Understanding the CRISES
ASSOCIATED WITH DEEP DEPRESSION
There are two main crises that may be associated with depression in young people. For Young Adults if the young person has suicidal thoughts or Behaviors;
The List:
- Assess for risk of suicide or harm
- Listen with non-judgment
- Give reassurance and information
- Encourage appropriate professional help
- Encourage self-help and other support strategies
SUICIDAL THOUGHTS AND BEHAVIORS
Not every young person who is depressed is at risk for
suicide, yet depression is a major risk factor for suicide.
People who die by suicide are frequently suffering from
undiagnosed, undertreated, or untreated depression.:"
A young person may feel so overwhelmed and helpless
that the future appears hopeless. They may think
suicide is the only way out. Sometimes a young person
becomes suicidal very rapidly, perhaps in response
to a trigger (such as a relationship breakup or failure
at school), and acts on their thoughts quickly and
impulsively. The risk is increased if the young person
has also been using alcohol.
If you have concerns that the young person may be
having suicidal thoughts.
Thoughts and Behaviors
If you think that a young person you care about may be
depressed and need help, approach the person
about your concerns. It is important to choose a suitable
time when both of you are available to talk as wen
as a space where you both feel comfortable. Let the
young person know that you are available to talk when
ready; do not put pressure on them to talk right away.
It can be helpful to let the young person choose the
moment to open up. However, if the young person
does not initiate a conversation with you about how
they are feeling, you should say something to them.
As you talk with the young person, be on the lookout
for any indications that they may be in crisis.
"If the young person is engaging
in non suicidal self injury."
NON SUICIDAL SELF-INJURY
Self-injury (such as cutting, scratching, pinching, or
burning) that is not intended to result in death is
relatively common in young people. Depression is a
major risk factor for no suicidal self-injury.’’ Young
people who engage in no suicidal self-injury also
report more emotional distress, anger problems,
lower self-esteem, more risky health behaviors, and
more antisocial behaviors. Youth who have emotional
difficulties are more likely to engage in non suicidal
self-injury if they have close friends or peers who have
engaged in similar behaviors."
If you have concerns that the young person may be
engaging in no suicidal self-injury.
No suicidal Self-Injury
If you have no concerns that the young person
is in crisis, you can move on to another action.
If you believe that the young person is not in a
crisis but needs immediate attention, you can
engage the person in conversation by asking
how the young person is feeling and how long
they have been feeling this way. Listening
non-judgmentally is important at this stage,
because it can help the young person feel
heard and understood while not being judged
in any way. This can make it easier for the
person to feel comfortable to talk freely about
the problems and to ask for help.
TIPS FOR NONJUDGMENTAL LISTENING
It is very difficult to be entirely nonjudgmental
all of the time. People may automatically make
judgments from the minute they first see
or meet others, based on their appearance,
behavior, and what they say.
There is more to
non judgmental listening than simply trying
not to make those judgments-it is about
ensuring that you do not express your negative
judgments, because this can get in the way
of helping.
If you have decided to approach a
young person with your concerns about them,
it is a good idea to first spend some time
reflecting on your own state of mind and
You can be an effective, non judgmental listener by
paying special attention to two main areas:
• Your attitudes and how they are conveyed
• Effective communication skills, both verbal
and nonverbal
ATTITUDES
The key attitudes involved in nonjudgmental
listening are acceptance, genuineness, and
empathy.
Adopting an attitude of acceptance means
respecting the young person's feelings, culture,
personal values, and experiences as valid,
ensure that you are in the right frame of mind
to express your concerns without being
judgmental.
Although the focus of your conversation with
the person you are helping is on their feelings,
thoughts, and experiences, you need to be
aware of your own as well.
NOTE: Helping someone who is in distress may evoke an
unexpected emotional response in you; you may find
yourself feeling fearful, overwhelmed, sad, or even
irritated or frustrated.
In spite of any emotional response you have,
you need to continue listening respectfully and
avoid expressing a negative reaction to what
the person says. This is sometimes difficult and
may be made more complex by your relationship
with the person or your personal beliefs about
their situation.
"You need to set aside these beliefs and reactions
to focus on the needs of the person you
are helping-the person needs
to be heard, understood, and helped."
Remember that you are providing the young
person with a safe space to express themselves,
and a negative reaction from you can prevent
them from feeling that sense of safety.
even if they are different from your own or you
disagree with them. You should not judge,
criticize, or trivialize what the young person
says because of your own beliefs or attitudes.
Sometimes this may mean withholding any and
all judgments that you have made about the
young person and their other circumstances. For
example, listen to the person without judging;
these problems are not the result of weakness or
laziness-the person is trying to cope.
Genuineness means that what you say and do
shows the young person that they are accepted.
This means not holding one set of attitudes
while expressing another. Your body language
and verbal cues should show your acceptance of
the person. Young people are especially good at
recognizing when an adult is not being genuine. Being
genuine also means not trying to mimic the young
person's language, slang, and mannerisms if these are
not natural for you.
» Empathy means being able to imagine yourself in
the other person's place, showing the person that they
are truly heard and understood by you. This does not
mean saying something glib such as, "I understand
exactly how you are feeling;" it is more appropriate to
say that you can appreciate the difficulty the person
may be going through. Remember that empathy is
different from sympathy, which means feeling sorry for
or pitying the person.
VERBAL SKILLS
Using the following simple verbal skills will show that you
Are listening:
• Ask questions that show you genuinely care and
want to understand.
• Check your understanding by restating what the
young person has said and summarizing facts
and feelings.
• Listen not only to what the person says, but also
how they say it; tone of voice and nonverbal cues
will give extra clues about how the person is feeling.
• Respect the youth's culture by asking about and
exhibiting verbal behaviors that convey this respect
• Use minimal prompts, such as "I see" and "Ah,"
when necessary to keep the conversation going.
• Be patient if the young person is struggling to
communicate.
• Do not be critical or express frustration at the
young person or their symptoms.
• Avoid giving unhelpful advice such as "pull
yourself up by your boot straps," "get a grip,"
or "cheer up." If this were possible, the young
person would have done it.
• Do not interrupt the young person when they
are speaking, especially to share your opinions
or experiences.
• Avoid confrontation unless necessary to prevent
harmful or dangerous acts.
Remember that pauses and silences are okay. Silence
can be uncomfortable for many people, but the young
person may need time to think about what has been
said or may be struggling to find the words they need.
Interrupting the silence may make it difficult for the
Young person to get back on track and may damage
the rapport you have been building. Consider whether
the silence is awkward or just awkward for you.
With all mental health Issues...it is important to
understand the impact of culture on person's perceptions
of depression, help-seeking behaviors, and treatment
response. Many youth learn to identify their feelings
through their parents and caregivers, who may perceive
mental health challenges In different ways.
For example,
in ethically and culturally diverse, low-income
communities, women used different terms to describe
depression (blues, sadness, homesickness), even though
the physical symptoms and severity of depression were
commonly reported across the different ethnic groups.
NONVERBAL SKILLS
Nonverbal communications and body language express
a great deal. Good nonverbal skills show that you are
listening and can strengthen the rapport between you
and the young person you area assisting.
Keep the following nonverbal cues In mind to reinforce
your nonjudgmental listening:
• Pay close attention to what the young person says.
• Respect the youth's culture by asking about and
exhibiting physical behaviors (e.g., eye contact,
physical space and distance) that convey this respect.
• Maintain comfortable eye contact. Do not avoid eye
contact, but do avoid staring; you can do this by
maintaining the level of eye contact that the young
person seems most comfortable with.
• Maintain an open body position. Do not cross
your arms over your body, doing so may appear
defensive.
• If it is safe to do so, sit down, even if the young
person is standing; this may seem less threatening.
• It maybe best to sit alongside the person, angled
toward them, rather than directly opposite them.
• Do not fidget
(More information about communicating effectively with
A young person is available in in other info).
TREAT THE YOUNG PERSON WITH RESPECT
AND DIGNITY
Every young person's situation and needs
are unique, and it is important to respect
the person's autonomy and culture while
considering the extent to which they are able
to make decisions for themselves.
DO NOT BLAME THE YOUNG PERSON FOR
THE ILLNESS
Depression is a real health problem, and the
young person cannot help being affected by
depression. It is important to remind the young
person that they have a health problem and
that they are not to blame for feeling down.
HAVE REALISTIC EXPECTATIONS FOR THE
YOUNG PERSON
You should accept the young person as they
are and have realistic expectations of them.
Everyday activities such as homework and
household chores may seem overwhelming to
the young person. You should let the young
person know that they are not weak or a failure
because they have depression and that you do
not think less of the young person. You should
acknowledge that the person is not faking,
lazy, weak, or selfish.
OFFER CONSISTENT EMOTIONAL SUPPORT
AND UNDERSTANDING
It is more important for you to be genuinely
caring than for you to say all the right things.
The young person genuinely needs additional
care and understanding to help them through
the illness, so you should be empathetic,
compassionate, and patient. Young people with
depression are often overwhelmed by irrational
fears; you need to be gently understanding
of someone in this state. It is important to be
patient, persistent, and encouraging when
supporting someone with depression. You
should also offer the young person kindness and
attention, even if it is not reciprocated. Let the
person know that they will not be abandoned.
You should be consistent and predictable in your
interactions with the young person.
GIVE THE YOUNG PERSON HOPE FOR RECOVERY
You need to encourage the young person to
maintain hope by saying that, with time and
treatment, they will feel better. Offer emotional
support and hope of a more positive future in
whatever form the young person will accept.
PROVIDE PRACTICAL HELP
Ask the young person whether they would like
any practical assistance with tasks, for example,
"Do you need a ride or some money to get
home?" Be careful not to take over or encourage
dependency. You can offer and provide help in
many ways, but you cannot make the changes or
engage in treatment for the young person.
PROVIDE INFORMATION
Give the young person information about
depression (see Helpful Resources at the end of
this section). It is important that the resources
you give are accurate and appropriate to the
young person's age and situation. At the same time, do
not assume that the young person knows
nothing about depression because they, or someone
else close to them, may have experienced depression.
You may want to ask whether they are already getting
help for their depression.
WHAT IS NOT SUPPORTIVE
- Do not tell the young person with depression
"to snap out of it or get over it."
- Do not be hostile or sarcastic when the young
person's responses are not what you would
usually expect. Rather, accept the young person's
responses as the best they have to offer at that
time.
Everybody feels down or sad at times, but it is
important to be able to recognize that professional
help is warranted when depression lasts for weeks and
affects a young person's functioning in daily life.
PROFESSIONALS WHO CAN HELP
A variety of health disciplines can provide help to a
young person with depression. Ideally, the health
professional should have expertise in providing mental
health services to youth and young adults.
The first aider should seek individual professionals who have
child, youth, and young adult expertise among these various professionals:
- Do not adopt an over involved or overprotective
attitude toward a young person who is depressed.
Primary care physicians & Pediatricians
- Do not nag the young person to try to get them to do what they normally would.
Nurse practitioners
- Do not trivialize the young person's experiences
by pressuring them to "put a smile on your face,"
"get your act together," or "lighten up."
- Do not belittle or dismiss the young person's
feelings by attempting to say something positive,
such as "You don't seem that bad to me."
- Do not speak with a patronizing tone of voice or
use overly compassionate looks of concern.
- Do not try to cure the young person's depression
or to come up with answers to their problems.
The short list:
- Allied health professionals, such as occupational
therapists, youth workers, and mental health
nurses
- Psychiatrists and child and adolescent
psychiatrists
- Psychologists and child and adolescent
psychologists
- Mental health care providers
- Social workers
More information about these professionals can
be found in Mental Health Challenges and Mental
Disorders in Youth and Young Adults in the United
States. Click the link above if you are looking for therapy/treatment.