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How To Have The Conversation

I’m concerned about a family member. How do I talk to them about it?

Initiating a conversation with your loved one about their mental health isn’t easy. But it can make a big difference.

PALS is a simple acronym to help you get started:

Prepare

It’s important that you feel ready and are in the right headspace.

Have a clear idea of what you want to say before you say it. Don’t be afraid to make some notes and practice different responses.

Be prepared for the conversation to not go as expected. Your loved one might not be ready to talk, or may express difficulties that are more serious than you anticipated. Both reactions are possible, and valid.

Timing is key, so choose your moment; asking as soon as they walk in the door, or during the dinnertime rush might not yield the best results.

Ask

Start by asking how they are feeling. It might sound simple but approaching them, and being willing to have the discussion shows you care.   

Use open-ended questions to encourage conversation. It can help to point out changes you have noticed:

“You’ve seemed a bit quiet lately. What’s on your mind?”

“I’ve noticed that you’ve been sleeping a lot. How are you feeling?”

“How are things going?”

“We’ve both been busy lately and I feel like we haven’t checked in with each other for a while. How are you?”

“It seems like you’ve been really down recently, and I’m worried about you. Are you ok?”

If they don’t want to talk, or minimise their problems:

Avoid a confrontation. Pushing people to talk when they’re not ready can cause more harm than good.

Reiterate the changes you have noticed, and that you’re concerned. Let them know that you’re here if they ever want to talk. Encourage them to talk to someone else if that’s easier.

Get help if you’re worried about your loved one. A mental-health professional can give advice and provide you with support.

Listen

Sometimes the most important thing you can say is nothing. Give your loved one the opportunity to talk, and really listen. Pay them your full attention, it sends a powerful message that they are not alone. Resist the urge to jump into problem-solving mode.

Instead, listen and validate their experience by:

Asking clarifying questions:

“So things have been really stressful at work. Have I got that right?”

“Can I just check- are you saying ­­–?”

It sounds like this might have been going on for a while. Has it?”

Reflecting back what they are saying:

“That sounds really hard”

“That would be difficult to deal with”

“You’re really frustrated”

“I think it’s really understandable that you feel sad”

Support

Remember not to rush into ‘fixing’ your loved one. Once you have a good understanding of their situation, ask what you can do to help.

For some people, listening will be enough. For others, practical support might be needed. Be guided by their response.

If appropriate, it could be a good time to make a plan. This shows them that you are in this together. Brainstorm some short-term goals. Ask them what they have found helpful in the past.

Some simple things that can improve mood include:

  • Exercising
  • Eating regularly
  • Going to bed earlier
  • Socialising- even if it’s just texting or calling at first
  • Carving out ‘me time’ – for relaxing, reading, gardening, journaling, DIY jobs, etc.
  • Avoiding alcohol and other drugs
  • Encourage them to talk to other family and friends. Ask them how they feel about seeking professional support.

Before you end the conversation, invite them to keep checking in and get permission to do the same. Some days will be better than others, and your support on the difficult days could make all the difference.

Common Mental Health Issues

Depression

Depression is different to feeling sad, having a tough day, or experiencing grief and loss. Depression is a debilitating condition, involving a very low mood for a period of at least two weeks.

There is not always an obvious cause or reason for depression. Its development is likely due to several factors, including stressful life events, a family history of depression or a lack of social support.

Depression can make someone feel like everything is more difficult to do and nothing is worthwhile. For some people, a very depressed mood can also involve thoughts of harming or ending their life by suicide. 

 

Common symptoms include:

  • Feeling low for days on end
  • Feeling emotionally flat or numb
  • Not being able to enjoy your usual activities
  • Cannot be bothered staying in touch with friends and family
  • Struggling to get out of bed OR struggling to sleep
  • Feeling much more hungry than usual OR not hungry at all
  • Deflated and out of energy
  • Difficulty concentrating
  • Thinking more negatively – ‘What’s the point’, ‘I can’t cope’, ‘I’m a failure’
  • Recurring thoughts about death, suicide, or harming yourself

 

Coping & Support

Whilst depression can make it hard to stay active, it can be really helpful to get back out there and reengage with the things you used to enjoy.

Some helpful tips for planning out your day include:

  • Intentionally schedule in activities that might make you feel good or proud of an accomplishment (even when you feel like they won’t)
  • Starting these activities might not be easy at first, but by focusing on small tasks and working up you can build momentum. Don’t wait for the motivation to come – once you’ve done a small amount of activity you will feel motivated to do it again. If you’re still finding these tasks too effortful, try breaking them down a little more
  • Find some time to connect with friends and family. Their support and encouragement may help you find some extra motivation to keep active

People who are depressed often feel the urge to withdraw and hide away. It can also be particularly hard for people who are used to being in a ‘helper’ role to admit to needing help. If this is you, remember there are people out there that want to be there for you to provide support. For some, this may be family members and close friends, and for others it may be local health professionals and community support systems. You can directly contact one of our many supports services (LINK – Our staff page) at Ambulance Victoria.

For further information on depression, check out Beyond Blue and Black Dog Institute.

Anxiety

Anxiety is an unpleasant, apprehensive feeling in response to a potential threat.

It is a normal human emotion, just like sadness or joy. 

Importantly, fear and anxiety are needed to keep us safe in life-threatening situations. They act as our internal alarm system, alerting us to danger and urging us to act. This can be particularly helpful as someone who works in and around emergency services.

However, anxiety can become a problem when it starts to impact our day-to-day functioning or when we start to perceive danger where there is none. 

Anxiety

  • A normal reaction to a stressful event
  • Short-term
  • Lessens or disappears when away from the stressful situation
  • Can involve a realistic fear of a dangerous situation
  • Can be helpful and motivate action

Anxiety Disorder

  • Intense and excessive reaction to a stressful event
  • Can last weeks or months
  • Feeling anxious, worried or on edge most of the time
  • Intensity of the feeling is out of proportion to the situation
  • Interferes with your daily life, stopping you from doing normal activities

Around 1 in 6 Australian adults will have experienced an anxiety disorder in the last 12 months1.

Different anxiety disorders can have different symptoms, but there is usually some overlap.

 

Common symptoms include:

  • Always fearing the worst outcome
  • Avoiding work, school, socialising or other previously enjoyed activities
  • Difficulty concentrating
  • Issues with indecisiveness, procrastination, second guessing
  • Agitation, irritability, and restlessness
  • Rapid breathing and racing heart
  • Chest tightening
  • Sweating, shaking, hot or cold flushes
  • Feeling tense, wound up and cannot switch off
  • Poor sleep
  • Butterflies in the stomach, nausea, and other digestion issues

 

Common Anxiety Disorders include:

Generalised Anxiety Disorder

  • Worrying a lot of the time about anything and everything
  • Feeling like your worry is uncontrollable
  • Feeling on edge
  • Difficulty winding down and relaxing

Panic Disorder

  • Regular panic attacks
  • Fear of panic attacks
  • Avoiding situations that might trigger a panic attack

Health Anxiety Disorder

  • Worrying about getting sick/injured/physically hurt
  • Constantly checking your body for symptoms
  • Avoiding situations that might cause bodily harm
  • Regularly looking for reassurance on symptoms through googling, doctor’s visits, asking others

Social Anxiety Disorder

  • Fear of being judged, embarrassed, and criticised in social situations
  • Avoiding social situations (e.g., public speaking, parties, meeting new people)
  • Trying to avoid being the centre of attention (e.g., looking at your phone, sitting in the back row)

Coping & Support

Although anxiety can be an unpleasant sensation, it doesn’t last at peak intensity forever. There are many different relaxation strategies (LINK to relaxation strategies page) that we can use to help our body naturally calm itself. Some common strategies include slow diaphragmatic breathing, progressive muscle relaxation, and mindfulness meditation – Check out our guided videos here. 

For further information on anxiety, check out Beyond Blue.

1Australian Bureau of Statistics. National Study of Mental Health and Wellbeing 2020-21. ABS. 2022 July.

Post-traumatic Stress Disorder (PTSD)

PTSD is a disorder that can occur after someone has witnessed or experienced a traumatic event. It can be simple or complex, and often presents with significant anxiety and depressive symptoms.

Most Australians will be exposed to a traumatic event at some point in their life. It could be a car accident, assault, natural disaster, or sudden death of a loved one. Traumatic events can be scary but experiencing them does not mean that you will develop PTSD. Many people will recover, without progressing to PTSD.

 

Acute Stress

Paramedics are more likely than the average person to be exposed to traumatic events. It’s important to know that having a reaction to a traumatic experience is normal and understandable. In the immediate aftermath, it is common to experience acute stress. This can look like heightened anxiety, difficulty sleeping, restlessness, or even nightmares and flashbacks to the event.

Acute stress is temporary and usually resolves on its own, so be gentle on yourself.

However, if the symptoms are intense, and last longer than a few weeks, it may develop into PTSD.

 

Common symptoms of PTSD include:

  • Re-living the traumatic event through unwanted and intrusive thoughts or memories, nightmares, and flashbacks (vivid images which make you feel like you are back at the traumatic event)
  • Feeling wound-up, hyper-alert and/or on edge
  • Avoiding any reminders of the event, like driving a longer route, avoiding certain people, shutting down any conversations about the event
  • Feeling detached from others
  • Feeling emotionally flat or numb

Seeing loved ones affected by PTSD can be also be traumatic in and of itself. Family members of first responders are known to experience symptoms of vicarious (or secondary) trauma. Hearing about their job, seeing their trauma symptoms, and knowing they may be returning to more traumatic events every time they leave the house, can cause significant anxiety and distress in those close to first responders.

 

Coping & Support

If you have experienced a traumatic event, try not to bottle up how you feel. Try to talk it through with your peers and loved ones, or a medical or mental health professional.

It’s best to avoid drugs or alcohol, or other numbing mechanisms like over-working or spending too much time on your phone, as this may end up just prolonging or delaying symptoms. Instead, use healthy coping strategies like exercise, socialising, maintaining routine and engaging in self-care. Like other anxiety disorders, engaging with relaxation strategies (LINK to relaxation strategies page) can also help with coping through the distress.

For more information on PTSD and other trauma reactions, check out Phoenix Australia.

Relaxation Strategies

Relaxation can be one way to take care of yourself when you are feeling stressed. There’s no one right way to relax. Everyone relaxes differently, so what works for you might not work for someone else and vice versa. It’s important to really think about what makes you relax and to even brainstorm strategies you can use when your stress picks up. That way, when your stress does increase, you know exactly what you can do to bring it back down.

Here are a few general ideas of what you and your family can consider for your relaxation list.

 

Schedule in break time

We often take a break only when we need it, however, proactively scheduling break times can be really helpful in reducing the accumulation of stress. With your family, think about setting aside a break time for an activity that involves little demands, is stress free and helps everyone to check out. Example activities may include:

  • Going for a walk
  • Playing a video game or boardgame
  • Listening to music
  • Doing a puzzle
  • Reading a book
  • Watching a favourite film/tv show.

 

Soothe the senses

Use your senses to help your body settle and calm down. Examples may include:

  • A nice warm bath/shower
  • Easy-listening music
  • Soft-smelling lavender-scented candles
  • Peaceful sounds of nature
  • A weighted blanket
  • Cuddling a pet
  • Sweet homemade baked goods
  • Star gazing
  • A walk through the park

Paying extra attention to your senses through these activities may also help your body get the most out of it. For example, on a mindful walk, you could pay attention to the feeling of the breeze, smell of the fresh air, and the vibrant colours of any trees and plants.

 

Try a breathing exercise

Breathing is a tool you can use at any time, in any place, to calm the body and quieten the mind. A simple trick is to breathe in for a count of three, hold, and breathe out for a count of three. Try to breathe all the way into the stomach, rather than from the chest (you can rest your hand on your belly to see if it’s moving). See if you can do this for a couple of minutes at a regular time each day (e.g. when you get in the car to drive home, after picking up or dropping off the kids at school, or just before bed). 

Use imagery

If you can’t get away physically from your stress, you can always imagine yourself somewhere peaceful. Think up an image of a place you have been, somewhere you have always wanted to go, or a general place of peace and serenity.

Examples images may include:

  • A tropical beach
  • A lush woodlands forest
  • A majestic mountain range
  • Floating amongst the clouds

Once you have your image, simply close your eyes, immerse yourself in the details and focus on all the sights, sounds, and feelings that image brings up.

 

Ease Muscle tension

When we are stressed, our muscles become tense and tight. Try progressive muscle relaxation by tensing and relaxing the muscles. You could also do some light stretching, yoga, or book in for a professional massage. 

Be creative

Get in touch with your artistic side by drawing, colouring, playing an instrument, baking etc. Anything that you enjoy that absorbs your attention. If you can do a family project together, even better. Try not to focus on the finished product, and instead on the enjoyment of creation and connection.

 

Use a guide

There are many guided relaxation or mindfulness exercises readily available on the internet or through a free app, such as Smiling Mind. Set up a family schedule to find times where you can all listen together.