What Can I Do? Helping a Friend or Family Member with a Mental Illness

It’s hard to know what to do when a friend or family member has a mental illness.

All of us know that the support of family and friends is an essential element in the recovery process. 

But how to give that support is outside the experience of most people. We want to do something, but we feel our hands are tied.

Actually, there’s a lot you can do. This post is rather long, but it offers a wealth of information to help your friend, your family member — and you under these headings:

• How it feels when you first learn of your friend’s or family member’s mental illness
• Do not abandon your friend or family member in their time of crisis
• How to talk to your friend or family member about mental illness
• Support strategies you can use
• What to say if your friend or family member is unreasonable or delusional
• When your friend or family member is not manageable or is out of control
• For more information

How it feels when you first learn of your friend’s or family member’s mental illness

Grief, confusion, anger are normal emotions

When you hear of or suspect that one of your friends or family members has a mental illness, you may experience emotions such as shock, grief, sadness, anxiety, confusion, guilt, shame, and anger. It is important that you accept your feelings as normal, and to not feel ashamed of them. While you work through these feelings, please remember that:

• It is essential to understand that neither you nor the person with the mental illness are to blame for it. There’s nothing that either one of you could have done to prevent it.
• Many of these feelings are the result of the negative associations that mental illness carry in our society. It is imperative that you break through this stigma in order to give your friend or family member the help they need and deserve. It isn’t easy, because our daily language, the assumptions we grew up with, and the media are saturated with it. I have written a series of posts entitled, “Scapegoating and the Stigma of Mental Illness, Part 1” and Part 2 that can help you do this.

Often, friends or caregivers of the mentally ill do not know what to do for themselves, either. It is easy to become stressed out and lose sight of your own needs when you become deeply involved in helping a friend or family member. I have written a post entitled “How to Take Care of Yourself When Your Partner Has an Anxiety Disorder” to address just these sort of issues. Though it has specific help for partners and Anxiety Disorders, there’s a lot of general help for friends and other family members, too.

Do not abandon your friend or family member in their time of crisis

Do something, even if just a phone call

Above all, it is important that you not abandon your friend or family member in their hour of greatest need due to your own emotions or the stigma of mental illness. It is all too common for people, in their confusion about what to do, to do nothing to help or support them. Many of the mentally ill are simply abandoned by friends and family, or as bad, treated as if nothing were wrong at all.

When I had “the big breakdown” some years ago, I was totally abandoned by friends and my extended family. Perhaps they did not know what to do, or were negatively affected by the stigma of mental illness. Needless to say, they were not there for me in my time of greatest need. I cannot tell you how much this hurt or how alone I felt in the morass of mental illness. I can say without question that it lengthened my recovery time a great deal. It also has distorted our relationships since — that is, if our relationship survived it at all.

Please, if you have a friend or family member who needs help, break through your reluctance and give them support, even if it is just to call to let them know that you are thinking of them. 

How to talk to your friend or family member about mental illness

Show your friend or family member that you care

It may feel awkward, embarrassing, or intrusive, but don’t avoid having a conversation if you suspect your friend or family member has a mental health problem. It’s important to talk about it, so they know that they have nothing to be ashamed of. It’s possible they are already being treated and didn’t know how to tell you. In that case, you have an opportunity to offer your support. If they haven’t yet been diagnosed, your concern and encouragement might be just the thing they need to seek professional help.

The most important thing you can say to a friend or family member when beginning this conversation is that you care. Make it clear that you want to help them. Keep in mind that this conversation isn’t about offering advice. Rather, it’s about listening to them without being patronizing, judgmental, or trying to solve their problems yourself. Remind them that you care, you want to support them, and that mental illness is very treatable. 

Here are a few ideas to get you started:

• “I’ve noticed that you seem a little down lately. Is there anything I can do to help?”
• “I feel as though you’ve been distracted the last couple times we’ve seen each other. Do you want to talk about it?”
• “I’m concerned about you. If something is wrong, I’d like to help.”
• “Because I know you well, I can tell when something seems different. Can we talk about it?”
• “Our relationship means a lot to me. I know when I need help, you’re here for me. It seems like you could use some help right now, and I want to do whatever I can.”

Support strategies you can use

You need to be proactive

There are many things you can do to help your friend or family member — and yourself, too. Most of the following suggestions start with you. You need to be proactive in helping your friend or family member, not only in your dealings with them, but in your personal preparation as well.

Following is a list of tips for things to you can do to help your friend or family member, and yourself:

• Accept your feelings. You may find yourself denying the warning signs,worrying what other people will think due to stigma, or wondering what caused your family member or friend to become ill. Accept that these feelings are normal and common among others in your situation.
• Avoid being judgmental. Keeping an open mind will help to create a safe and comfortable environment for your friend or family member.
• Develop a positive attitude. It will help you to provide better support for a friend or family member with a mental illness, and will help you through your own difficult emotions.
• Educate yourself. Learn about the diagnosis, symptoms and available treatments. Mental health associations, public libraries and the internet are all good resources. (See list below)
• Recognize and accept that symptoms may come and go, and may vary in severity. Everyone has a different rate of recovery. Varying levels of support will be required at different times throughout recovery.
• Be compassionate. Recognize that your family member or friend may feel scared and confused after receiving a diagnosis. Although some people are relieved to get diagnosed and actively seek treatment, it may be devastating to others.
• Motivate. Encourage your friend or family member to learn about what treatments and services will promote recovery. Help them follow through with medication and the instructions their therapist will give.
• It takes time. Recognize that finding the right treatment or services can take time, and can involve a process of trial and error. It can be very frustrating. Be patient, and encourage your friend or family member to be patient, too. 
• Talk about what they find helpful. Make conversations about their mental health difficulties easy and open. Try asking about what helps them when things are tough. By talking openly, you are letting the person know about your love and support for them. You may like to talk about what you have read and ask how they feel about it.
• Practice “active listening.” Listen to your family member or friend and express your understanding back to them. Acknowledge the feelings they are experiencing and don’t discount them, even if you believe them to be symptoms of the illness.
• Understand the challenges of medication. Although treatments have improved tremendously in the past decade, they can also lead to side effects that can make your family member or friend want to stop taking the medicine. There are many psychiatric medications, and sometimes it takes a while to find the right one with the least side effects. Encourage them to speak immediately to their health care provider about any problems related to medications. And urge them to keep taking their medication until a better one is prescribed.
• Recognize that feeling better, getting better and staying better are distinct stages in recovery. Your friend or family member may feel better relatively quickly, but if they do not continue treatment until they get better and stay better, a relapse is almost certain. Urge them to keep taking their medication and seeing their therapist until they are released.
• Recovery from mental illness isn’t only a matter of “just staying on your medications” or regularly visiting a therapist. Self-esteem, social support and a feeling of contributing to society are also essential elements of recovery and should be supported.
• Offer practical help. Offer to drive or accompany your family member or friend to medical and other appointments. And, if they want you to, discuss the treatment, side effects or other issues with the doctor and treatment team. You may need to do other things they are unable to do, such as shop, run errands or clean the house.
• Give respect. Always respect the individual’s need for and right to privacy. People with mental illnesses have the same right to be treated with dignity and respect as anyone else.
• Respect your friend’s or family member’s limits. There may be times when they say they are not able to do something because of their illness. It is important that you respect this and don’t put extra pressure on them. For example, people who are taking medication often are not able to drink alcohol. This may make it hard for them in certain social situations. If you know they are unable to drink, it may be helpful when you socialize with them to choose to do something that doesn’t involve alcohol.
• Recognize your limits. No matter how hard you try, there will be times when you just don’t understand your friend or family member, or don’t know what to do next. You get tired and frustrated, too. Sometimes it is best to just step away a short while and take some time for yourself.
• You should decide what level of support and care you are realistically able to provide. Explain this to the friend or family member with the mental illness as well as the health professionals involved in their care. Don’t commit to things that you know you cannot do.
• Make sure that you have contact numbers. Having the contact numbers of people like their psychologist, doctor or psychiatrist is often important in helping your friend or family member through a crisis. It means that you can contact someone who knows them should they be in a situation where they are unsafe.
• Maintain hope. There is hope for recovery, and with treatment, many people who have mental illnesses return to productive and fulfilling lives.

What to say if your friend or family member is unreasonable or delusional

Approach from their point of view

If your friend or family member is paranoid or having delusions, don’t argue with them. Instead, approach the topic from their point of view: “That must be scary. I’d like to help,” or “I can understand why you’re upset. Can we figure out together how to make this better?” Be supportive and respectful and offer to help find someone they can talk to about their state of mind.

What to say:

• “I’m bringing this up because I care about you.”
• “Nothing you could tell me would change our relationship.”
• “I’m here for you if you want to talk.”
• “If you were sick with an illness like cancer or diabetes, I’d be concerned. A mental health problem is no different.”
• “What can I do to help?”

What not to say:

• “You’re acting really emotional lately.”
• “Lighten up!”
• “What you should do is…”
• “All you need is an antidepressant and you’ll be back to normal.”
• “I know you would be embarrassed if anyone knew about this, so we’ll keep it just between you and me.”

When your friend or family member is not manageable or is out of control

When medication and coping strategies don’t work

For those who have a mental illness, there may be periods of time when things are simply not manageable. Harder times may be triggered if your friend or family member has been over-stressed, if there has been a traumatic event, or there has been a change in medication. These things can generate difficult symptoms that are very hard to control, particularly if they haven’t had time to learn coping strategies.

If you are concerned that your friend or family member is getting beyond their ability to manage their mental illness, it is important to encourage them to talk to a trained professional they trust, such as their doctor, psychologist or psychiatrist. Remember, you should keep a list of contacts either with you or in an easy-to-access place for emergencies.

If you think that your friend or family member is out of control or likely to hurt themselves or others, find help immediately, even if they don’t want you to. Do not try to handle it alone. Stay calm and call the appropriate numbers on your list of contacts. If you need to, do not be afraid to call 911. 

The National Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service available to anyone in a suicidal crisis. If you need help call 1-800-273-TALK (8255). You will be routed to the closest possible crisis center in your area.

For more information

A wealth of information is available

There’s a wealth of information available by phone, mail, and online. For online searches, Google is your friend. But remember that there are a lot of quacks, hucksters and snake oil salesmen just waiting to take your money with claims of a cure. See my post “Can Anxiety Disorder and Panic Attacks Be Cured” for more information. Watch out for sites sponsored by drug companies, or those who have an axe to grind. Look for sites that are peer-reviewed or have stated resources for their information.

Who can you trust, then? Three of the best online resources for general information are:

• Mayo Clinic 
• National Institute of Mental Health (NIMH) 
• Brain Explorer 

The following are grassroots organizations devoted to promoting mental health and reducing the stigma of mental illness. They both offer general information, and have helplines:

Mental Health America

2000 N. Beauregard Street, 6th Floor

Alexandria, VA 22311

703-684-7722

800-060-6642

MHA Helpline: 800-273-TALK (8255)

Web site 

National Alliance on Mental Illness (NAMI) 

200 N. Glebe Road, Suite 1015

Arlington, VA 22203-3754

703-524-7600

NAMI Helpline: 800-950-NAMI (800-950-6264)

Web site 

What do you think?

• Do you have any further suggestions to help your friend, family member or yourself?
• Have you ever been in a position to help a friend or family member with their mental illness?
• Do you have any good information sources you could add?

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Resources used in this post:

Better Health Channel. (2007, July). Mental illness — family and friends. Retrieved October 6, 2008 from Better Health Channel Web site: http://www.betterhealth.vic.gov.au/BHCV2/bhcarticles.nsf/pages/Mental_illness_family_and_friends?open

Koenig, Vicki. (2006). Mental Illness — Information for Families. Retrieved October 6, 2008 from Sanctuary Psychiatric Center’s Information Network Web site: http://www.spcsb.org/articles/mental_illness.html

Mental Health America. (2007, May 16). Supporting Friends and Family Who Have Mental Illnesses. Retrieved July 1, 2008 from Psych Central Web site: http://psychcentral.com/lib/2007/supporting-friends-and-family-who-have-mental-illnesses/

Reach Out. (2007, June 30). Supporting a Friend with Mental Health Difficulties. Retrieved October 6, 2008 from Reach Out Web site: http://www.reachout.com.au/default.asp?ti=277

Support a Friend Iowa. (2008). How to Begin a Conversation. Retrieved October 6, 2008 from Support a Friend Iowa Web site: http://www.supportafriendiowa.com/HelpaFriend/Howtobeginaconversation/tabid/76/Default.aspx

For further reading:

What a Difference a Friend Makes web site 

Rosalyn Carter’s book, Helping Someone with Mental Illness: A Compassionate Guide for Family, Friends, and Caregivers

©2008 Anxiety, Panic & Health. All rights reserved.