You Asked, “R U OK?” And I Said, “No.” Now What?

“Are you okay?”

It’s the kind of question that can open the floodgates when you’re struggling. And Australians will know that simple question is the spark that ignited the suicide prevention charity R U OK?.

The theory – and it’s a good one – is that starting a conversation can help people feel connected and loved. Since social isolation can be such a risk factor in suicide, the day has become a way to “break the ice” between friends or colleagues.

That’s often a good thing, and I don’t want to criticise R U OK? for what it is. But it occurred to me that R U OK? is just the tip of the iceberg.

By all means, ask the question. But don’t we need to know what to say next?

What if my answer to “Are you okay?” is “No”?

If you ask the question, you have to know what you’d say if I say “no”.

After all, the response to that kind of disclosure can be significant. Some questioners may get overly awkward, making me feel like I’ve overstepped. Others may tiptoe around me from then on, completely changing our relationship.

There are also a host of common things that people may say that aren’t helpful – for instance, making it about them, or dismissing it as “life is rough sometimes, huh?”

It’s also possible the questioner can’t cope with my troubles and distances themselves, leaving me more isolated than ever.

The fact is, we shouldn’t be encouraged to ask a question if we’re not able to deal with the answer. As Alex Walker wrote on Lifehacker:

What RUOK Day has become is an opportunity for people to ask a question …

But the trick is to make an environment where people feel comfortable talking. The focus should be on getting the story told, not convincing someone to ask a question they’re not prepared to hear the answer for.

Then there’s the issue of what comes after the initial conversation.

What will you do to follow up?

What’s an appropriate way to follow up a colleague who is struggling? A boss? What about an acquaintance on Facebook? (The number of people posting their suicidal thoughts on social media is more frequent than ever, according to Suicide Awareness Voices of Education.)

Your relationship to the person isn’t the only determinant, too. Everyone is different, and everyone will respond to their struggles differently. Some people will want to talk, some won’t, and others will yo-yo between the two.

This doesn’t have to mean a big commitment, and you do need to set boundaries. But it’s part of why asking the question can’t be taken too lightly. Asking “Are you okay?” and never taking the time to follow up can be as destructive as not asking at all.

Suggesting professional advice may help. But that’s complicated, too.

First of all, professional advice isn’t always easy to come by, and not just financially.

After seeing their GP, many people have to sit on waiting lists for weeks before they can see a psychologist or similar. Even then, it can be a long process to find a psychologist that meets your needs, and after that, it can be a process to drill down to deeper issues through conversation.

But considering that Medicare only covers 10 sessions in a calendar year, your time is limited to find your right fit, talk through your problems and find some strategies.

And for many people, 10 sessions are just not enough, but the cost is prohibitive. As Fairfax journalist Jill Stark sadly notes,

Many people are no longer here because they couldn’t afford their mental illness. It’s a devastating indictment on a system that is fundamentally broken.

According to the Breaking the Silence suicide prevention report, up to 83 percent of people who eventually commit suicide did seek professional help within a month of their death. The ABC reported that as many as 40 percent of patients who are hospitalised for a suicide attempt are not given any follow-up mental health treatment, either.

So, saying to someone, “Just talk to your psychologist” isn’t going to cut it. At least, not by itself. Their next appointment could be weeks or months away.

What then?

All this is to say – it’s complicated. And while asking the question is good, we need to do more than ask a question.

R U OK? Day helps prompt us to check in with people. It helps remind us of the power of networks. But culturally, there’s much more work that needs to be done.

It calls for a community-wide conversation, all year round. Because we need eyes – every day – to see people who are struggling with their mental health, to recognise the warning signs, and to know what (and what not) to say.

We also need to keep advocating for better Medicare support for people with chronic mental health concerns.

And when you ask “Are you okay?”, how can you prepare yourself? It’ll vary from person to person, and this isn’t an exhaustive list, but here are some tips:

Make the time.

Give the person space to talk, and just listen. Don’t ask before you’re about to rush off. Give them your full attention.

Don’t be afraid to talk practicals.

So often, the conversations we are taught to have about depression are up in the clouds, talking about psychological concepts and feelings.

That can be useful. But sometimes, people don’t want to be analysed, more than to be acknowledged in their pain and discuss steps to alleviate their distress.

Helping that person have hope – to feel like they have some practical way of helping themselves, whether it’s making an appointment or scheduling time off – can help give a sense of progress.

Make clear boundaries.

Sharing a problem can make it feel smaller. But having the person transfer all their problems onto you isn’t necessarily good or healthy for either of you.

Tell them you’d like to keep tracking with them – maybe set a time to check in. But also encourage them with other avenues where they can find support, too – recognising that you may need to be their shoulder to lean on in the short term.

And don’t ever say…

• “I know how you feel, I have bad days too.”
• “Get out of your own head, you’re fine.”
• “But you’ve got such a great life! How can you be depressed?”
• “You’ll get over it.”

Or anything that minimises their feelings. They may not be able to see a way out right now, but that doesn’t mean how they are feeling isn’t valid to them.

It’s not just about asking me if I’m okay. It’s knowing what you can do when I’m not.