R U OK?

Today is R U OK? day. It’s an annual day nominated by the R U OK? suicide prevention charity to think about the people in our lives and consider if they are okay. More than that, it’s a day to take ourselves in hand, try to be brave and open a conversation if we think someone we know is struggling. Of course this is something that should happen every day. But today is a day to revive our intentions to be a good mate to our family, friends, colleagues, anyone we bump up against in our daily lives. It’s a day to understand a bit more about what drives people to consider suicide, and to learn ways that we can safely help them.

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I’d love each one of you my readers to check out the R U OK? website. Just pick one topic and give 5 minutes of your time to taking on some new knowledge, or understanding, or strategy. It really can change and even save a life. It’s that important.

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Some of the topics I think are great are Mates, resources for every day, news stories and information, but I’m sure you’ll find the topic that makes most sense, or means the most to you.

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I’ve been a mental health advocate (at least I think I have been) for a lot longer than I’ve been ill with mental illness. By that I mean that I’ve considered mentally ill people the same as myself just with a condition requiring treatment, and tried to show to others that they don’t need to be feared. As a child I was used to being around mentally unwell patients. One family friend had schizophrenia and another had bipolar disorder. We saw them regularly, saw them better and worse, visited them in hospital and knew they were just people like the rest of us. And they were just the people who had known, obvious, must-be-treated illnesses. Who knows how many people in my acquaintance had depression or anxiety that was more or less invisible. I wouldn’t know. It was never talked about. If they were there, I never knew. Which is a terrible shame.

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So today is about conversations. I want people to have conversations. But first of all I want to tell you why R U OK? as a charity and a question is so important to me.

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When I was depressed or anxious, I felt awful. I was barely dragging myself around, limping from bed to work and from work to bed. My brain was either whizzing or sluggish; it wasn’t very useful. I felt like all of this must be pasted across my face, and that surely someone would notice today that I was struggling and ask me about it. It had to be written on my forehead, I thought, why can no one see it, why is no one wondering what’s wrong with me? I was just dying for someone to see it and come to my aid.

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But nothing happened. I didn’t want to be attention seeking and bring it up myself, I wasn’t one of those people who was always making a fuss. But I was in pain here, it must be obvious. I thought of a hundred ways to bring it up, but I just couldn’t. It was too obvious a way to start a conversation, there was no easy lead in.

“So you’re having tuna for lunch, that’s interesting, did you know that I’m depressed?”

So I dragged myself around, wondering and waiting and hoping that someone would do the hard part for me and bring up so I could let it all pour out. And do you know the funny thing? Having felt so isolated, like no one could see the real me inside, like I was alone in this experience and so on, once I was officially sick and had told people about it, I had several comments along the lines “oh I thought so” and “I figured something was wrong” and “I knew something wasn’t right” and “you didn’t seem like your usual self”. If just one, only one person had actually said that out loud, it would have been such a relief, a balm, a comfort! It probably would have meant that I got help sooner. It could’ve shorten the process, and I would have been so thankful. It would’ve meant such a lot.

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Speak up. If you can see a change, say something. If things seem different, say so. The worst that can happen is that you’re wrong, and they are just having a bad day or week, or are preoccupied. But how can it hurt? At the least, I’m sure they’ll appreciate your concern, the effort that you’ve gone to, your care. It would be a rare person who would take exception to your kind heart.

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The second part is knowing what to say. The reason for this charity’s name is that R U OK? is a powerful question. It might not seem like it, or seem much different to our usual greetings, but it works. We say hello, hi, howdy, how are you going? what’s up? how’s it going? how’s things? alright? and a hundred similar things so many times a day. And we’re programmed to response almost rote: good thanks, hey there, great, how about you? not much, well, yep and so on. So much so that if someone says something different to these, we can accidentally get caught saying good thanks before we’ve even registered that they’ve asked us what’s up?!

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But R U OK? hits a different nerve. It makes us really think about how we are, and it elicits an honest answer.

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So here’s what I want to do. I want you, one day over the next day or two, to count how many greeting encounters you have in one day. I consider one encounter to be one person say hello and/or how are you and the other person responding. Now I know for myself, home most days, there aren’t very many encounters. But for people working in retail there might be many, maybe more than what I’ve allowed for. I really want to know what your number is! Please get involved and let’s see how many times we bump up against each other each day.

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I’ll post the results as early as possible once you’ve had a chance to respond with data from your working life today and tomorrow. If you don’t read this until the weekend, give me your weekend numbers too.

My aim for this poll is to think about how many times we have a typical hi/how are you conversation. The next step after this is to consider what might happen if we changed ONE of these rote conventional habits into an R U OK? conversation. What could U achieve, how could U have an impact on someone else’s life? You already read my tales of mental illness, so you already have a kind heart and I daresay you want to help others too. This is the perfect chance, and I hope to take the baton and run with it.

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Departure lounge

This week was always going to be a week of goodbyes.

After my sister’s wedding last week (photos to follow!!) my cousin, one of the bridesmaids, flew out to France for an open dated holiday in her favourite country on earth. Having been there before and having good French language skills, she is planning to spend this holiday off the beaten track. We’ll miss her at our weekly gathering point, Grandma’s fabulous Sunday lunch roast and dessert! More for us!

Then of course, my newlywed baby sister and her hubby are flying back to Latvia today! I say back because that’s where he was born and grew up. Their plan is to be there for 4 years because they are both planning to start and finish their undergraduate degrees there. So It’s a big goodbye!

I don’t think that any one of us has grasped it yet, especially Dad who wonders why everyone is asking him if he’s sad to see her go! Not much to wonder at, but he’s fixed himself in the mindset that its exciting and happy to see her marry her love and move off into their new life. We’ll see how long that lasts once she has actually gotten on the plane for 4 years!

Of course the two students may scrape together enough money to come back to Australia, and most of us are planning a visit at some point but it’s still a long time. Mum and Dad and her have been the only ones at home since my brother moved to Melbourne for uni 3.5 years ago, so I think they’ll really notice her absence around the house.

Then my teacher brother-in-law is flying to England for a year on Thursday! How’s that, sister and brother-in-law, plus brother-in-law, flying out in the same week! It makes more sense when you know that the school year starts on the 1st September across the UK and Europe. So for a teacher, and two students, it makes sense to move with a few weeks grace to get settled into accommodation etc. A year isn’t so bad, there’s an end point to look forward to. But it’s so hard to imagine his Mum and Dad without him. He’s also the youngest and it’s been the three of them since his older brother moved away to do his apprenticeship YEARS ago. Not sure how many, but it could be eight or so years. They’ll definitely be looking for him around the house!

So those are the scheduled departures. We’ve had the goodbye parties, given them advice, wished them farewell. Everything according to plan and tradition, and everyone has had their part in it.

I want to add one more departure to the list.

This was not a scheduled departure. There was no celebration beforehand where people got together with the person leaving and shook their hand and talked and laughed and got their fill of the person departing that would tide them over til they next met. No advice was given about the next step of the journey about to be traveled by the departing and how to traverse it.

I think that most people involved felt that this was a tragic departure, in the literary sense that tragic means inevitable.

I want to wish my own farewell to RT who departed his life this week. You know when someone starts a sentence and they haven’t finished yet, in fact they’re only in the middle but you know the end is going to be something you don’t like? That’s how I heard about it. There is no other way to hear it, other than someone telling you but the hearing of it is never easy.

Many months of a terrible depression preceded this departure, I heard. A mighty, mighty battle has taken place. That battle involved good friends doing their best, multiple inpatient psychiatric admissions, previous suicide attempts, medications, and more that I don’t know about.

In fact I don’t know this person, only in passing. I would recognise him on the street, we’ve maybe exchanged a dozen words in total in our lifetimes. Every year while I was growing up we would spend 3 Saturdays in October at a farm where our annual Christian convention was held, getting it all ready. Our family was always there, he and his wife were always there. They were the cool, young couple that girls growing up through their teens can admire. That was the full extent of “knowing” him.

But there is this phenomenon I’ve heard spoken about where people can experience grief for someone they don’t know, or have barely met, or celebrities etc that is disproportionate to their relationship with that person. Sometimes it can be as profound and take as emotional a toll as the death of a family member. Like when the news of Elvis having left the building descended on the world. Tears and sobbing from people who “knew” him from a concert, a tape, magazines. It’s valid.

I don’t think that’s what is happening here. I think what is happening is several months ago a mutual acquaintance described to me the suffering this person was experiencing as a result of depression. And it resonated with me very strongly because of my experience with depression. I had amazing support and all the help that I could possible require and there were days when I didn’t think I could survive.

As far as I heard, this person had no one at home, some friends around town and family nowhere near by. I could totally connect with his deep need for support and love and care, and the absence of these needs being met. No amount of psychiatric care can compensate for having a partner, family member, very close friend who “gets” you, who understands your suffering, who can be there for you to help you keep safe, who feeds you with love and care and hope, and reminds you again and again that you can fight this war to a victory and they will help you all the way.

His story just made me want to reach out and say, I feel for you, I’ve been where you’ve been and I know how awful and hard and dark and hopeless it is, and I want you to know that I came through and it is worth the fight. Or something like that.

That’s what I wanted to say. But after his wife left, his whole world crumbled, he had nothing to live for on this earth. Because I think kind honesty is the best way to support someone, I don’t know that I would have been able to say convincingly that it’s all worth it in the end, keep fighting, one day this will be all behind you and be a distant bad dream and you’ll be glad that you fought and won.

When you have nothing to live for on earth, it’s a very hard situation. I had everything to live for, and it was a hard, uphill, difficult road, and still may be in the future. But with nothing to live for, why would you try? Why would you fight for, scrabble for grip to, desperately cling to, and give your all to hang onto life? What for? Giving everything to hold onto life that doesn’t feel worth living, that holds searing pain, awful agony, sorrow, struggle, being alone, without love etc. All that terribly difficult effort while drowning in molasses, and what for? That’s what being suicidal is like.

And so he left us. It was inevitable. It’s sad, because nothing more could be done to hold him here on earth, because he couldn’t find enough to hold him to life. But I strongly feel that now he has peace and rest from so much awfulness. And how blissful will that peace and rest be, after so much difficulty on earth.

I have more thing to say. I believe in God, in Jesus, in eternal life. I’ll write about this point more one day. God’s commandments in the Old Testament were, thou shalt not kill. And I think that would have included ourselves. But the New Testament came in Jesus who has showed his great love and mercy. I believe that although we would want to help someone not to end their ow life, when someone is hurting so much that they can’t handle it anymore, Jesus understands and forgives. He knows what we have gone through and why we have reached such a point of desperation. He offers his help and grace in our lifetime, which is promised to be sufficient for us, but in our agony we can’t see much beyond our hurting self.

I feel that our mental health and our spiritual health are two disparate things. But they get confused. We don’t confuse our physical health with religion. We don’t expect our faith to help our gout. But our mental health has foggier borders. Our religion can be a help to us in all situations, but it’s not a cure for any illness, and depression isn’t a religious issue; it’s a medical issue.

I say this just to make the point that when someone we know hits the threshold of what they can possibly bear and can no longer suffer their daily life, let’s recognise that they have succumbed to a medical condition that was unable to be sufficiently treated with the medications and therapy that we have available these days. Let us never consider that their faith wasn’t enough, or they lost their religion, or they somehow should have found a way to survive. Suicide isn’t a comment on the sufferers ability, but the disease’s severity.

Farewell, fierce fighter. I recognise how much you fought, and I’m sorry that the disease was too strong for you. You will be missed. But I will remember your story. I won’t forget your bravery.

To all of you in this post, til we meet again.

Saturday Shoutout

I have hedged around this and hinted at in and mentioned it obliquely but it’s time for some straight speaking about an important part of my life.

My peeps.

Specifically, my psychologist, my psychiatrist and my GP.

My support crew.

Without them, I don’t know where I would be. Literally and figuratively. Would I be in a psychiatry ward in a hospital? Would I be in rehab? Would I be doing a lot worse than am I now? Would I be a vegetable in bed? They have stood by me, held me up, dealt with me, kick-started me, bucked me up and saved my life.

I don’t say this lightly.

They saved my life! They’re that important.

Everything I say here has what to me is an obvious unwritten addendum: as well as my husband. He is the most important person in my life and has been my most supportive friend through every hill and valley, through every new discovery and every boring pushing-on day, through every heartache and excitement. He is so critical in my life but there are times in life when you need to call in the experts!

And these times have been the last year!

My aim today is to give a shout out to my current team because I truly do owe my life to these people. There are other people who have also been hugely helpful to me and I acknowledge them mentally; they might get a write up another day.

Starting with my local doctor, my general practitioner or GP, Dr Richard Young.

I came to see him accidentally after a false start with the GP that I used to see back when I was at uni. She charged a fortune and didn’t give me any confidence that she knew what she was doing. In fact she said to me, I’ll ask my colleagues and check some textbooks; can you come back next week? Well no I couldn’t wait a week, I needed help now! I complained to a colleague at work that I didn’t know where to start looking for a good GP and that I wanted to find one close to work.and who didn’t cost me so much and she handed me a business card for this doctor. I rate this as the best recommendation I have ever had and am always so thankful to her for this!

I didn’t tell this colleague why I needed to see a doctor and yet she gave me a recommendation for a doctor with a special interest in mental health, and who sees many patients with depression and anxiety. That was lucky number one. Lucky number two was the location of the clinic, within a 5 minute walk from work! Could anything be more perfect? I could easily slip away from work in my lunch break, between discharges, after ward rounds etc for my 15 minute appointment. And lucky amazing number three is bulk billing for mental health patients! That is, no fee to pay for each visit! Thank you infinity for this amazing policy that has benefited me and my husband so much!

Richard is a young enough doctor to have passion for his job in spades, old enough to have experience and knowledge and confidence, and has bedside manner and compassion like you dream of in a doctor!

His knowledge of the health system is unsurpassed. I have attended many different GPs in my old clinic last year as well as here, and have never experienced such thorough care! I have cervical migraines; I get Medicare subsidised visits to a physiotherapist. I’m gaining weight on medication; I get some of those visits changed to see a dietician. I have deficiencies; I get treated. I have risk factors; I see the practice nurse to develop a care plan for how I will reduce my risk factors. I have depression/anxiety and need help managing my symptoms; I get ten Medicare subsidised visits to a psychologist, and when I use them all up, I get more! We need help managing the medications; I get Medicare subsidised visits to the psychiatrist. And most importantly, when I’m suicidal he doesn’t let me go home; he sends me straight to the hospital where I can be cared for and a new plan can be made for my treatment.

You get the picture: this doctor is amazing! There is nothing I have that he can’t fix me up with the appropriate health professional or service!

After 8 months of seeing Richard once a week every week I have no complaints! I have had to wait on occasion, I have had to be rushed through on occasion but I have proved abundantly that when I have acute and severe needs, I will be given as much time and attention as I need and be cared for exactly how I need. How I want not always; but always how I need. I think you do need to give credit where it is due and understand the limitations of the medical system and within those limits I have been wonderfully and carefully looked after!

I would absolutely recommend Richard to anyone!

It is due to Richard’s amazing insight and care that I was first given a referral to see a psychologist. Unfortunately the first lady I saw did not connect with me at all, and in fact I left worse than I arrived!! Crying going down the steps is not the right way to go. So Richard promptly organised for me to be assigned another psychologist and I have loved her since the first meeting!

Patty Sabbagh from the Nexus Psychology group is her name and place.

She has seen me through all kinds of scenarios. Happy, sad, suicidal, excited about life, demotivated, purposeful and everything in between are the ways that I have turned up at her door and she has adapted and given me real help and hope and a new way on from every problem! She has helped me to deal with all kinds of issues, she is so resourceful and like a good friend. Sometimes I have gone and its just been a good chat with an understanding fellow human that I needed, and she has been a listening ear, a shoulder to cry on and a clever therapist able to give me a better way to fight on. A mother, a friend, a support; all labels I could give her and more!

She listens and considers and recommends the best approach. Sometimes talking about it really does solve the problem, sometimes a new way of looking or thinking about an issue is needed, sometimes there is need for meditation, or mindfulness, or cognitive behavioural therapy. Whatever is needed, this talented psychologist and counselor has the remedy!

Anyone in trouble needing someone to help would be well advised to seek the help of Patty from Nexus Psychology or one of her colleagues.

Lastly my newest support crew member, and one who has changed my life. Another big statement but well deserved! My psychiatrist, Dr Ian Katz.

He entered later in the picture because I initially saw a psychiatrist as part of my outpatient follow up from being in the emergency department of the local hospital. He was the one who suggested cautiously that bipolar was indeed a possibility and who first started me on a mood stabiliser. However his role is to see patients in the short term then send them back to their GP to be managed. Which is what happened.

My GP and I went along with the plan for Seroquel and for a while we seemed to be winning. Then that started to fall apart and my GP gave me the referral for Dr Katz. He picked up the pieces, made a sensible picture out of it all and gave me a ‘wait and watch’ directive and asked me to come back in a few weeks. I returned with a history of the most manic-like state that had happened to me so far coupled with a long period of depression and the diagnosis of bipolar was complete. He prescribed lithium, one of the best things that has happened to me in a long time, and things have been improving ever since! He calls it “the game changer”; I call it a life changer!!

I have been so impressed with Dr Katz because of his huge capacity to listen, and hear all the information then process it in a logical and helpful manner. He will then set out a considered, clinically sound plan and make everything clear and easy for me, the patient. That takes a huge lot of knowledge, skill, patience, kindness and clinical experience to attain and I think there are very few other clinicians like him. In addition, his commitment to his work amazes me. I have had appointments at 6.45pm, 8pm and 9pm!! Thank you for that!

I have a very high respect for his opinion and his directions and am just so grateful to him for being the one to really turn my life around!

So there you have it. The three most important people in my life just now, besides my husband. Three people who have left a permanent impression on my mind, and my heart really. Conditions like bipolar absolutely need to have this three pronged approach, which in the past was not such a priority but I would not give up either one of these three for anything! Each has a separate but vital role, and each one contributes in a different way to my overall mental and physical health.

I don’t think I could step into any of their shoes, even assuming I had the appropriate training. They each have some strength of character to do what they do that is beyond my understanding but its so important to me that they continue to do what they do.

I don’t know when they take holidays, I don’t know how their families cope with their dedication to their jobs but I know that without them I wouldn’t know where to go or who to turn to and I am forever grateful to them, and everyone like them who works for us, the patients.

So tell me…?

Something that I’ve found out along this journey with me, my head and I is that questions are really important.

It was that question that has become an advocate for helping others with mental health concerns that first triggered my understanding of the need for questions; R U OK?

I’ve always been interested in mental health and I saw this group pushing people to understand and use the question R U Ok? to start talking to others about what’s going on, what’s wrong, what’s troubling you, what’re your concerns? I thought it was a great idea and I bookmarked it in my head to use someday if I saw someone having a hard time.

I wasn’t sure that it would be effective but I planned to give it a go anyway; nothing ventured, nothing gained, right?

But then, before I had a chance to use it to help another person, someone asked me, and I burst into tears!! Just like that! That is how powerful the question is and how right on target it is to really hit the spot when someone is down, anxious, fearful, despairing etc.

I didn’t think it would work. But I walked into a doctor’s room to get some routine results, she asked ‘are you okay?’ and it turns out I wasn’t, to a severe degree which I had not even realised up until that moment.

When she said, ‘how are you?’, as I walked in the door I said fine. That question is just too automatic and we are too programmed into a standard response that doesn’t really give an answer. We know when we ask it that it’s more for form than for really enquiring into someone’s health. It has become a greeting more than a query. Not to say that it can’t be used as a question; some people can inject that something extra that shows that they genuinely are enquiring about your health, but usually that’s not the case.

But there is something unique, direct and unusual about the question ‘are you okay?’ that hits a nerve, that registers with a person as an actual question and that demonstrates some extra kind of care and interest on behalf of the asker.

Questions are so important in mental health.

We can’t lay open a wound, or show an obvious dislocation, or contusion, or register a positive blood culture, or low blood level as evidence of our condition.

We may not look ill, or sick, or injured to other people.

All the evidence of our ailment is locked inside our heads.

It is literally all in our minds, but not in the way that that saying is usually used, to suggest that it’s a figment of our imagination!

There is nothing imagined or exaggerated or fictitious about any mental illness.

However there is a level of difficulty for anyone treating a mental illness, be it doctors, nurses, psychiatrists, psycholgists, counsellors or any other health professionals.

To diagnose a mental illness, as with any other condition, a set of diagnostic criteria must be met. But none of those criteria are obvious when a patient walks in the door.

The diagnoser (doctor or psychiatrist) must be able to draw out the information that they need to make a diagnosis by asking questions. They need to ask a lot of questions. Questions designed to gather information, to confirm suspicions, to determine signs and symptoms of the condition.

They have to be very skilled in asking questions AND in listening to the answers for clues about what is going on with the patient.

It takes time! Sometimes a lot of time. Sometimes questions are asked over and over. There is a purpose to that; it is to gather the right information so that the right diagnosis is made and the right treatment given. It might seem repetitive but every question fills a useful part of the overall picture. It’s not a sign of incompetence on the part of the person asking the questions; its a part of their professional skill.

Patients most often don’t know what is going on with them. I’m a health professional with a clinical understanding of mental illness but I still didn’t recognise mental illness in myself. I just thought I was stressed at work. The fact that I was constantly obsessing over work all day and night, that I couldn’t sleep, that I was being clingy and petty and being a huge strain on my husband with my concerns and fears and anxiety didn’t occur to me to be an excessive reaction. So I can’t even imagine how patients with no prior knowledge of mental illness feel when they start to suffer from symptoms.

They might be scared, afraid, stressed, anxious, overwhelmed, confused, in denial or fearful of what the diagnosis will mean and what treatment will be prescribed. So the doctor also has to tread carefully around the person’s soft or sore spots but still trod and poke enough to get what they need to do their job.

In any emotional state a person has more difficulty remembering and recalling, trouble giving an accurate history, limited ability in listening and responding, and struggles with taking in information. This is one of the reasons why questions need to be repeated; to be sure that the right answer has been given. It’s also why seeing multiple doctors on different occasions can be useful in building a clearer picture of what is going on.

Often a patient may not be diagnosed immediately, because of these factors. It may be considered in the patient’s best interests to allow them time to go away and calm down, to give more thought to the history of symptoms that they have experienced, and then to bring them back and ask further questions. Of course it isn’t safe for all patients to be sent away; some need to be kept for their own safety, some need to have treatment started immediately. For those who are sent home to return late, maybe the same questions will be asked all over again, and although it seems tedious to the patient, it is all for the purpose of gathering as much information as possible so that the best outcome can be achieved for every patient.

So, questions.

Tell me what’s been going on?

How have you been feeling?

When did this start?

Who have you already seen about this?

What treatments have you tried?

Has anyone in your family experienced any mental illness?

How long have these symptoms been going on for?

How severe are your symptoms?

What symptom is the most difficult for you?

What has brought you here today?

How are you today?

Compared to then, how are you now?

What do you think has triggered these symptoms?

What has happened that might have caused this?

What do you know about your condition?

What do you know about the treatment for this condition?

What’s the worst symptom that you are experiencing?

How are you coping?

Are you experiencing any side effects?

Give me a run down on how the last week has been for you?

How often do you shower?

How often have you been getting out of the house?

Are you finding enjoyment in life?

How has your motivation been?

What have you been getting up to?

Have you been hearing or seeing things that don’t exist?

Has anyone been speaking to you through other objects?

Are you suicidal?

Have you had thoughts of harming yourself or others?

Do you have a plan to harm yourself?

Have you had suicidal thoughts?

Have you had thoughts that are frightening to you?

How has your sleep been?

Tell me what you are afraid of?

Do you ever have periods of great energy when you can achieve a lot? Or when you don’t need sleep?

When are you not anxious? Are there any places where you feel comfortable?

What things make you anxious? What things trigger a panic attack?

There sure are a lot of questions that can be asked!! And this is probably the tip of the iceberg really, these are just the questions that I can remember from the health professionals that I saw. I’m sure there are many others for other mental health disorders.

And yet, the most important question is whichever one you ask to the person that you see struggling. It really doesn’t matter what it is. It can be r u ok?, how ya doing?, what’s up with you?, how are things?, how have you been going lately?.

As long as you take the courageous step of asking and listening, you will be doing the right thing. Go you!!