In a recent episode of the popular television series "Better Call Saul" (very minor spoilers follow), one character is seen having an emotional breakdown on a bus. As she attempts to casually utilize her community's mass transit services, she finds herself unable to contain her emotions — and so publicly starts to cry. In the background other passengers are seen awkwardly ignoring her, although a single hand is placed on her in a feeble attempt to offer comfort.
While "Better Call Saul" is a work of fiction, it is not unusual for people struggling with mental health issues to have uncontrollable public displays. Indeed, even when a mentally ill individual isn't having a literal emotional breakdown, it is still common to get spurned for not behaving in a socially acceptable manner.
Humans are, by nature, compassionate and empathetic creatures: sociologists say we wouldn't have been able to create such complex societies if not for our predilection for helping each other. And just about everyone at some point has this experience of passing by or observing someone having an emotional breakdown in public.
But we don't always know what to do for them — or if there even is anything we can do.
"We should remember that, at their core, mental health conditions are health issues," psychologist Doreen Marshall, Ph.D., the American Foundation for Suicide Prevention's vice president of mission engagement, told Salon by email. This means that they deserve sympathy — especially since they are often "frightened and unsure where to turn for help."
"They can also feel disconnected from what is happening around them, have worrisome thoughts, or even unaware that others are seeing their distress," Marshall explained. "There is also a public misperception that those who experience mental health concerns may be violent or aggressive toward others, but the reality is that the vast majority of those who experience mental health conditions have never been violent toward others and are more likely to be victims of violence than perpetrators of violence."
As such, "If you are witnessing someone having a public mental health episode, it is okay to approach them and ask them if they are ok and how you can help them," Marshall wrote to Salon. "You should approach these situations with compassion and care and recognize the goal is to help the person get connected to what they need."
At the same time, you should be mindful of whether that person is already receiving assistance. If too many well-intentioned people converge on a person with a mental health crisis, the one they hope to help might instead feel overwhelmed.
"Only one person should really be speaking to the person going through the episode — not like five or six," Kelly Abreu, a Mental Health Worker at the Worcester Recovery Center and Hospital and Vice President of AFSCME Local 137, told Salon by email. "Because they [the person going through the episode] is confused as it is, so only one person should be speaking to that person. And it should be in a tone that they can understand. Not fast. You can't be abrupt. You just need to ask them 'What's going on? Is there anything I can help you with?'"
Of course, one shouldn't be too harsh on bystanders whose main mistake is being overwhelming in their desire to help. Their attitude is a stark contrast from what often happens if a person has a public display of poor mental health. There are many mistakes that can be made, and a lot of those errors are derived from the stigma we attach to mental health issues.
"A lot of times, others don't want to be near someone going through a mental health episode," Abreu pointed out. "They'll isolate them. Or they'll call the police on them. It can get blown out of proportion really fast and make the situation more dangerous. They start yelling at them. It's not what's needed."
Deshonda Copeland of AFSCME Local 1963, a Senior Residential Unit Specialist at Florida State Hospital in Chattahoochee, emphasized that while there are many ways to help a person, would-be allies should avoid seeming confrontational or accusing.
"When people are having mental health issues, there [are] different ways to help," Copeland wrote to Salon. "But you never want to yell or approach from a place of frustration or anger. Get to know the problem they are having before dealing with it. A lot of folks just need someone to listen to them, talk to them."
It is also important to understand that people experiencing public mental health episodes are, almost by definition, dealing with an uncontrollable issue. While it may be tempting to simply urge them to calm down and rest, doing so can mistakenly presume that their medical condition is somehow due to a set of conscious choices. It also wrongly simplifies the complex situation at hand.
"It's also hard to tell why someone might be having a crisis," Abreu observed. "It could be drug-induced, or it could even sometimes be the result of a medical crisis – like high blood pressure, or diabetes, or other issues that are going on. Sometimes these medical issues present psychological symptoms."
"We should remember that, at their core, mental health conditions are health issues."
There are also many factors entirely external to the individual in question that can put them in a mentally compromised state. There is evidence that depression may not stem from neurochemical imbalances in the brain, but rather from systemic injustices that wear people down.
"Unfortunately, poverty and discrimination can play a role in receiving appropriate diagnosis and care for mental health concerns and accessing adequate care," Marshall explained. "While these situations are not alone responsible for symptoms of mental health conditions, they are certainly stressors that can make growing mental health and other health concerns worse, as well as prevent early identification and care of mental health concerns."
Moreover, mental health problems can affect everyone — no one, regardless of their background, is immune. That means that, regardless of a person's background, there are ways to have a positive attitude that can be effective for anyone.
"Some respond like they would respond to a relative or a friend," Copeland suggested. "If they are having an outburst, approach the situation positively…be their support. A lot of folks just need someone to listen to them, talk to them."
"It is important to remember that mental health concerns do not discriminate and people from all races, economic levels, genders and backgrounds can experience mental health conditions," Marshall told Salon. "This is why it is important for all of us to educate ourselves on the mental health resources available in our areas, to challenge our notions of who may experience mental health concerns, and be ready to meet those who struggle with support and compassion."
