Mental health problems — most commonly depression, anxiety, and drug use — are some of the main causes of the overall disease burden worldwide. In fact, in the past week, it is estimated that one in six people have experienced an issue with their mental health.
It's likely either you personally or someone close to you has come up against a mental health problem. But unfortunately, we are not always well equipped to know what to do or what to say.
Sometimes it will be obvious that someone is struggling, but other times the signs will be a lot more subtle. According to the Mental Health Foundation, sometimes you don't actually need to know.
"It's more important to respond sensitively to someone who seems troubled than to find out whether or not they have a diagnosis," the foundation says on its website.
It's also really important you don't minimise the other person's experience in any way, which many people can do without realising. Sometimes, by trying to give advice or be helpful, the friends and family of someone with a mental health problem can do more harm than good.
Therapist and psychologist Perpetua Neo spoke to Insider about what you shouldn't say to someone who is struggling with their mental health. Here are the main topics and phrases to avoid.
1. 'But you're so rich, famous, successful...'
Someone lives in a nice house, has a good job, and has close friends. From the outside their life is successful and seems perfect, but they still struggle with depression. Neo said it's important not to minimise someone's pain by pointing out how super someone's life is despite their mental health.
"Don't tell them things like 'oh but you're rich, you're famous, you're intelligent,' because pain does not discriminate," she said. "And sure, if you are a starving child in Africa with one meal every three days, then your pain sucks, your pain is very different — but that doesn't mean that pain from depression doesn't matter."
If someone is suffering from a trauma from an abusive relationship, or is anxious and depressed about their life, comparing them to those who are "worse off" isn't likely to be much of a comfort. Instead, keep in mind that everyone's feeling are valid, no matter how things look from the outside.
2. 'I went through the same thing when I...'
Sometimes we relate to someone in pain by talking about our own experiences. But this isn't always necessary, and can come across like you're trying to compete.
"It is really not a competition," said Neo. "Sometimes when you want to tell someone the truth, no matter how you say it, other people come in and will tell you all this historical stuff, like they just want to compete with you. And that's just not what you should be doing."
Maybe you are trying to be empathetic by saying you have been in pain too, but it's more helpful to the other person to simply bare witness to their pain and tell them you are here for them. That way, they don't feel like they are burdening you with their feelings, and they know you're really listening — rather than waiting for your turn to talk.
That being said, there's every chance they might appreciate hearing about your own experiences. But wait for them to ask about it first.
3. 'You're just looking for attention.'
You should never tell someone they are just looking for attention. You have no insight into what they are feeling, so you should never try and invalidate them.
"We have a lot of empathy towards cancer patients, or anyone with a physical ailment, but why is it that we don't have the same empathy towards someone with an invisible illness?" said Neo.
"And by invisible, I don't just mean someone suffering from anxiety or depression, I also mean things like fibromyalgia, chronic fatigue syndrome, things that don't really register on scans, but are obvious problems for the person suffering through it — it's not a bid for attention."
There are some people, like narcissists and psychopaths, who might mimic mental health problems or fake having diseases, but that doesn't mean the majority of people are untrustworthy.
4. 'Just exercise.'
"Another thing people always say: 'just exercise,'" said Neo. "We know exercise is great for making people feel better, because it gets all your endorphins going. But when we actually feel good, how many of us go exercise? Not many.
"When someone is down in the dumps, they don't have the will to, they feel like they don't deserve to exercise, or get the benefits from exercise. Or they feel like even if they exercise they won't get better. Because they feel like they have degenerated to the point where it is too late to change. And they want to punish themselves. So already the struggle is on five or six levels."
5. 'When the pain is gone, everything will be great.'
Anyone who has struggled with their mental health will know it can easily become part of your identity. Sometimes, not all the time, people can be living with depression or anxiety for so long it starts to define who they are — which means they might not be sure who they are without it.
"[This] is something they are never going to tell you: 'I've been struggling with this pain for so long, who am I when the pain is gone?'" Neo said. "It's all very well saying when you wake up one day and the pain is gone life will be great, but how the hell are you going to take that identity with everything else?"
This is likely to be something that has gone through their mind. So rather than painting a picture of how wonderful everything will be once they are out the other side, simply make it clear you'll be there for them every step of the way.
6. 'Am I not enough for you?'
When you're talking to someone you care about, it can be hard not to make it about you. Especially if they are deeply depressed, or suicidal.
"Do not ever say 'Am I not enough for you?'" Neo said. "Because the truth is, when you are in that hell, nothing is going to be enough for you. Saying things like that, you add this extra burden, and they start feeling guilty for making you feel that way."
You may feel like you are reminding them of all the good they have in their life, and how many people care about them. But you might just be adding to the negative feelings they are holding, according to Neo.
"In spiritual healing we call it darkness of the soul," she said. "And sometimes people don't return from it."
7. 'Suck it up.'
You might not be so blunt, but words to the effect of "suck if up" are never going to be helpful.
"In our daily lives we can't use our minds to make everything go away, otherwise everyone would be hot and skinny and happy too," said Neo. "And so I can do a lot of affirmations, like 'I'm smart, I'm efficient, I'm productive,' but there are all these deeper stories that are running me, and I store them in myself emotionally. So no matter how logical I am, it's not going to happen because we are not rational creatures — we are run by our gut emotionally."
If you try to always suck it up and get on with things, eventually you will crash, according to Neo.
"It's not worth telling someone to just think positive, because there's a lot of life that is not positive," she said. "And this is not to say be negative, it's not to say be unrealistic... You can't think your cancer away, so you can't think depression away."
You can't think your cancer away, so you can't think depression away."
8. 'But you don't look sick.'
This isn't something you would usually expect a friend or family member to say, but it does happen. Some people just aren't as empathetic as others, and so they expect proof of someone's illness.
Sometimes it will be clear that someone is struggling with mental health issues, because it'll show on the outside in the way they dress or even in their body in how they sit or walk. But with others, it isn't so obvious.
For instance, Neo said people can sometimes say "you don't look sick," because the person still puts a lot of time and effort into their appearance. By essentially asking them to prove that they are ill, you're asking them to take away the one thing that might be keeping them afloat.
"You shouldn't expect a person to be completely down in the dumps all the time," Neo said. "You should celebrate and be there whenever they are on an upward trajectory... so proving illnesses is stupid. You don't ask a person to prove cancer. You don't ask a person show me your blood tests — you believe them."
9. 'I feel so sorry for you.'
It's important you don't treat the person as a victim, and realise they are still your friend— they're just going through a tough time.
"When a person is struggling with suicide or anxiety, or depression, anything like that, the reason they are still alive, they are still trying to seek help, they are asking for help, is that there's a part of them that fighting — the warrior part of them," Neo said. "But then the problem is sometimes we meet people who give us advice convincing us that we are victims."
They might be trying to help by showing sympathy, but Neo said by treating you as a victim, you are essentially keeping them small. And it's the warrior part you want to focus on and grow.
"You don't keep a person small," she said. "I always tell my clients you can't grow a jungle in a tiny pot... You need to be clear about your personal identities and how you relate to any kind of struggle because a lot of people do see themselves as victims or martyrs. It doesn't mean the person you are talking to is a victim or martyr. So be very careful when you say things to them."
10. 'You'll go to hell.'
In some religious communities, mental health is still not particularly well understood. Especially when it comes to depression and suicide. In fact, in some religions, ending your own life means you go to hell, which some people may use as a scare factor in stopping someone from doing it.
"I've heard people in religious communities saying if you want to kill yourself you will go to hell," said Neo. "Sometimes it is well meaning — you hope that this fear of eternal damnation is going to stop someone from taking their own lives."
But in reality, if someone does believe in hell, they must be in unimaginable pain to risk ending their lives to end up there. So that's no way to help them, Neo said.
11. 'Cheer up.'
Someone who is existential, for whatever reason, is still capable of being happy. But the things that seem to bring everyone else joy might not have the same impact on them.
"Maybe they see through the social charade. Maybe they see death and all that stuff," said Neo. "We don't know what makes a person existential. But there are some people who are just a lot more existential than others."
It isn't helpful to say things like "just be happy," because they work hard to understand everyone else's point of view, and they deserve the same in return.
"So don't tell them of just be grateful, because they do try to be grateful," said Neo. "But they say depression is like looking at life with a black lens."
Most of us do tend to have rose-tinted glasses when we are not depressed, which makes us more optimistic. Studies have shown when we are depressed, we tend to be a lot more realistic.
"Depression isn't about looking at the world extremely negatively, it's more looking at the world in a realistic way," Neo said. "And sometimes realism is sad."
12. 'How did you get into this situation?'
"Really importantly, we shouldn't punish someone for how they feel right now," said Neo. "And don't say things like 'You're intelligent, how did you get yourself into a situation like that?' Or 'How did you get stuck with abusive men?' Or 'How did you get yourself depressed or anxious?'"
She said it's almost like you're saying "How dare you feel this way?"
"But as I said, pain doesn't discriminate who its victims are," she said. "You shouldn't punish people for how they are feeling, because until you see it yourself you don't know what it's really like."
13. 'Snap out of it.'
We are all human, and when you don't truly understand where your loved one is coming from, it can be frustrating. This can sometimes lead to people saying "just snap out of it," when their patience is running low.
"Asking someone to just snap out of it in the present moment is not cool," said Neo. "Instead, what you can do is tell them that there are options for you to feel better, where you take control of your timeline, and your future."
You may not be able to understand everything that led up to someone feeling the way they do, but you can ask them "How would you like me to be here for you?"
The answer might be as simple as sitting down with a cup of tea and some cake, or to listen for a few minutes. Very importantly, Neo said, don't try and offer an opinion.
"No matter how well intentioned you are, don't offer solutions unless they ask you to, and be very aware your solutions might not be the best for them," she said. "You feel like you're counseling someone, but you're not. The most powerful and loving thing you can do is just to listen to someone's pain."