It’s never easy to see – or experience – a loved one struggle mentally. Maybe it’s your sister who’s been dabbling into vices, a parent who can no longer provide, your child who no longer wants to go out and play, a partner who “isn’t himself” lately, or a friend who’s been lashing out.

It’s also equally difficult to gauge whether it’s just a “mood”, “just a phase”, or actually a cause for concern. Is it a serious problem that needs immediate intervention? As a loved one, what should you do about it and where do you stand?

If you’re growing concerned about your loved one’s mental well-being, Empath clinical psychologist Rich De Jesus says there are ways you can help. Whether that’s spotting the signs before enlisting the help of a mental health professional, or having an open and honest conversation, here’s how you can best support a struggling loved one, while also honoring your boundaries.

Major signs: The four D’s

According to Rich, the first sign to spot is Deviance, which means that the “actions, thoughts, and feelings of your loved one are far off from what you typically can observe from them.” If your demure and rule-abiding sibling is suddenly engaging in risky behaviors and bad habits, this could be a sign of deviance.

The second one is Distress – when your loved one may be suffering from psychological concerns that they do not want to identify with. “For example, people who are anxious do not want to continuously worry, and yet they do; people who are depressed do not want the feeling of sadness that they possess, and yet they still have that feeling,” Rich said.

The third is Dysfunction, which is when your loved one is no longer fulfilling their responsibilities in school or in career. This can be seen in a sudden dip in grades, absenteeism in school or work, being constantly late, or taking longer hours to complete work they are familiar with.

The last and most urgent sign is Danger, wherein your loved one – under the stress and pressure of the three prior symptoms – starts to withdraw from their own life. This could range from “Non-Suicidal Self-Injury” (self-harm), attempted suicide, and/or the possibility of danger towards someone else.

Minor signs: ‘SIGE-CAP’

For the “sake of simplicity,” Rich shared an easy acronym to help remember the minor signs to spot in a struggling loved one. “SIGE-CAP” stands for:

S- sleep (lack or excess) 

I- interest (lack or excess) 

G- guilt (lack or excess) 

E- energy (lack or excess) 

C- concentration (lack or excess)

A- appetite (lack or excess)

P- psychomotor movements (lack or excess) 

If majority of these signs have been happening for a week or two already, this is enough evidence shown that your loved one is in urgent need of mental health help.

Taking the first step

You’ve now decided to step in and extend help. Do you reach out to a professional right away, or have a conversation with your loved one first? Rich said that in most cases, it’s best to calmly approach your loved one and initiate an open conversation first, using the “ORA system.”

The O stands for (Observation). “First, begin by observing the changes within your relatives based on the SIGE-CAP criteria, and diligently take note of the frequency and the intensity of each instance,” Rich said. Note the date, time, and instance. “You can even gather other people’s observations that will add value. This way, there is concrete proof of their behavioral changes,” Rich added.

However, this route can get tricky. “There are cases wherein your loved one may become more reluctant to open up, knowing that you went behind their back to investigate their mental state,” Rich said. They could become more defensive or feel offended and betrayed. Depending on the case, it may be more acceptable for the feedback to come solely from you first.

The R stands for (Reflect) – meaning reflect your own observations back to your relative. “Open up about what you have seen in the last few days or weeks. This will enable them to be properly oriented for the discussion. Zero in with the topics to be processed, and minimize distractions.”

Lastly, don’t forget to A (Ask). Ask your relative about what they are currently feeling and thinking, and accommodate what they say. “Remember that the goal is not to compete with them and win. Allow yourself to hear options for them,” Rich said.

If your loved one is open to receiving help, you can suggest either seeing a counselor, clinical psychologist, or psychiatrist, depending on the gravity of the issue. A counselor handles non-clinical concerns brought upon by difficult adjustments to day-to-day problems, a psychologist caters to clinical concerns brought by moderate to severe levels of psychological distress, while a psychiatrist uses medications to alleviate physical and behavioral symptoms usually brought by chemical imbalances.

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When should I see a psychologist? Or a psychiatrist? Or both?

Rich points out that this list isn’t the end-all. Given the faith-centered culture of Filipinos and older relatives, spiritual counselors can also be involved in the healing process.

Just remember that beyond the appropriate function of each professional, what matters most is that your loved one is comfortable with the help they’re getting. The process of healing must always be consensual and ultimately self-motivated. If not, it will likely go nowhere; your loved one may even resent you eventually for being forceful.

Having the hard conversation

Rich shares a sample spiel to use when non-judgmentally approaching your loved one, using your observations from the SIGE-CAP criteria.

“Hi (loved one). I have noticed in the last few days that you have been spending more time in your room. You have also eaten less, and are more active at night until the early hours of the morning. I understand that you are the best judge of your actions, but I am becoming more concerned with you.”

“Is there something that you would like to talk about regarding these? I just want you to know that if there is anything that you want to get off your chest, we, your family, are here for you. We might not be able to provide the right answers, but we can help you find them.”

There are many possible reactions or responses your loved one may give. A typical one may be: “I do not want to talk right now.” Your response can be: “Okay. If you need more time to think about it, we will give you the time. I just want to let you know that your family (or friends) are here for you.”

If your loved one says: “I do have something to talk about, but not with you,” you can respond with: “Okay, who would you like to talk to? I can get them for you.”

If it’s “I also don’t know what’s going on” or “I think I need help,” you can respond with: “We will get someone to talk to you. In the meantime, what can I do to minimize your distress/ pain?” or “Maybe you can tell me what’s troubling you so that I may see what I can do. “

Make sure you are coming from a place of concern, non-judgment, and acceptance. Be accommodating and open, and not speculative, combative, or accusatory. “This is to ensure that your loved one feels reinforced to talk or expound on what they feel or think,” Rich said.

Remember that a high level of sincerity is needed on your part. If you promised that you will get someone to talk to your loved one, fulfill this to the best of your capacity and don’t procrastinate. If you said that you will give your loved one some space, don’t hound them every minute of the day following up your conversation. 

“The important thing here is get your cue from the person. Sometimes, they do not want to open up, since they feel that trust has not been properly established. Instead of constant interrogation or the reminder that they still need to talk, they should instead be presented with compassion and patience,” Rich said.

“We need to let them make the first move. Any forced action from the point of view of the patient may be detrimental to their recovery.” After all, true and lasting change has to start from within.

In case of an emergency

If your loved one isn’t ready to accept help – but still poses as a danger to themselves or others – there are other means you can do to ensure their safety, which should be the first priority.

“In these times, it would be significantly helpful to implement a no-locking policy for your doors at home (which includes your doors as well). Likewise, anything sharp should not be kept within immediate reach or have easy access to. Medications also have be out of plain sight,” Rich said.

The second priority is their physical health. In cases where their appetite can be low, consistently supply them with food (even in small quantities), in order to help them understand that food is available for them whenever they need to. 

If the personal approach is exhausted, a more social, community-centric approach can be done. This is where family interventions can pose as a good option. However, this can also get tricky.

“You need to be very selective on which friend or family member would be a part of the process. Having the wrong person with whom your loved one may not be fond of or respect may be hurtful. Sometimes, the help of a professional may be needed here to help facilitate the process,” Rich said.

If there is an imminent threat to the physical safety of your loved one or towards another member of the family, additional medical reinforcements may be necessary. Call your local emergency hotline services immediately if you need to.

To support is to love

Once your loved one is already receiving the appropriate mental health assistance, what more can you do for them? The best manifestation is support, in the form of open, honest, and accommodating communication.

“You need to learn to listen to their needs, and to be accepting of them even if they do not align with your own personal values,” Rich said, excluding needs that involve any form of self-harm or external threat to family or friends.

You can also share your observations with their therapist, but only if your loved one is comfortable with the idea. Do not inundate the therapist with only their shortcomings and setbacks; ensure that there is a balanced observation of the good things that your loved one is doing or trying to do for their progress.

Likewise, avoid reminding them too much of what they need to do. “Sometimes, being hounded by constant reminders just lets your loved one feel too overwhelmed, and may produce additional stress,” Rich said. “In the end, listen to your loved one,” he added. Allow them the space, time, and freedom to think more independently and have their own improved understanding of their well-being.

Congratulations! Your loved one is getting the help they need. You’ve done your job. However, don’t forget to remind them of joy and happiness. Initiative activities they enjoy, and continue doing the things you enjoy together. Healing is hard work, so it helps to help get their mind off their healing journey once in a while and live a little. With the right resources, a solid support system, and the self-empowered decision to get better, healing is possible for your loved one. – Rappler.com

To avail of Empath’s psychological and psychiatric services, you can book an appointment through the website.