How to check on a friend
Do it in a way that helps both of you.
In the immediate
RALEIGH, N.C. — aftermath of three suicide deaths in five weeks at UNC-Chapel Hill, Chancellor Kevin Guskiewicz called on the school community to “reach out to a friend, a classmate, or colleague and ask them, ‘honestly, how are you doing?’ ”
When I was struggling to keep my mental health under control in college, people in my periphery would occasionally send this type of text message to me. It was always well-intentioned, but it was seldom answered truthfully.
With acquaintances, I would navigate the fine lines between being truthful and being courteous, knowing that the honest answer would be overwhelming for people who didn’t know me well. It was also just hard to explain what I was feeling: I knew I wasn’t OK, but I wasn’t suffering a monumental loss or even anything that seemed extraordinary.
Suicide is a public health crisis, but we have failed to tackle it beyond throwaway phrases. There were 1,368 deaths by suicide across North Carolina in 2019, the last year of available data. Across the country, suicide is the 10th most common cause of death overall, and the second most common cause of death among 10- to 34-year-olds.
The number of deaths by suicide have been steadily increasing since at least 1999, but our culture has yet to allocate enough resources for folks struggling with suicidal ideation when compared to other causes of death, like heart disease or cancer.
When you notice friends struggling with their mental health, there are ways to check in that are better than “how are you doing?” UNC-CH associate professor Tara Bohley, who leads the school’s Mental First Aid activities, says it’s best to ask openended questions that can’t be dismissed with “yes,” “no,” or “I’m fine.”
“In your personal life, you start doing that, you’re going to find people are just looking for listeners,” Bohley says. She recommends coming into the situation with observations, like telling your friend you’ve noticed them withdrawing from others or acting differently.
Listen, but don’t necessarily offer advice
Once in the conversation, Bohley recommends validating someone’s experiences and feelings. That’s one of the main areas of teaching in mental health first aid: listening, not necessarily offering advice. It’s something that helped me personally as the friend struggling, and as the friend trying to help.
“It trains them on what types of responses are appropriate, what are some things to listen for that might indicate that this person is in crisis,” she says. Once you understand someone could hurt themselves, it’s important to get them to someone who is trained to help, like a crisis counselor for your local department of public safety or the national suicide hotline.
When I was struggling in college, my best friend helped me determine when it was best to get outside help. It also meant that she had to be honest with me when she realized she wasn’t able to support me in the way I needed. It’s important that you realize when something is outside your capacity as a friend or acquaintance.
“Being able to understand what you see in other people and to be aware of it yourself is one of the added bonuses that people sometimes walk away with from the training, recognizing that ‘I am not the best one to intervene,’” Bohley says. “One of the things that person can say is, ‘I’m concerned about you, and I noticed that you seem to really be struggling more than you were before,’ or ‘I noticed that these are different, and I’m not sure I can help you with that, but I want to help you get to help.’ ”
Expanded infrastructure is important
This is where infrastructure comes into play: expanding Medicaid, broadband infrastructure to offer telehealth, gun buyback and other control initiatives and requiring mental health first-aid courses will ensure people have options for care and make sure that people are treated before they’re in crisis.
It requires more resources for suicide prevention lifelines: More than 37,000 callers contacted the state branch of the National Suicide Prevention Lifeline in 2020 and received crisis counseling, an 11.5% increase from 2019. Despite this, some hotline callers have noted that these lines can do more harm than good, because of a lack of training for volunteers or long wait times.
When we just “check in on our friends” without understanding our own mental health needs or the best way to come into a conversation, it’s putting a Band-Aid on a gaping systemic wound. It’s important that you have enough resources to navigate these conversations, and that you know what to do if it’s an issue bigger than you. Having my own friends do this is what got me help when I needed it.