I Need Directions…to Mental Health Help

Three little words.

Three little words that take big bravery to utter.

We’re not talking “I love you” here—that’s another story—but rather: “I need help.”

Experts and orgs and we here at Mental always say that if you’re struggling with mental health, the first step is to ask for help. 

But how exactly you ask for mental health help is less clear. What’s the first step to the first step? It’s not as benign as typing “Starbucks near me” into Google Maps or Slacking a coworker about where she got that cute “to-do” notebook.

“Asking for help with your mental health can be really scary. The stigma around mental health is real,” says therapist Shelby Castile, LMFT, founder of The OC Shrinks, an organization of 3,000 mental health professionals in Orange County, California.

To wit, 45 percent of Americans who need mental health help don’t seek it, according to a 2021 report from Sapien Labs, and stigma is indeed one reason why. Other significant reasons? A vote of no confidence in the mental health system, and a lack of knowledge around what kind of help to get. 

It’ll take us a leeetle bit of time to work on that confidence-in-the-system piece, but what we can address now are the stigma and knowledge parts. You’ve likely heard the stat that 1 in 5 people are dealing with a mental health issue in any given year.

But there’s another key percentage that rarely gets cited: Nearly 50 percent of people will, at some point in their life, be diagnosed with a mental health condition. (The U.S. Department of Health and Human Services says so!) So try not to self-stigmatize. You are far from alone. And as with a physical illness, mental illness is not your fault.

As for the tactical steps—the who, how, and what—we’ve put together 10 tips that we hope will function as GPS for mental health help. Here’s what experts advise.

1. Start with a person you trust.

“Asking for help can be incredibly vulnerable and potentially scary depending on one’s symptoms, how mental health is talked about within one’s culture and family, one’s vocational life, and so much more,” says therapist Alegra Kastens, LMFT, founder of the Center for OCD, Anxiety, and Eating Disorders, who treats clients in New York and Los Angeles.

“Given the sensitivity of the ask for many people, it can be safest to talk to someone you really trust—someone with emotional intelligence and an open mind who will not judge you,” Kastens continues. “This may be a family member, close friend, partner, school guidance counselor, or mentor.”

Not sure who fits that bill? Consider this: “It’s that person you feel takes a little extra time with you, listens a little closer, or responds with a bit more compassion,” says Castile. “Someone in the healthcare industry with these attributes would be ideal. However, if that isn’t clear at the time, finding a relative or a friend who has these qualities can hopefully lead you to a professional who is more equipped to help.”

2. Talk face-to-face.

It can be tempting to text or email, and if that’s all you can muster, that’s enough. But if you’re up for it, chat in person.

A face-to-face ask is a better way than an email to get what you want, per a study published in the Journal of Experimental Psychology (for the record, the study wasn’t specifically about mental health help). The researchers cited “the implicit trust” that gets conveyed in person but lost over email, and that trust “activates empathy.”

3. Try to articulate the kind of help you want.

Workings of the mind are a complex thing, so when we say “try,” we aren’t soft-pedaling—just do your best. Don’t blame yourself if you haven’t got a succinct end goal.

“We may have difficulty articulating what kind of help we need,” says Stanford social psychologist Xuan Zhao, Ph.D. “You might just need someone to listen, or you might need practical help—like making a doctor’s appointment. It is okay to take the time to figure things out together.

Not sure what you need from the person you’re talking to? “Be open about that, too,” she adds.

When Kastens—who both treats and has OCD—first started experiencing “terrifying intrusive thoughts and images out of the blue, I didn’t know that there was a name for the jarring symptoms: OCD. I couldn’t say ‘I need help with my OCD,’ so I said the only thing I knew how to say to my family: ‘I’m feeling really anxious.’”

During your discussion, Kastens says it’s cool to keep things vague, like this:

• “I have really been struggling with my mental health and would like to talk to a therapist/psychiatrist/doctor about it. Do you know of someone who could help?”
• “I don’t know what’s happening, but I am not feeling well mentally. Can we find me a therapist?”

Even if you do have a decent sense of what you’re experiencing, it’s up to your discretion and comfort level how much you share. Kastens gives two examples of what you might say:

• Anxiety. “About a month ago, I started experiencing really scary thoughts and intense anxiety. I would like to see a therapist to better understand what is happening and get help with this.”
• Depression. “I have been struggling with depression, and it’s making my life very difficult. I need to see a psychiatrist.”

This may be a tough chat, but it’s worth it. “Even if things don’t make sense and coming out as clearly as you might like, you’re at a starting point and this is the important part,” Castile says.

4. Remember that people feel good about helping.

“People who care about you want to help,” says Castile. And that’s not just conjecture. In a study published last year in Psychological Science, researchers discovered that people are much more willing to help and much less annoyed about doing so than we tend to predict. “Even though our studies didn’t involve asking for help on mental health needs, I think this phenomenon is likely to hold true for those as well,” says Dr. Zhao, who led the study.

“For instance, research has shown that people who disclose their mental health struggles to others often report positive outcomes, such as increased social support and a greater sense of connectedness, especially when the listener is more empathic and responsive,” Dr. Zhao tells Mental. “By speaking out about mental health, seeking help when needed, and offering help when others are struggling, we can help to reduce the stigma and create a more supportive and inclusive society.”

5. Consider a PCP or a mental health org. 

If you don’t have someone in your circle who feels right, you can try a primary care physician (PCP). Yes, we’ve heard many stories of PCPs who brush off mental health or don’t understand the intricacies of a specific diagnosis. And we certainly don’t want you with those peeps.

But PCPs are often the first place people go when they’re dealing with mental health issues, according to the Anxiety & Depression Association of America. In fact, anxiety and depression are in the top 10 reasons for PCP visits. Some health centers house both primary care docs and mental health pros, which makes it easy for them to work together—you can always look for that setup.

There’s another advantage to seeing a PCP. You’ll be prompted with a mental health questionnaire about generalized anxiety disorder—in other words, there’s a built-in way to get the convo going. While anxiety may not be your issue, your answers can help guide the visit.

If the PCP route is a NGH for you, might we suggest a mental health nonprofit or organization? “You may want to explore online to see what’s out there,” says Castile. “There are a lot of community support groups and online resources, and sometimes, reaching out to a stranger can feel less daunting.” Look for a “.org” versus a “.com” at the end of the website name to ensure it’s a not-for-profit group.

Castile typically refers people to NAMI, the National Alliance on Mental Illness. As the nation’s largest mental health organization, “they have branches all over the world, and they’re known to have a plethora of reliable resources, including a helpline, a chatting feature, and a new texting feature,” she says. “They also have community events and support groups, both online and in-person.”

6. Ask for discretion.

“Once you decide on the person you trust, make sure you make it clear to them that you want your words to be kept private,” says Castile. No pinky-promises needed, just an agreement that this isn’t meant for a Threads broadcast.

7. Take notes before a pro appointment.

This can be a nerve-rattling situation. Being prepared can help you remember what you want to bring up. “Writing down your thoughts first will help unscramble them from your head and help you identify what you’re needing help with,” says Castile. 

And while much has been written about the perils of Dr. Google—or: Googling your symptoms and ending up in a doom spiral—it can provide helpful background info for some. “The internet can be a great way to learn more about one’s symptoms, even if they don’t have a name for them,” Kastens says. “I eventually typed ‘why am I having scary thoughts?’ into the Google search engine, and that is how I found a name for OCD. Doing this before the conversation can better clarify the help a person needs.”

8. Bring a friend.

Don’t discount the power of moral support. At a PCP or therapist’s office, it’s fine to show up with a plus-one if needed.

“They can either hang out in the lobby while you are in with your doctor, or you can ask your doctor if they can join you for the appointment if you are comfortable with them being in the room,” says Navya Mysore, M.D., a primary care physician at One Medical Group. 

9. Explain how you feel.

Conversation starters take on a weightier feel when you’re sitting on that flimsy white appointment-room paper than, ya know, at a Barbie/Oppenheimer double feature. How to break the proverbial ice? “State your concerns and feelings as plainly as you can—the more direct the better,” says Dr. Mysore. 

If you’re thinking, Mmkay but, um, like, what exactly do I say I need exact words help  please and thx? Dr. Mysore offers this simple statement: “I would like to talk to you about how I have been feeling lately.”

Then what? “Typically when people reach me, they’re clear that they need help with their mental health—although many don’t really know what that entails… They just know something’s off,” Castile says. Knowing something’s off and knowing what specifically is off are two different things. Remind yourself it’s no big deal if you can’t perfectly express the latter.

You can also use a pop culture reference to help a friend or a professional understand what you’re going through. It might seem funny to cite a character in Succession or The Bear, but it gives a good frame of reference.

Or, suggests Castile, give examples of how the issue is presenting itself in your life. A la:

• “I start to sweat and feel panicky every time I have to give a work presentation.”
• “I don’t feel like reading anymore, and I’ve always loved books. I just scroll my phone for hours and start feeling bad about myself.”
• “I’m having such a hard time falling asleep and I have to force myself out of bed in the morning.”

10. Feel free to stop the convo at any point.

So you just spilled your guts and you get the ‘ol “everyone feels sad from time to time” or a platitude like “you just need to think positive.” No need to go further!

If the person responds oddly, it’s them, not you. “If you are uncomfortable with something they are suggesting, let them know,” says Dr. Mysore. This is true whether you’re talking to a friend or a pro. “If you do not have a comfortable therapeutic relationship with your PCP, change and find someone that is a good fit for you,” she adds.

Of course, it’s important to recognize that, by nature, these discussions are—to quote Winona in Beetlejuice (hey, it’s what came to mind, and part 2’s out next year!)—a little weird and unusual. You’re talking about hard stuff. But if you don’t feel like you can open up or you’re getting strong N-O vibes, exit stage left.

When you find your person (therapeutically speaking), you’ll be on the road to better times. “We can navigate together where the issue is stemming from,” Castile says. “Once we identify the root cause, this is where the therapeutic process begins and a treatment plan is born.”