Today I wanted to focus on some tips and techniques for when you encounter a stranger or acquaintance in distress. This can occur anywhere; public transport, the supermarket, local schools, at work or at a restaurant. It can take many forms including someone crying quietly or being actively distressed, as well as aggressive, threatening or erratic behaviour. The cause of a person’s outward distress is not the focus of your intervention; it is to provide support to alleviate some of their disruptive feelings and avoid further upset from others and the environment itself.
A few years ago, I participated in a training course for ‘Mental Health First Aid’ which included a “plan of action” for intervention, similar to the acronyms used for general medical emergencies (eg., DRABC; Danger, Response, Airway, Breathing, Circulation).
The MHFA’s response guidelines used a coded system called ALGEE. This stands for:
Approach, assess and assist with any crisis
Give support and information
Encourage appropriate professional help and;
Encourage other informal supports (family, friends, etc)
I want to take this a step further and actually break down the steps necessary to intervene. First, as with all situations you encounter, you need to access your ability to help. Think about your current mood or emotional state; will this be triggering for you? Are you in a position to safely intervene? Do you have the resources to help? How will your actions affect the people around you? If you are not in the right headspace to help; don’t force it. Nothing is worse than an unwilling or resentful mediator.
Next, you need to approach with plenty of warning. Think of this as similar to approaching an animal which might be easily startled; don’t make fast movements and keep your body language relaxed and non-threatening. Gauge whether physical touch is appropriate (such as a hand on the shoulder, hug or holding someones hand). Always ask before sitting down or getting too close to someone — respect their need for control and space.
Once you are seated with the person, offer simple statements such as: “I can see you’re hurting” , “You look upset” or “You seem to be feeling _, would you like me to __?”. Listen to their responses and offer minimal feedback or solutions. Brene Brown has a fantastic video on the difference between empathy and sympathy. Remember to listen and respect their point of view and be prepared to be vulnerable by recognizing their emotions within your own.
Don’t expect the person to be expansive or know what they need; offer a maximum of three prompts for help and avoid overwhelming them with too many questions, “What happened?” “Was it something I said?” “Can you explain to me what’s upset you?” might seem helpful for you to gauge the situation; but this situation isn’t about you. Learn the difference between helping altruistically and helping out of a sense of duty or to be admired by others.
If possible, offer a cup of tea or glass of water after about 5 minutes. This gives the distressed person an opportunity to work out whether your presence is helpful or unhelpful while you are away. Allow the person an out at this point, for example, “Here’s the tea you asked for…how are you feeling now? Would you like me to stay and sit with you or give you some space alone?”. Respect their right to be alone in their distress — you are not their warden or guardian; you are a friend or support person.
I cannot stress enough how important it is to respect all emotional expression — even anger, self harm or suicidal ideation. Sit with the person while they feel this way. Concentrate on making the space safe, eg. pillows for head banging, removing sharp objects or asking others to leave the room. Keep in mind the type of environment you would find most helpful and offer to adapt it to suit their needs, “Would you like me to turn the lights off?” “Do you need a jacket or blanket to keep you warm?” “You seem to be unsettled, would you prefer to sit on the floor?”
One skill I’ve picked up from the fabulous Janet Lansbury (a specialist childhood educator and advocate for child-focused parenting in America) is the power of naming emotions. Janet reinforces the need for clear communication in times of upset and frustration, especially giving emotions a name rather than just a feeling, “I can see that you feel really angry at the moment, maybe because __” “You seem to be feeling really sad, I can see that it’s hurting you to feel this way”. Avoid simplified language (which can come across as patronising) but keep the message clear and concise.
Another tool which I have picked up since reading Janet’s book on parenting is to treat everyone in distress with the same degree of compassion and empathy, whatever the circumstance. Imagine the person in front of you as a child; compare a situation where a child might express similar emotions (eg. child having a tantrum at the supermarket). Would you ignore a vulnerable child crying alone in the supermarket? Would you be afraid to approach them or consider it someone else’s job to do so? If it’s okay (even arguable healthy!) for a child to lie on the floor screaming, throw toys around their room or hit out; surely it’s okay for adults to behave that way too? It’s about making this experience as physically safe as possible.
Once you’ve imagined them in a child-like state, it becomes far easier to design a course of action. Treat their current behaviour as an expression of pent up emotions. Janet recommends phrases like, “I can see you are angry and want to __ but I won’t let you hurt others” “I know you feel overwhelmed and frightened but it’s not safe to __” or “I know you’ve held these feelings in for a long time, it’s okay to express them now, it’s a safe space and I’m here to help if you need me”. Prioritise comforting words and minimising stimulus over solution-based intervention.
Other more simplistic suggestions include: encouraging the person to breath, asking them to list 5 things visible in their surroundings (a technique from minderfulness), suggesting phoning someone they trust or simply approaching and offering a smile or look of sympathy if that’s all you can manage.
I was planning on discussing some specific situations where I have intervened and what’s been helpful/unhelpful while also drawing on personal experience. However I think I’ve written enough for one day. Perhaps another time.
With kindness and compassion, x