How can we responsibly direct users with serious mental health issues?

Question

I am not talking about people with borderline personality or spectrum disorder issues (like rudeness), rather behaviours like paranoia and depression.

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A recent question on Ask Ubuntu highlighted that I just don't know how to safely deal with some personality traits. It was a long and extremely paranoid ranty-question from the sort of person who knew just enough to be dangerous, who had convinced themselves they were under surveillance and being hacked.

The post was well written English and clearly by somebody with an education, but it fervourously flitted from topic to topic. It wasn't the product of a settled mind.

There appear to be only a few direct actions in a situation like that:

• Follow them down the rabbit hole and try to answer their question at face value.
• Call out their paranoia and answer what you think is most likely.
• Close is as unintelligible.

I'm not a doctor, but all of these seem to have negative repercussions that may escalate their issues into further delusions, self-harm or worse.

I do understand we have limits, but is there a good way to advise somebody to seek professional help? Ideally without telling them they're a paranoid nutbag, even if the shoe fits.

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This is a sincere post. One in four people will have mental health issues of some kind this year. As a moderator I'd like to think we're doing the best for all our users. I'd like to be better prepared.

Answer 1

Your question strikes a chord with me, because I was the primary carer for several years of someone who suffered from severe mental health problems (including paranoid delusions).

I think the most respectful way to deal with this situation is to treat the question as you would any other – answer it if it's on topic and you have a useful answer to contribute, close it if it's off-topic, etc. – while taking particular care to explain clearly to OP the basis for any moderation actions you take:

• If it does deserve to be closed on its merits, write a clear and polite comment explaining your close vote, with links to the appropriate resources.

• If the question morphs into a Chameleon Question (which may be more likely), again, treat it as you normally would, adding a comment explaining how to ask follow-up questions as appropriate.

You get the idea: explain your actions, and link to evidence that shows you're not singling OP out.

As a conscientious moderator I'm sure you already do this as a matter of course, but it's going to be particularly important in a case like this for OP to see that your action is based on the rules of the community, rather than any attempt to silence them.

I think that's the limit of your responsibilities. Furthermore, I don't think it's productive to attempt to advise OP to seek help. You don't know them, they have no reason to trust you, and there's very little chance they'll take your advice over that of the people they already have around them.

On the other hand, it may just be that, treated respectfully, they could end up as an outstanding member of the community. If they're paranoid, they're probably also obsessive, and nothing helps to build encyclopaedic knowledge on a subject like obsession. And if that happens, and they find themselves respected in the community for their knowledge, that could go a long way to improving their mental state.

Answer 2

The post Oded linked to seems to sum up what I think is the best thing we can do.
What's the official SE response to serious mentions of suicide in posts?

I have seen similar issues myself on a Stack site, and while not outright admitting "suicide" or other concerns, it is sometimes worrying to see other "people" (not "users") having what seems to be, or could be, some serious troubles.

The difficult thing about this activity being "online" is it's hard to read people properly.
They might just be trolling, or mentally stable but have a personality trait which makes them over exuberant or perhaps just don't have a friendly/positive writing style (etc).

It's really hard to know with text, and no facial expressions or bodily movement etc.

You do have to read carefully, however.

We all enjoy helping people with code and other questions within the scope of the sites, but to be able to do that we have to be knowledgeable.
For example a user new to PHP could not correctly advise on OOP factory pattern - their advice will be missing some important information or even just lacking in important considerations.
They may not know that, however, and go on to tell someone how to approach factory pattern, and someone ends up with a poorly arranged application as a result.

And the same is with all professions, but with mental health one has to be much more careful because it's not just someone's PHP script which doesn't work. The nature of mental problems means the potential outcome which could occur if handled incorrectly could be serious.

So with something like a potential mental health situation, unless trained and experienced in that area of expertise, we are simply not equipped to be trying to advise, so have to be very careful with what we say.

Maybe saying "You need to speak to XYZ group and get some support" is ill received and could have a negative outcome.
Of course, that's all we can do, but my point is keep is simple and don't so much "try to help" other than some basic advice and try to get them to consider speaking to someone else.

I have some experience with mental health issues from a family friend, and while I'm in no way very knowledgeable, I can say from a slightly experienced stand point, that while the words you are giving out seem kind and you might be giving a glimmer of hope or light to someone, might actually be detrimental and cause harm.

I know that might sound wrong, but without complete knowledge we can fall into something like the Dunning–Kruger effect, where we believe we're giving out good advice, but in fact there is something important that we do not know we don't know.

Some people with mental health issues can be in denial, as many of us are with most negative traits. And this means trying to persuade them to "seek help/advice" makes them not only deny they need it, but frustrates or even depresses them further from a conflict in their mind.

One really does have to tread carefully.

But again, we have the choice of ignoring it and leaving it, or trying carefully to give them some kind advice to go talk to someone - and I think the latter is probably best as long as it's simple and not given with any of our own "personal advice" on the matter.

It's also nice to see you care, and even post a question about it.