Written by National Director, Substance Use Policy and Programs, Alexandra Perry.

"But Alex… what do I do if someone says they're struggling?"

I get asked this a lot, and I'll be honest, it's a hard question to answer concisely. Not because it's complicated, but because there's a lot underneath it. We live in a world where the messaging is constant: "let's talk," "check in on your people," "be authentic." And I believe in all of that. But those messages are often shared without fully acknowledging the system people are operating in. Because right after someone hears "just speak up," there's usually another voice that follows: what if I get judged, what if this impacts my job, what if everyone else is handling it fine, what if this is just normal here? And just like that, we're in a tension point between what we say we want and what feels safe to do.

So, when someone does say something, it matters. When a colleague says they're struggling, directly or indirectly, that's not a small moment.

 "That's someone pushing past all of that internal noise and risk. And then it lands with you. No script, no perfect response, just a moment where you're figuring out how to show up." 

Start With What You Already Know

I often come back to something I say to my students: if you were struggling, if you felt overwhelmed, scared, frustrated, or alone, what would you need? For some people, that's a hard question to answer (myself included). But if you take a moment, it's usually not that complex. Most of us need someone to listen, for it not to go somewhere it doesn't need to, for someone to check back in, and to feel like someone genuinely cares.

 "It sounds simple, almost too simple, and maybe that's why it can feel like it's not enough. But often, it is." 

And we can build on that in practical ways - because being a supportive colleague isn't just about being kind in the moment. It's also about helping someone navigate what comes next. Being a peer can mean helping someone make sense of the system. If someone is overwhelmed, the last thing they're going to do is read through policies, understand benefits, or figure out where to go. This is where you can step in. Sit with them, pull up the mental health policy together, walk through options, and help them understand what's available. Not as an expert, just as someone willing to slow it down with them.

You Don't Need to Understand It All

It also means keeping things grounded in real life. You're not expected to diagnose anything, so we can take the pressure off there. You don't even need to fully understand what's going on - that might take time, and your colleague might not even know yet themselves. But you can gently ask what's been feeling hardest lately, like, "how are you managing all of this and work?" You can also ask what parts of their day feel manageable and what don't. This helps shift the conversation from something abstract and overwhelming into something that can be supported. And often, just having that conversation creates space for reflection. It allows your colleague to pause and realise: this is a lot. I am carrying a lot. I might need support.

Ask Instead of Assume

A lot of people pull back when they're struggling, often because of fear, worry, or feelings of worthlessness. These are hard emotions. Relentless emotions. And if you think about times you've felt that way, it's not hard to understand why someone might withdraw. Simply understanding that, relating to it, and responding with empathy will give you a lot of your answers.

But support doesn't look the same for everyone. Instead of assuming, you can ask: "What does support look like for you right now?" or "What would feel helpful?" - and let them guide what comes next.

Think About the Culture You're Part Of

I also think about organisational cultures here. Connection can be defined by shared interests, even when those interests aren't necessarily supportive of our health. Being a peer means staying open to how workplace culture can contribute to stress and even substance use. It also means being willing to notice how we might be participating in that - not intentionally, but by not challenging it.

Sometimes being a peer is taking one conversation and carrying it forward, remembering it at the next work function, noticing when someone isn't okay, and asking yourself:

 "Are we truly connecting? Are we connecting as people, or just in the ways we've been socially taught to?" 

If we can shift that, even slightly, we start to create spaces that feel genuinely connected rather than performative.

The Part People Forget Most Often: Check Back In

The first conversation matters, but what people remember is whether you checked back in. A simple message or moment of connection can go much further than trying to get everything right in the initial conversation.

I know this can feel like one more thing to do. But supporting someone else almost always gives something back to you.

"It slows things down just enough to notice what's going on around you - to value how people are feeling, not just how they're performing."

And sometimes, in that pause, there's a moment of recognition: I'm carrying a lot too.

You Don't Need the Perfect Words

I understand why this question comes up so often. In some ways, we've done a good job encouraging people to speak up, but we haven't always equipped people for what comes after. So, I want to offer some reassurance - you don't need to have the perfect words. You just need to:

• Listen
• Ask a few simple questions
• Walk with them where they're at
• Check back in

And that last part - walking with someone where they're at - is often the hardest. It means accepting that you can't fix it. It means sitting with the possibility that things might not change, or at least not in the way or timeline you would hope for. But that doesn't make the support any less meaningful. If anything, it makes it more real.

"That moment, when someone says they're struggling, it's often the difference between someone getting support early, or not at all."

Alexandra Perry is National Director of Substance Use Policy and Programs at SOMA Medical. With a background in trauma-informed practice, organizational leadership, and clinical systems design, she works with insurers, employers, and healthcare providers navigating complex substance use and concurrent-disorder cases. Alexandra is currently completing her PhD in Industrial and Organizational Psychology.

Connect with Alexandra: Alex.Perry@somamedical.com