written by BreakingDownTheWall
NEVER underestimate your power to help a mentally ill person. Sometimes you might feel that you are fighting a losing battle, but I promise you, you are not. Just by standing by your friend or family member, you can make an enormous difference. Below are some practical things you can do to help.
Remember that the way towards wellness for someone with a mental health condition lies in empowerment. They need to get back to doing things for themselves, and to believing in themselves and their own abilities. Therefore, none of the below suggestions will work if you force them on the person. Whatever you try to do to help, remember that it will only help if your friend or family member chooses to let you do it. Often they will say no to things, and you must accept that.
Coping with mental illness is a long road. Supporting someone who is suffering from a mental health condition can be frustrating and stressful, and progress slow and often disheartening. Remember that no matter how challenging it is for you, it will never be more so than it is for your friend or family member who is suffering the condition. But no matter how dark things get for them, there will ALWAYS be something you can do to help.
If this website makes you significantly change the way you are dealing with your friend or family member, tell them what you are doing and ask for their feedback. We’re trying to give generic advice, and nothing will help everyone – it’s different for different people, so check with them to see if it’s helping.
1. Just be there. Never give up and never be out of touch. Even if they keep cancelling coffee dates or rejecting your advice, or even if they lose their temper with you and tell you to go away, please never give up on them. A normal friendship/family relationship is the BEST thing you can give them – and they really need it.
Mental illness is often a very isolating experience which can significantly limit people’s ability to interact with others – through being sick and unable to go out, through stigma, through being unable to act on the advice of mentally well people, through needing flexibility to cancel or change plans at the last minute, through social anxiety, and many other things. The best thing you can do is to be there for the person, to keep them in your life, no matter what.
2. Ask them what makes them feel better when they’re struggling. Sometimes, they’ll need to be alone, but a conversation with a friend at the right time can really help. If they’re really struggling, they might not be up to talking on the phone, but just exchanging a few texts can really help too.
What helps can be different at different times, and for different people, so ASK your friend/family member what helps them the most, and how and what YOU can do to help.
3. Socialise with them. That is the best way to either keep them in, or get them back into, a normal life. And having as close to a normal life as possible is the best way to cope with mental illness.
If you are trying to include your friend or family member in social activities and they keep saying no, or saying yes and then pulling out, it’s neither your fault nor theirs. Just like if they had a physical illness, sometimes their condition means they just can’t make it to your party/coffee date/movie night. Rather than stop inviting them, ask them what social activities they feel most able to do. If they suffer from social anxiety, for example, they might struggle to go to a café for a coffee date, but might be fine if you go to their house to have coffee. They might struggle to go to a party with lots of people, but be fine to catch up with just you or you and one other friend.
Depending on the severity of their condition, there might be some days when they just can’t do anything. Maybe they might be having a bad day, or maybe something might happen earlier in the day (a trigger, for example) that wipes them out for the rest of the day. So even if you get them to choose the social activity and arrange it around them, if their head is messed up on that particular day (this can happen without warning, and it goes up and down, so it’s rarely predictable), they might still have to cancel on you. Please don’t blame either them or yourself for this. Tell them that it’s OK and that you understand that sometimes they just have to change plans. And ALWAYS make sure you contact them again to reschedule another time!
“I’m sorry, I slept really badly last night and I can’t see you today”
does NOT mean
“I’m too lazy to see you,” “I didn’t like what you said to me last time,” or “I don’t value our friendship”!!!
“I could not sleep well because I had (for example) nightmares/racing heart/insomnia last night and as a result, today every noise makes me wince, I feel like crap and I cannot hold a conversation. It’s not your fault. I just need to rest up and I’d love to see you next week instead.”
“I’m sorry, I had a really bad time at the supermarket/at work/in traffic this afternoon so I can’t come tonight”
does NOT mean
“I’m too lazy to see you,” “I give up easily,” “I didn’t like what you said to me last time,” “I don’t value our friendship” or “I hate shopping/work/cars”!!
“I got triggered today, and it floored me. I now have to go home because I’m shaking/heart racing/feel physically sick and I need to spend the rest of the day curled up on my bed in the foetal position. It’s not your fault. I just need to rest up and I’d love to see you next week instead.”
For more information about triggers, click here.
4. Use positive rather than negative language/pay compliments whenever you can.
People with mental health conditions often suffer from low self-esteem. They also often struggle with tasks that a mentally well person would find much easier. Positive encouragement, and giving credit where credit is due, can go a long way. It’ll take a while, but if you can keep chipping away at the negative thoughts and anxieties that your friend or family member is enduring, you CAN help them through it. When someone pays you a compliment, does it make you feel good? And when someone tells you you did something well, does it reassure you a lot better than it would if you tried to tell yourself you had done OK? Positive feedback from others is really important for everyone’s self-esteem, not just people with mental health conditions.
*Key point* ALWAYS pay attention to your friend or family member’s reactions to what you say, and change your actions accordingly. Don’t belittle or badger them to achieve things; rather, when they achieve things, pat them on the back for it. For people with mental health conditions, some days just getting out of bed is an enormous achievement, and thus worthy of a pat on the back. Also, telling someone what you love about them and what you think they do well is a great way to give them a psychological boost, so don’t hold your compliments inside!
Using positive language is particularly important, and is something that is used in many psychological therapies. For more information, click here.
5. Check in. Give them a friendly text or phone call every so often. If you find out they’re particularly struggling at the moment, do it more often. It doesn’t have to take up much of your time – just texting them a hug, a joke or a cute GIF or emoji can give them a smile (VERY important, a much-needed shot of endorphins to the brain!) whilst also letting them know that you are there if they need to talk.
Even if they’re not up to conversation, you can still give them a lift by sending a simple text like, “I’m sorry you’re feeling shit *hug*” or “Look at this funny video I found on YouTube, it made me laugh xxx”. It won’t make them well, but when you’re struggling with mental illness every day of your life, small things that make you smile, make you laugh or make you feel loved really really count, because they are all you have to cheer yourself up. To put this in context, think of a time when you were really struggling yourself – maybe through grief or a bad breakup or losing your job. When people said kind things to you, or did little things to show they cared, or made you laugh, did it help? Imagine how much worse you would have felt if you had had nobody to talk to about your problem, or to give you a laugh, a smile or a hug. When you’re really struggling, those little things REALLY count, and they really help, one step at a time.
6. Never make assumptions
(….list a few common assumptions and explain why they’re wrong…….I’m looking for input on this!)
“Last time I saw him he was talking and laughing – he must be doing a lot better!”
Never make any assumptions about your friend or family member’s condition. Mental health symptoms are different for every person, so only they can tell you how they’re really feeling – but often they won’t. Mental illness is very isolating in itself, and people often try and “cover it up” to fit in better socially. They may want to avoid worrying you, or may find it hard to explain to you what they’re really feeling (often mental health symptoms can only be truly understood by someone who has experienced them first hand). Also, as a lot of people with mental health conditions suffer from low self-esteem, they might be afraid that if they tell you how they’re really feeling, you might be put off or scared away, and they might lose your support.
For these and other reasons, it is rare for a person with a mental health condition to tell their friends and family exactly what they are going through. They might be able to put on a brave face and carry on normal conversations with people in a social setting, so that nobody present can notice anything amiss, but when they get home they may collapse into a mentally ill mess.
So, never make assumptions about how your friend or family member is doing based on what you see them doing, because you will never see the whole picture. This doesn’t mean that you should mistrust what you see and demand they tell you what’s really happening – they (and you!) may well function better without you knowing everything that’s going on. But not making assumptions is important to make sure that, for example, you don’t make them do things they don’t like or are not capable of. It’s also important when watching out for suicidality.
For more information about putting on a “social face” to hide mental illness, click here.
For more information on what mental health symptoms feel like, and how they can affect daily life, click here.
For more information about how to watch out for, and react to, potential suicidal thoughts or behaviour in a friend or family member, click here.
7. Offer to help with practical things.
This is a tricky one, for two main reasons:
- To get well and learn to cope in future, a person needs to be able to do things on their own.
- Having people do things for them can cause them to have negative feelings about their own abilities, for example, “I couldn’t even manage to do the shopping so my mum/aunty/friend did it, how useless am I?” Needing other people to help you do things you used to be able to do yourself can be a really depressing and degrading experience.
This varies from person to person, but it’s something you need to be aware of. There are things you can do to mitigate it, for example by doing things with the person instead of for them, and by modifying what you say to make sure it doesn’t sound like you pity them or think they aren’t capable of doing things for themselves. For example:
“I cooked too much food last night, we had some lasagne left over, would you like some?”
“I’ve made this lasagne for you, dear.”
“I’m going into town anyway that day, do you want a lift to your appointment?”
“You probably shouldn’t drive in your state, I’ll drive you.”
“Would you like some help to fix that leaky tap? I love doing DIY stuff. We can do it together.”
“Jeez that dripping tap must be driving you mad, I’ll fix it for you.”
You want to help the person, but if you don’t do it on their terms, you could be hindering them instead. The best way to figure out how best to do things is by talking. Ask them if there’s anything they need help with, or offer to do a specific thing, and let them choose if and how you help them with it. Involve them in the doing of it where possible, so that they can feel empowered and in control of their life as much as they can. This is the best way to recovery.
The decision as to whether it’s causing a problem and whether they need help fixing it should never be yours, always theirs. You will not help them if you are constantly buzzing around them vacuuming their house when they need silence/fixing the latch on a window they prefer to leave open/taking them to see people they do not like/spending 2 hours teaching them how to make a recipe when they never cook anything that takes more than 10 minutes. You can only offer – they know themselves best, so they know what will help them and what won’t, so you must let them tell you and you must listen.
Sometimes there will be things your friend or family member is or isn’t doing that you are convinced are really bad for them, and you want to change this. Remember that if you try to force it, you could make things worse. Talk to them about it openly and honestly, and listen to what they say (in particular regarding why it is happening). If you still think there is a better way, ask them again another time, but don’t force things now.
8. Help them manage their illness.
Again, putting pressure on your friend or family member to do things when they are not ready is a hindrance, not a help. You need to be patient and let them make their own decisions. But they will need medical treatment, and, if they need or want support in this, there are a number of things you could do. For example:
- Going with them to medical appointments (they might not want you to go into the appointment with them, but driving them there and back and giving moral support can be a great help)
- Going with them to support groups (they might not want you to go into the group with them, but driving them there and back and giving moral support can be a great help)
- Making yourself aware of the symptoms of their condition, and how best to deal with them.
- Finding out what services are available that they qualify for and that might help them, for example medical services, support groups, advocacy services, social services and emergency mental health services. Click here for information on services in your area.
- Making sure they remember to take medication and do not go off it suddenly (going off mental health drugs suddenly can have a devastating impact on a patient’s health)
- Helping them to accept that they have a mental health condition and that they need treatment for it (medication and/or therapy, plus a lot of self-management).
This can be hard to accept, just as it can be for patients with physical health conditions. They may struggle with the fact that they can no longer do things they used to do, or feel how they used to feel. You can help them by telling them that that’s OK, that things are just a little different now, and that it’s not their fault. Help them to understand that they can help themselves by learning to manage their illness.
- Understanding that your friend or family member will need to do a lot of work on their own, and will need a lot of support from their friends and family, to manage their condition and work towards wellness.
Doctors can only help so much: it is the patient who must do the most work, to implement all the advice given by doctors and treatment plans, and to work hard every day to try and break through negative thought processes and irrational feelings and beliefs. The hardest job will always be theirs, not yours and not the doctors’. But if you can be there for them as they work their way through it, encourage them, congratulate them on small successes, and help them pick up the pieces when they fall down, you CAN help them to manage their condition.
- Visiting them in hospital
If your friend or family member is admitted to a mental health facility, you should visit them in just the same way as you would if they were admitted to a physical health facility. This means all the usual things you might do: text or ring first to ask if they’re up to a visit, take them chocolate or a teddy bear, and have a nice normal chat to distract them from their circumstance for a while (having a “normal” chat makes one feel “normal”, which is very important) and make them feel that somebody cares (given that many people with mental health conditions suffer from low self-esteem, this is particularly important).
It also means following the same respectful rules as you would with a physical health patient, such as not disturbing them when they’re resting and not staying too long in case you tire them out.
- Monitoring their relationship with healthcare professionals. Some mental health conditions can cause patients to be mistrustful of health professionals and not follow their advice. Conversely, some health professionals can make diagnostic and treatment decisions through assumptions made based on observation of the patient’s behaviour in crisis, which can be drastically different to their behaviour when they’re not in crisis. Equally, the way the person interacts with health professionals can be drastically different to the way they interact with their friends and family members, and this can also lead to incorrect conclusions being drawn about a patient’s condition, character, diagnosis and treatment. A significant contributing factor to all three of these problems is the fact that many people with mental health conditions struggle to express themselves openly, meaning that health professionals often lack vital information due to their patients either not telling them things at all or not explaining things effectively.
If you become aware that your friend or family member is having problems working effectively with mental health professionals to treat their illness, DON’T IGNORE IT. Anything which impacts on the ability of a patient and healthcare professional to work together effectively is a MAJOR problem which can have an enormous impact on both the short and long term health of the patient. And sadly, very many mentally ill people have died before they had the chance to get their treatment right. This is colossally important. If you become aware of a problem in the doctor-patient relationship, investigate (calmly, and without apportioning blame), speak up, and do whatever you can to help fix it. It is best not to direct blame anywhere, but to explore all possible reasons and solutions – and there are people and organisations than can help you with this. Click here for more info on these.
You may not have any medical training yourself, but as a friend or family member, YOU know the person’s basic character better than their doctors do. NEVER sit back and think, “The doctors know best.” Doctors know a lot, and they work very hard and we could not survive without them, but it is only when they, the patient and the patient’s friends and family work together that long term mental health management and recovery can be achieved. YOU can help achieve that. Click here for more info on how.
In some cases, addressing these problems may mean that your friend or family member needs to change doctors or treatment facilities. This is quite common in mental health treatment. To treat a broken bone, all you need is somebody who knows how to fix bones, but to treat mental health conditions, you need a doctor with whom you can develop a rapport and a trust-based relationship, to have deeply personal conversations with over a prolonged treatment period. It can therefore take longer to find the right person to treat a mental health condition than to treat a broken leg – and the right person may be different for different people.
- Monitoring the way your friend or family member is treated by hospitals and emergency services.
Practises you might have thought were relegated to the dark ages of confined mental prisons like Bedlam and Blackwell’s Island, for example strapping patients to beds for extended periods, DO still happen. And the impact on the patient’s health can be catastrophic (as indeed it would traumatise even a mentally well person). So keep a watchful eye out.
9. Follow through. If you have shown your friend or family member that you are sticking by them and are willing to help, you might be the one they contact when they are really in trouble. This could be quite challenging for you, but please remember that in order for them to ask this of you, they must have first acknowledged that they need help (very hard), gathered the strength to ask for help (even harder) and chosen you because they think you are the best person to help them (and they might have nobody else). So, gather your strength and be there to help your friend or family member through their darkest times.
To find out what you need to know in a mental health crisis situation, click here.
*Very important* Look after yourself too! You can’t help others if you are not in a good mental state yourself, and looking after someone with a mental illness can expose you to significant stress, worry, frustration and, in some cases, serious trauma. For tips on how best to look after yourself, click here.