Being able to communicate how you feel can help others to understand you better – and we all want to be understood. However, mental distress can affect communication, so there are times when it can be much harder to find the words – even for articulate people.

"Effective communication is essential in building rapport and developing therapeutic relationships."

Even when not distressed, and fully able to explain feelings and emotions, recall how it feels when you tell someone something that’s really important to you, but they just don’t ‘get’ it. Or they’re not listening or giving their full attention. Or quite simply, you’ve been listened to, but not heard. Experiences like that can make you feel diminished, unimportant, misunderstood, alienated, without value, and alone. It can hurt, whether it’s coming from a friend, a family member or a healthcare professional.

Active listening

The latter – doctors, nurses, social workers and others working in health and care – ought to know better, because they’re trained to listen and empathise. That’s part of their job: actively and mindfully listening, and showing that they’re listening.

Listening is a key component of communication, and a substantial body of research has demonstrated how good communication can help produce positive patient/client/service-user outcomes. Writing in ‘Nursing and Mental Health Care: An Introduction for All Fields of Practice’, Reuben Pearce said: “Being able to communicate and relate to people and their unique experience of mental distress is vital for meaningful and effective nursing intervention." Effective communication is essential in building rapport and developing therapeutic relationships. Where communication between patients and staff has been good, and where communication between professionals on the multi-disciplinary team is effective, the service-user experience is significantly improved.


Good communication can even help speed both physical and mental recovery. Writing in ‘Engagement and Therapeutic Communication in Mental Health Nursing’, Sandra Walker says: “Research has consistently shown that it is the human relationships we develop that have the biggest impact on recovery in mental healthcare; successful engagement and therapeutic communication are essential in order to help people find their way out of the maze of problems that may have beset them.”

Conversely, poor communication by professionals can hinder recovery by adding to mental distress and feelings of isolation. It is incumbent upon healthcare professionals to know how to communicate with a wide range of people and their conditions, including those who are experiencing mental health difficulties. Of course, everyone is different and should not be defined only by their condition. Health and care staff need to recognise this too: a ‘one size fits all’ approach will fail.

When someone is anxious or distressed, the things that help humans warm to others – a smile, a friendly greeting or appropriate eye contact – may be missing. This can sometimes affect how professionals react. I have seen healthcare staff regard a patient’s distressed behaviour as a sign of hostility, and they have responded in a hostile fashion in return. This is unprofessional in its own right, but it also gets the therapeutic relationship off to a bad start that may never be repaired. Even well-meaning professionals can get it wrong, perhaps by talking too much and not listening enough. Never underestimate the positive therapeutic effect of being listened to.


Simple things can make a big difference: a genuine smile, an empathetic look, a cup of tea… small, human gestures than can mean so much in times of crisis. Be non-judgmental. Try to understand. Create time and space. Listen actively and show that you’re listening, using nods and encouraging gestures. Use open body language. These things come naturally to some, but need to be learned by others. Reflect on your own attitudes and behaviours and commit to making a difference by using the therapeutic value of communication when working with all clients, whether affected by mental health issues or not. Good communication works, full stop!

Moi Ali has acted as communications advisor to a number of NHS hospitals and healthcare clinics, to two children’s hospices, a voluntary sector hospital, the Royal College of Nursing in Scotland, and to healthcare charities. She is a former Vice President of the Nursing and Midwifery Council and former chair of a healthcare charity/social enterprise.

Moi Ali’s book, How to Communicate Effectively in Health and Social Care: A practical guide for the caring professions, costs £28 from Pavilion Publishing: