Supporting someone when they struggle

Hi everyone,

This maybe a strange question, but I would really appreciate your answers. Especially if you have every stayed in a mental health institution/ care home.

How do you want people/adults/staff to support you?
Especially, if they approach you while you are very distressed or just after?

I work with young adults (16+) for a long time now, and even tho I have great relationships with people I work with, I would like to know more...

I would like to learn more about keeping people safe, while they can't keep safe on their own.

Of course, I take into account that everyone is different, that's why I am interested to hear different perspectives.

I've only had brief inpatient stays (on the order of days to weeks), so this is with that in mind:

-Don't assume I'm not self-aware. I can be very rationally aware of how irrational my emotions are. Help me by talking to the rational side of me about managing those emotions, rather than assuming that I don't even realize they're irrational

-Put yourself in my shoes. The last time I was on a psych watch in the ER and I was being forced to hand over all my possessions I was told that I couldn't even keep my bra under the hospital gown. When I was unhappy about this (not throwing a tantrum, just less than thrilled), the nurse, in an attempt to make me feel better, made some comment about how she loves being able to get home at the end of the day and take her bra off. I had to point out to her that there was a big difference between choosing to relax in your own home vs already feeling vulnerable and exposed and having your agency taken away, and to imagine how not even being allowed to keep your bra would further add to those feelings and the humiliation. She hadn't imagined what it might feel like to be going through before I said that (she was a nurse in an ER, not on a psych ward, and she was just the one they stuck with babysitting me)

-ask me. It's okay to ask what or what would be helpful at that moment. The answer might even be different at different times. It can be helpful to offer choices rather than expecting someone to know exactly what they need, e.g. "Would you rather I stay with you right now, or would you rather have some time to yourself?" "Would you like a hug, or would you prefer not to be touched right now?"
Making this choice also helps the person feel more in control at a time when they probably feel like they're having their control taken away from them. It's also a sign that you respect us enough to ask. If it were someone who wasn't hospitalized/in a care facility, you probably wouldn't presume to know what they needed without giving them a choice.
You can also ask before or after someone is distressed, if they're unable to tell you in the moment. Like "if you get upset like that again, what can I do to help?"

-Don't treat me like a child. You're seeing me at the worst possible moment. I'm sure you wouldn't want us to treat you based on your lowest moments in life. In my "real life" I function as an independent adult. Depending on how long you'd been out of school, I could have been your TA. If you assume that I have less life experience than you do or that I am naive and childish, it will show. It's not easy to set aside my pride and accept help, and it's a lot harder if I feel the need to defend my pride because the other person doesn't seem to respect me.

-You don't have to be completely serious all the time. It's depressing enough to be there as it is. It's a lot easier if you appreciate humor when we try to use it. It doesn't mean you're not taking our issues seriously if you laugh at our joke.

-The relationship we have when I'm not distressed will be the biggest factor in how helpful you can be to me when I'm distressed. If I feel like you don't respect me or there's no connection whatsoever between us when I'm not distressed, I'm not going to be at all receptive to you when I am distressed. If I really like you and I feel like we connect well and you understand and are trying to help me, then I'll generally find you trying to be supportive when I'm distressed helpful, even if the same words or behavior from someone else would have upset me more.

Oh, and this should really go without saying, but do not try to make someone feel better by complimenting their physical appearance, especially if they haven't brought it up.

This will hopefully already seem obvious, but if I hear one more medical or mental health professional tell me how pretty or beautiful I am as if believing that would solve all my problems, I am going to scream. It comes across as dismissive and patronizing at best, and often creepy and uncomfortable.

Around here you (the patient, with assistance from a staff member) makes a safety chart/plan/pyramid/traffic light/..

The simplest one has 3 levels: red, orange/yellow, green.
For every colour it lists:
- What happens during this colour?
- What should I do now that is helpful?
- What should/can another person do now?
Depending on the person's specific struggles, he might also add a line or two that indicates he's in a certain colour (e.g. muttering to self = yellow in my case)

The chart can be used for any issue at all: panic, anxiety, flashbacks, sadness, anger, urges.
And also for longer-term issues as a way of relapse prevention: not showering every two days might mean orange, when depression is the problem.

I actually have 3 - one for trauma-related panic (meaning flashbacks and severe triggers), one for escalating anxiety (basically meaning tension, or arguments with any person with authority (that really scares me)), and one for acute panic (basically meaning over-stimulation).
Adding everything to 1 chart just wasn't practical for me. Although most people only have 1 - or 1 for acute and 1 for relapse prevention.

It's been very helpful to me because it tells me what I can do to help myself (and it also gives me permission to do so!) and also how the staff etc will most probably act. One of the scary things about any loss of control through emotions, is that you can't control how other people will react to it - you don't know what to expect. Which will cause even more anxiety. Which doesn't help.
But now I know how others are most likely to (re)act, that means less stress - and also allows me to seek help more easily.

I summarized my plan for school and added a line on acute hopelessness/self destructive urges. I know now that if I ask for help in that area, they will - as instructed - find me a place to sit (that's semi-public) and ask me to agree to stay there until the urge has passed.
This means I can ask for that help: they won't require me to make promises I can't make (such as: not hurting myself) and would only lead to stress and noncooperation (I don't make promises I can't keep, so I would panic if it's required of me), they won't overreact ("hand in your bag empty your pockets and sit next to me until you feel better") and they won't do the wrong thing (put me in a room by myself with a door I can close).

Thank you so much for your answers, very helpful!

I have been doing this job for nearly 2 years now, and I mostly work with age group 16-21. I am really trying not to pretend that I know more then the girls I work with. I am not that much older and I struggle with anxiety so I do understand how vulnerable people feel when they are distressed.

Sometimes giving someone options while they struggle is very challenging, as usualy in response I get 'i don't know', but I guess showing someone that they have options and that I respect their wishes is helpful.

But as you said, I will never fully understand how it feels and we will never know what goes in someone's head. I just have to take every incident as it comes and try to learn form it to be able to provide the best support.

I do agree that the relationship while not struggling is very, very important. I work at a step down from secure, so luckily, there is a lot of opportunities to build supportive relationship and have some fun.

Once again, thanks for answering!

The thing is that you don't give the options when they struggle - you ask them "What would help you in that situation" when they are not actually in it. Or "What helped in the past" and add that to the list. So that when YOU(I) don't know, and THEY(staff/others) don't know, THE PLAN does.

Also, you'd be surprised at how often people /do/ know what they need, but are afraid to ask for it: embarrassment might be a factor, but often it's the /I KNOW I'll totally lose my grip if they say 'no' or ask 'why'/. Or: the thought /It's impossible./

Maybe your group has a "not in bed during the day" or a "TV only after homework" rule. So a girl just wants to curl up and throw a blanket over her head, but can't. Asking might get her permission but it's more likely a genuine 'why' or outright 'no' will be the answer - which she know will make her feel trapped, thus worse. So she doesn't ask.

But if she writes it in her plan, and the staff agrees with the plan and puts it in her file - she CAN ask to lie down and hide from the world. Because she knows it will be allowed.

A while ago in class I needed to leave, but I didn't dare ask. I was only getting worse and worse and I knew that a 'no' or even just a question ('Why?' 'Is that (really) necessary?') or anything but an immediate "yes of course" would push me over the edge (in my case: total flashback, meaning a lot of screaming and thrashing on the floor). So I stayed. Eventually I asked to go to the bathroom, which was allowed, and didn't return - I went to my homeroom teacher instead.

In a vulnerable moment, anything helpful you ask that's denied leaves you feeling worse. So knowing that, you might decide to just not ask.
But knowing you're going to/supposed to receive permission, you likely will ask.

One of my acute panic/over-stimulation thingies is simply /Walk away/ (remove myself from the situation) and it's been SO helpful! Because by allowing me to put that in my plan, the staff gave me permission to walk away when necessary!
And I would have been allowed to, probably, even if it wasn't written down or agreed upon somewhere. But I'm obedient like that: if I'm supposed to sit at the table, I won't generally leave the table.

Also, you're a step-down from secure, you say. It's a real possibility that some of your girls are afraid of (because of threats from parents/staff/authority, stories from groupmates, own experience, having witnessed it happening, or just because they feel like a hopeless case, nutcase, or a bother) having to go to secure (if they are from 'outside') or having to go back to secure (if they were in a secure setting before) if they 'take' (do) or 'demand' (ask for) things that aren't allowed.
'Anteroactive' (proactive?) agreement/permission can help in a huge way.

Also, as for word choice - "May I sit with you?" feels more supportive and less /I'm a bother/ than if someone asks "Do you want-" or "Do you need-". (Although I can't imagine much other situations where that 'may I' would feel both natural and helpful. Only in the "May I join you" sentences I think)

I definitely agree about the embarrassment thing.

I'd also add that people might feel silly asking for what they need.
I wouldn't be able to ask someone to sit with me or give me a hug (depending on the policies in touch). I'd feel silly and childish asking for it, and I'd be worried the person would say no, and I would be mortified.
If it was offered as an option though, I'd be much more likely to say yes, because I'd know that the person offering it wouldn't then say no, and if they're offering it they're probably not going to judge me for finding it helpful.