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How to support a friend who is suffering from mental distress
13 January 2021
I am frequently asked for advice concerning the best way to help a friend through a mental health crisis or in supporting a friend to manage their mental health difficulties. The experience of anxiety, depression, trauma or psychosis can be frightening and isolating. It is natural to want to do something to try to alleviate your friend’s suffering, and also to feel a little bit out of depth, perhaps worrying about saying the wrong thing and making things worse. Here I offer a few rules of thumb that should help you avoid common pitfalls and become better at supporting your friend.
Do not be in and out
Consistency is crucial. Research has shown that what makes a friendship beneficial for mental health is not the determined by the number of good deeds done, or hours spent together – but the expectation that someone will be there in the future. A common mistake at the beginning of a mental health episode or during a crisis is for a supporter to feel that they must suddenly ramp up their involvement with their friend, to be extremely generous and available and to make up for every person who has let their friend down. This ramping up can be counter-productive, as it is based upon an unrealistic expectation of what an individual can provide – you will likely become jaded and even resentful of the friend for not improving as a result of your enlarged efforts to help. What would be of greater benefit is the maintenance of your present level of involvement in the face of your friend’s changeable need. This will be tricky enough in itself.
Sometimes it may be the case that your efforts may seem to be spurned, it is best not to take this personally and to send messages by text or other Instant Messenger services that you are thinking of them.
Make a space for “real-talk”- but don’t demand it
On top of the experience of challenging thoughts and behaviours people also often feel considerable shame and embarrassment at their difficulty in coping with day to day life. Quite often people with mental health difficulties will compare their circumstances unfavourably with key people in their life. As a friend you may notice that your friend is not doing so well, but that they may also be unwilling to tell you exactly what is going on. Some people do not expect to be taken seriously or that some topics are even valid to open up about. What is important is that you are able to show your friend that you are willing to listen without making a demand upon them.
Doing an activity together, be it gardening, DIY or driving in a car together could be a good way to take the awkwardness out of it for both of you, as you won’t need to attempt eye-contact. Simple statements like: “I’ve noticed that you don’t seem to be doing so well,” or “you appear to be less happy lately” – “I’m not an expert but I am your friend and I want to be a good friend to you.” Please do not take offence if your friend is hesitant – your goal here is to open up a possibility of connection, which they may decide to take up at a later stage. Do not worry too much about saying the wrong thing – your friend will be able to sense your genuine good-will and willingness to share their burdens for their sake.
Try to avoid thinking of your friend’s mental health problem as an enemy to be defeated
Our wishes for our friend’s recovery and possible return to a pre-mentally unwell state can sometimes get in the way of accepting them and being there for them as they are now. I would advise against checking in with your friend in a manner that seeks to measure the extent of symptoms on a day-to-day basis. Your friend might interpret this as impatience or judgement about their recovery; that you are more interested in banishing the symptoms than being an accepting friend. You may also deny your friend the opportunity to have a normal good day without having to worry about their symptoms.
Try to avoid taking on the challenge of vanquishing the condition yourself, mental illnesses are highly personal, changeable and often touch on areas which are hard (or painful) to explain. However good your intentions, it is unlikely that your attempts to effect psychological treatment will be sufficient in themselves and you may grow frustrated in your friend’s seeming recalcitrance. Your responsive company, friendship and the expectation that you will be a safe harbour will be so much more valuable to your friend than your efforts to try to motivate them, overcome their fears and get them happy again.
Similarly, do encourage your friend to seek help and offer assistance in contacting local health services if this is what they want. However, demanding that they do so can be counter-productive for the reasons described above. If your friend is engaged with services, try not to pry too much into what is discussed or decided beyond the level they are willing to share with you. If your friend discontinues treatment abruptly, try to find out what specifically wasn’t working and encourage your friend to be find other sources of support e.g. a different therapist, a second opinion on medication,
How to be with challenging behaviour/ emotional experiences
You are likely at some stage to see the worst of the symptom – be it a sense of hopelessness, an inexplicable inability to do something that seems perfunctory, intense sadness, possibly anger. What is important in most instances is to be patient, calm and to not try to force anything. Ask your friend what they need at this moment, and try to facilitate this or be there with them in a compassionate and understanding manner. Your friend will be feeling very stuck in a hole at this moment, having you down there, sitting in the hole together until the worst passes will, in time be viewed as a valuable testament to your friendship. Try to let them be in control of the situation as much as they can – however do get them medical assistance if needed.
If in doubt – be a friend.
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