What’s the first thing most people are told when they receive advice and information on how to help people who are struggling with things like eating disorders and suicidal ideation?
You have to report it. You have to tell someone else. You have to get help. This is drilled in everywhere from workplace orientations where employees are told to watch each other for signs of mental health problems[1. Yes, really.] to college campuses, where signs advise people to call the counseling office if they see a fellow student struggling. If you see someone in pain, if you see someone who is having a hard time, you should report it. You should tell someone. It’s for their own good.
Reporting is usually followed with an intervention of some kind, where people will swarm in to offer ‘help’ to a person who didn’t request it. This, again, we are told, is for the person’s own good. If someone has alcoholism, or a substance addiction, the people around that person are supposed to help. To save the person. To not stand by while someone in need is flailing. This is what we are told, over and over and over again.
It is scary to be around someone who needs help and to not know what to do. The idea that you can appeal to authority to do your part for that person is a very appealing one. Rather than doing nothing, which is bad, you can do something. The posters on the wall in the counseling office show you the smiling faces of people whose friends got help for them, and they talk about how happy they are to be alive, how grateful they are that their friends took action on their behalf. They tell you that you are doing the right thing.
The report-intervene model has some serious problems. The underlying idea seems like such a good one, providing people with a way to help. The idea comes from people who mean well. But interventions are not very effective and they can actually be very traumatic. They can sometimes act in the reverse of how people expected. The person may experience more problems; I know that as a college student, if my friends had reported me for my eating disorder, I would have gone rapidly downhill because I would have felt betrayed. Abandoned. Hung out to dry. I would have had no one to trust.
It is a hard and scary thing to be around someone in trouble, someone you care about, and to feel like you cannot do anything. I have been there, I have been through it, and I have seen what happens when it doesn’t turn out well. I have attended entirely enough memorial services for what I would consider far too many people. So I speak from experience when I say that I get, on a very visceral level, the feeling of being around someone and feeling helpless, useless, like if something happens to that person it is your fault for not doing something.
But we cannot control the destinies of others. And the insistence on telling people to report things can be extremely harmful, because it can result in situations where people are afraid to reach out for help among their friends, because they worry that their friends will feel overwhelmed, and report it. Or will feel like they have to report it because their advisers at orientation told them to always report it if someone talked about suicide. Or violent thoughts. Or out of control drug use. When you have no one to talk to, no safe place to go to, yeah, it’s very easy to end up in a situation where something really bad can happen.
I don’t know how to fix this model, I don’t know how to make it better, but I know that the current approach is not working and it endangers people. I know that, for some (not all) people, help is something you have to want. It cannot be thrust upon you. You will not benefit when people forcibly help you. You may go along with it, but it will be all too easy to return to previous patterns because you weren’t ready for that help.
This model especially troubles me when it comes to the way people deal with mental illness in places like schools and offices. People are often told to report symptoms of mental illness, which is a very vague term that encompasses a lot of things, and it can make mentally ill people extremely unsafe. What if you are already in treatment but don’t want to disclose it for privacy reasons? What are you supposed to do when a coworker corners you to say she’s concerned about your behaviour? What are you supposed to do when you get called into a supervisor’s office to talk about something you do that other people think is weird? Are you supposed to tell people all about your diagnosis, your therapy, your medications?
For some mentally ill people, there is a tendency to want to conceal, as much as possible, to avoid stigma. Being out and mentally ill means that people will attribute everything they don’t like to your mental illness, and that you will be constantly discounted and ignored. You’re being overemotional because of your mental illness. Normal people don’t react that way. You’re reading too much into it. And anything, any casual comment, any ‘oh, I could really stab something right now’ suddenly makes you dangerous and scary. Under these conditions, why would you want to work, or go to school, or live, in an environment where people can report you for forcible counseling for any reason?
Observe, report, and intervene is not the right way to help people who need help. I should say, it’s not the right way to help everyone who needs help. Clearly some people do benefit from it, but it should not be applied as a blanket approach to addressing the issue, because for others, it can be very, very harmful. Is it about helping people, or about making other people feel like they are doing something?