How to give and ask for mental health support

A Carolina clinical psychologist explains peer support for mental health and offers tips to help yourself and others.

Graphic that includes
(Graphic by Zack Hall/UNC Creative)

When a friend or loved one faces a hard time and you don’t know what to say, show up anyway and listen. If, on the other hand, you feel depressed or anxious, ask someone to listen to you.

That’s how Edwin Fisher, a clinical psychologist and director of Carolina’s Peers for Progress program, sums up peer support for mental health.

Fisher, a professor of health behavior in the Gillings School of Global Public Health, shares more information about peer support.

Is the term “peer support for mental health” as complicated as it sounds?

No. Peer support is as old as humans and not limited to humans. There are examples among all sorts of animals like elephants, monkeys, chimpanzees and dolphins, as well as human beings. Peer support is part of who we are.

Gobs of evidence show that social isolation and loneliness are challenges to whatever you’re trying to do — raise an adolescent child, care for aging parents, get your taxes done on time, deal with mental health challenges. And there’s lots of evidence that isolation and loneliness are related to all sorts of mental health problems, including depression, anxiety disorder, schizophrenia, suicidality, etc.

Being supported by other people, feeling they share in some of what I’m feeling and are there for me is important. That’s the base on which peer support rests.

Who can provide peer support for mental health?

Professor Eugenia Eng, my retired colleague, wrote a paper over 25 years ago on the continuum of peer support. Peer support can be a friend I meet for a cup of coffee or a beer. It can be an aunt or uncle who I really feel comfortable talking with. Or it can be a trained peer supporter who I meet every couple of weeks for six months.

What are key parts of peer support?

When we train peer supporters, we teach them listening skills. Step one is listen. Step two is listen. Step three is listen.

Then comes helping people figure out practical ways of solving problems. My favorite example is from a program in Pakistan where women were trained to provide peer support for women experiencing perinatal depression. A woman was having problems with her husband somewhat centered around finances. Her peer supporter helped her buy a buffalo, which produced milk. She was able to sell the milk and bring in extra money that relieved the financial pressures and helped her depression. You might look at that and ask, “How is buying a buffalo a mental health service?” or you might say, “That’s what peer supporters do.” Peer supporters help people in practical ways that fit with their community, fit with their setting.

Another important part is that peer supporters usually have something in common with the people they support. For example, people who are being treated for cancer are often linked with a peer supporter who’s getting the same treatment because much of what they’re experiencing is in the details of the specific treatment.

How can a person who’s feeling isolated, lonely or depressed find peer support?

Most mental health services have peer supporters available. A single psychotherapist or psychiatrist in private practice may not have a peer supporter. But if I go to a Veterans Affairs clinic or an organized mental health clinic, usually they have peer supporters. So the individual could ask to be linked to a peer supporter or someone on their therapy team can suggest a peer supporter to them.

If we’re concerned about a friend or a loved one, how can we offer peer support?

Simply being there is important. We emphasize this in training peer supporters. If “all you do” is be somebody whom others feel they can talk to and who will understand and appreciate their situation, if that’s all you accomplish, that’s enough.

A simple but powerful three-step approach from a project in Zimbabwe is:

1. Make sure the person feels heard. Listen and accept their feelings. Don’t tell them that what they’re feeling is wrong or irrational.

2. Say, “We’ve talked about what you’re feeling, what you’re dealing with. I can appreciate how difficult this is for you. Do you want to talk about things that you might do to try to change it?” They may not be ready for that; that’s fine. Sometimes we just want to be understood and aren’t ready to try fixing anything.

3. If the person says they’re ready, then brainstorm possibilities. As much as possible, start with what the person thinks is possible. Don’t start with your solution for their problem. A good question is to ask the person if they’ve faced similar challenges in the past and how they may have felt successful in dealing with them. It might be something that doesn’t seem connected at all.