Non-professionals can improve others’ mental health care—by inquiring.
I similar version of this post was published earlier today in my Psychology Today post.
Because there was interest in my post describing how non-professionals can facilitate help for the suicidal patient, I thought it could be useful to extend this effort to a variety of other common mental health problems. My objective is to provide strategies non-professionals can use in identifying symptoms of mental disorders in loved ones.
If we can pry away the stigma I mentioned in an earlier post, we can help others recognize possible mental illnesses in themselves. Now typically unrecognized and unattended, this can lead, in turn, to consultation with professionals who can provide diagnostic attention and treatment.
We freely share with others our issues with physical problems, for example, diabetes, weight, cholesterol, arthritis, bunions, cancer, and heart disease. Let’s make it just as commonplace to discuss mental symptoms and problems.
We’ll now look at some specific ways that, in my opinion, can be helpful guidelines in exploring others’ possible mental health issues—of course, given that they wish to discuss their personal problems. Having specific strategies can help, especially if you practice them beforehand. In the next post, I’ll consider the specific symptoms you also ask about to identify patients with depression—and what one should expect in treatment. And, in later posts, we’ll consider other mental health conditions such as anxiety and chronic pain and drug misuse.
How to Communicate with Others.
Our work in the College of Human Medicine at Michigan State University identified effective, research-based ways to maximize communication and the doctor-patient relationship,1,2 and these experiences serve as the basis for my recommendations. My aim is to provide communication tools to guide in eliciting emotional and other psychosocial (personal) information from someone you’re concerned about, perhaps going through a divorce, losing a job, retiring, or having left home for the first time. Importantly, however, the basic interpersonal skills I’ll describe can be used with anyone, not just those with a problem. Try them with your spouse, your kids, or your boss. You’ll be surprised.
Sheep bleat (communication)
The key in communicating with another is to listen attentively but not passively. Keeping your own ideas and issues to yourself, pick up on what the other says on a personal level, such as comments about themselves and issues important to them. To focus on their ideas and concerns, draw them out by showing interest with eye contact and leaning forward and saying something like, “Tell me more” or re-stating (echoing) what they just said to focus the conversation on that topic, for example, “Your job’s not going well” or “Your classes suck.” Used repeatedly, your comments let the other person know you’re following what they’re saying, you’re interested, and that you want them to keep going. I know it’s tempting, but hold back on specific questions, providing advice, and sharing your own similar experiences. Rather, just listen in an active, encouraging way.
Continuing the conversation in this way, listen carefully with the intent of identifying information that may be emotion-laden, that’s where the action is. It’s okay to encourage that by focusing the person on potential emotional material by saying something like, “Tell me more about your wife dying (not being promoted; flunking a test).” Do this even if they just mention it and quickly move away to another subject, as many will do, “That’s important about the election but can you first tell me more about getting fired, you mentioned it just a second ago.”
After you get to this more loaded material and have probed further to understand it, ask what the emotion or feeling is that goes with it. For example, “How did that make you feel when you were fired?” or “What’s the emotion that goes with flunking that test?” Then draw out the expressed feeling to further understand it, “Tell me more about being angry at your girlfriend (sad they didn’t visit you; happy to be done with chemo”).
When you understand the problem and its associated emotion, it’s time to make verbal statements of empathy. Using these maximizes the relationship you have with anyone, distressed or not, and you can easily remember them by the mnemonic NURS:
• So that makes you feel (state the feeling you heard—sad, depressed, angry, upset, afraid, happy).
• You seem (reading the patient’s face—sad, depressed, angry, upset, afraid, happy).
• I can understand how you would feel that way.
• I can see you how feel.
• Anyone would be (upset, sad, happy) by this situation.
• It makes sense that you feel that way.
• Acknowledge Plight
o This has been a difficult time for you.
o It sounds like you’ve got a lot on your plate.
o You’ve been through a lot.
o That was tough.
• Offer Praise
o You have certainly worked hard on this.
o You show a lot of courage.
o You handled it well
o You have researched this problem nicely.
• Let’s see what we can do.
• I am here to help
• You’ve got a good team working for you here and I know they’ll do everything possible.
• I am really impressed at the support you have from your (religion/family/friends)
I deliberately omitted the last letter of NURS when we first published our patient-centered interviewing method in 1991.3 You know what it is. It’s an ‘E’—and ‘E’ stands for Empathy. And who’s more empathic than our nurses?
Use the NURS statements repeatedly, but don’t use all four each time. For example, you first might say, “That’s upsetting (naming), I can sure understand (understanding),” 30 seconds later verbalizing, “You’ve had a tough time (respecting),” and 30 seconds later remarking, “Good for you for talking about it (respecting), can I help (supporting)?” And so on during the entire conversation.
Let’s imagine you now have learned of a difficult situation someone has, for example, a divorce, lost job, or a serious illness. A concern you may have is, “I’ve opened a can of worms, but there’s nothing I can do.” This is often true about actually resolving the problem, but “hearing them out” makes people feel better. They feel understood and respected and supported. Using NURS does not make you responsible for solving the problem. Using NURS indeed is what we recommend physicians do when they have patients where there is nothing left to do medically such as a patient’s advanced cancer. There is something left to do. Be supportive of a suffering human being—listen and be empathic.
If it’s appropriate and feasible, you may choose to provide more support or, if asked, advice, perhaps to seek professional help. In the next post, I’ll provide guidelines for identifying the symptoms suggesting depression, which, if present, all the more indicates the need for professional help.
Copyright February 2021 Robert C. Smith
1. Fortin VI AH, Dwamena F, Frankel R, Lepisto B, Smith R. Smith’s Patient-Centered Interviewing — An Evidence-Based Method. 4th ed. New York: McGraw-Hill, Lange Series; 2019.
2. Smith RC, Lyles JS, Mettler J, et al. The effectiveness of intensive training for residents in interviewing. A randomized, controlled study. Ann Intern Med 1998;128:118-26.
3. Smith RC, Hoppe RB. The patient’s story: integrating the patient- and physician-centered approaches to interviewing. Ann Intern Med 1991;115:470-7.