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On the sidelines of a downward spiral

It's hard enough to watch from the sidelines as Britney Spears, Lindsay Lohan and other celebrities deal with their personal struggles, but what do you do if a loved one seems to be spiraling out of control?

First and foremost, don't just watch it happen and wait for things to get better, mental health experts say. You may be afraid of offending the person by speaking up or perhaps you just don't know what to say, but the consequences of inaction can be steep.

"I think there's a great risk of doing nothing," says psychotherapist Jeff Richardson, executive director of Mosaic Community Services, an organization that provides therapy, housing and other help to Maryland residents with mental health needs.

People who are struggling to cope with depression, anxiety, substance abuse, eating disorders, bipolar disorder or other mental health problems run the risk of destroying relationships, losing custody of their children, getting fired at work, and in severe cases, even harming themselves or committing suicide.

But at least in the early weeks or months, the affected individual may not realize there's a problem, says Richardson.

So without a Ph.D. in psychology, how do you know if someone is truly in trouble?

"We all have crappy days," says Richardson. "Some of us have crappy weeks. Life is difficult. Challenges hit us every day. What tends to separate that from a mental health disorder is when it affects our ability to function."

People who are suffering from a mental health problem often just don't seem themselves anymore. They may, for instance, exhibit marked changes in their disposition, frequently drop the ball on responsibilities or start drinking too much.

"What we're talking about are changes in the normal base-rate behavior," says Faith Tanney, a psychologist in Washington, D.C. "It's not a one-time thing."

It is not hard to see why people are worried about Spears, for instance. Once a Hollywood sweetheart, her more recent behavior has included shaving her head, driving with her young son on her lap, being photographed by paparazzi without her underwear, facing hit-and-run charges and plenty of late-night partying. A couple of stints in rehab don't seem to have remedied her troubles, and she recently lost custody of her two sons.

Generally speaking, behavioral changes such as those of Spears that are dramatic and persistent are of particular concern, experts say.

"But in some cases, the depth of the problem may be so severe that it doesn't matter how long it's going on," says psychologist Richard Shadick, director of the Pace University Counseling Center in New York. Certainly, for instance, anyone who appears suicidal needs emergency help.

Prompting others to seek help on their own can be tricky, experts concede. While some people are in denial, others may be afraid of being labeled mentally ill or being perceived as having a "character flaw," says Richardson. "People tend to avoid getting help for mental illness because there's so much stigma associated with it."

What to say

Approaching someone about their need for mental health help should be handled very sensitively because you're commenting on a person's autonomy and ability to run his or her life, says Tanney.

She suggests being direct but sensitive. "Be clear and come from a position of concern and caring," she says. It's also good to be able to offer a specific recommendation, such as the number of a local hospital or psychological group that can help, Tanney says.

Richardson recommends saying things like "Hey, I'm worried about you." Avoid being judgmental or dismissive, he says. "Don't tell someone to 'snap out of it' or 'it's all going to be good.'"

Even if you do everything right, the person in need of help may not respond, at least not right away, says Shadick. "Persistence is important."

Eleanor and William Myers of Baltimore know that full well. Their son, Bill, who is currently in treatment at Mosaic Community Services, was in denial about his mental problems for years before his parents and sisters convinced him he needed to get help and stick to a treatment plan.

"It was a long time getting him where he is," says Eleanor.

His teen years and early 20s were tumultuous, with him running away from home, acting out, cursing at his parents and hallucinating that people were talking about him. When, at 19, he told his mother he was going to go out and set himself on fire, his parents took him to a hospital, where he was diagnosed with depression and spent nine months receiving treatment. After being discharged though, he refused to take his medication and eventually his parents moved him into an apartment because they and their daughters were scared for their own safety. "We were afraid he might do us all in," Eleanor says.

But his parents never abandoned him. And finally, at 25, a combination of his family pleading for him to get help and he himself feeling "sick of being sick," Bill got more help. This time, he was diagnosed with paranoid schizophrenia. With psychotherapy and medication, things started to turn around. Yet there still were times when he "self-medicated" with drugs and alcohol.

Through it all, Bill, now 50, still relies on his family as well as friends for support. "I talk to my parents every day," he says. "And I have a few close friends who have stuck with me. They help me if I'm misinterpreting, if I get paranoid."

A tough job

Family and friends are one thing, but broaching the subject with a co-worker "is much trickier," says Tanney. Several years back when faced with a colleague who seemed to be drinking too much, Tanney started off the conversation by saying, "I'm concerned and feel apprehensive about saying this..." She says the colleague responded as well as could be expected because she seemed genuinely concerned.

If the troubled person is your boss, however, things may not go so smoothly. That person may think you're out to get his job, so you may have to involve human resources or an employee assistance program, she says.

Sometimes, it takes the whole world crashing in — losing a job, getting a divorce, losing custody of children, etc. — before people take action, says Richardson.

"There are some people who, frankly, need to hit rock bottom before they get help or respond to it," he says.