can do. Think of it this way: If you don’t know, you can’t stop them. If they have a plan or if they turn to you as a final cry for help, do not leave them alone until they are with a professional. At that point, you need a professional: You can call the Hopkins counseling center (available 24/7), a hotline, 911 or another resource, but make sure that you reach out with their knowledge and consent. Help them through the process of seeking help.
If they are struggling with anxiety, being respectful and calming is key. Respect their boundaries and do not push them into doing things which make them anxious. Let them know that it is okay, that they are not alone and that they need to do what is best for them to feel safe. If they are having a panic attack — symptoms include pounding heart, shortness of breath, shaking, sweating — then helping them feel grounded can help. You can try a breathing exercise: Place your hands on chest and belly and breathe in for five seconds, hold for five seconds, then exhale for five seconds. Do this with them a few times until they can breathe. You can also try a grounding exercise: Ask them to find five things they can see, four things they can touch, three things they can smell, two things they can hear and one thing they can taste. Have them recite these things back to you. Once they are calm, listen to them.
In general, being willing to listen and offering your support is the best way to help someone struggling with mental health. You can even bluntly say, “I may not understand what you’re going through but I am here to support you. You are not alone. If you need someone to talk to, I am here to help as much as I can.” You will be surprised to see how much that means for someone struggling with mental health. You may be shocked to realize how rarely they hear those words.
People surprisingly often lack proper listening skills, which is a true indicator of empathy and care. Listening well means listening without judgement, interruption or providing advice. Rather, ask them good, open-ended questions (never ask “why” since it’s perceived as judgmental); allow for silence before you respond; nod along with them; and show concern. Do not tell them what they should be doing. There are never any “shoulds” when it comes to mental health: Never tell them “you should be better by now,” “you should not be feeling depressed” or anything of that nature. “Should” is one of the worst things you can say.