Why Open-Ended Questions About Mental Health Are Important

This week I was having a pretty horrific week and, as part of my safety plan, I make a point of going out with members of my church to avoid doing anything that may harm me in the short or long term. As it happens, this particular time I ended up spending the night at a friend’s house so I could get a lift and, like most times I stay the night, we ended up talking about mental health. As we were talking, I noticed a lot of her questions seemed to be guided. After becoming a nursing student, I’ve become more aware of the language and actions of others around me and myself, especially during difficult conversations such as mental health.

The more we were talking about a particular mutual friend of ours, the more I felt I was being compared to her when, in reality, she was just saying I appear to have better control of my mental illness than our friend. Then, one of her questions shocked me.

“I mean, you’ve never self-harmed, have you?”

Before I go on, I should probably reiterate that I make a point of being as brutally honest about my mental health, especially to this particular person. So, this comment was like a slap to the face followed by another when I realized what I was feeling:

Fear.

I didn’t want to tell her I have a history of self-harm and that I constantly relapse, that I even out to about three or four suicide attempts per week per any given year and I constantly feel ashamed about this fact.

It really brought home something I learned in the mental health class we have partaken in, that open-ended questions can really mean the difference between someone getting onto the road to recovery and someone not seeking help and, at the very worst, spiraling out of control.

Closed-ended questions, in my opinion, is something we all do. If someone has a bad day, we ask, “You’ll be fine, right?” rather than simply asking, “Are you OK?” And, for the most part, closed-ended questions aren’t a bad thing. We make assumptions about where the conversation is going or about what we can see in front of us. They help shorten a conversation and get right to the point.

But in mental health, we don’t have that luxury of assuming everything is OK.

I have spoken about masking before, and about being a chameleon. People with mental health struggles tend to be able to blend into their environment and put up very high walls to hide the fact they are constantly masking. Assuming we are OK can put us in danger as we may not seek the help we need.

By saying questions like, “you aren’t suicidal, are you?” “You don’t cut yourself, do you?” or, “You’re fine, aren’t you?” we miss out on the opportunity to let the person speak, especially as people with mental illness tend to say what they can to fit in. So the answers might be yes, yes and no, but if you don’t allow the person to answer by leading them with your question, the answers you are given could be no, no and yes. Which is dangerous.

So, what do we do? I like to challenge people, and I like to be challenged. So I have a simple challenge for everyone.

People without mental illness! Attempt open-ended questions as much as physically possible. Allow those you are talking to the chance to say what they need to say. Learn from them as much as possible, both from their words and mannerisms. Replace “You’re OK, right?” with “How are you feeling today?” Replace “You’re not going to do x/y/z, are you?” with, “Do you think you might do x/y/z?” or “Are you safe to be alone tonight or do you need me to stay with you?” Listen. Validate what they are saying. Believe what they say, because just being an ear helps so much.

People with mental illness! Be vocal. I know it’ll be difficult, and you should only do this with someone you trust, but if you are given a leading question and the answer isn’t something they want to hear, give it to them anyway. It’s better for you and for them if they know you are not well and are in need of some support. Telling them you are not well or that you are in need of some assistance is nothing to be ashamed or afraid about, and just because you may feel like you are being led into a question doesn’t mean you have to answer it that way. Be noisy, be loud, say what you feel so you can be safe. If the conversation is too difficult at that time, that’s OK; it’s OK to be quiet until you find someone you trust, but know your struggles are valid. Just because you didn’t divulge into your life story to this one person with leading questions doesn’t mean you are a bad person or you have failed; it just means you are human. But, if you can, correct them for people with mental illness that they may talk in the future.

So, what did I do when she asked me this question?

I swallowed my pride and corrected her.

The following day, when she said I had better control over my mental illnesses, I corrected her and said I am better at hiding it.

And when I told her I felt like I was empty, like I wasn’t human, and she told me I should just think of it as a feeling, not as fact, I agreed even though I wanted to say that sometimes it’s not as easy as that.

Because there is a time for noise. And there is a time for silence.

If you or someone you know needs help, visit our suicide prevention resources page.

If you struggle with self-harm and you need support right now, call the crisis hotline at 1-800-273-8255 or text “START” to 741741. For a list of ways to cope with self-harm urges, click here.

Photo by Mārtiņš Zemlickis on Unsplash