The very act of seeking information to help your loved one with mental health difficulties is in itself supportive. It’s difficult, even painful, to watch someone you care about struggle with their mental health, and you’ve already taken an active step to walk beside them on their journey toward wellness. Here, you’ll gain a wealth of information to help you know when and how to step in, tips for having conversations, what to do if your loved one resists your help, and more.
The Benefits of Offering Support
Supporting a friend or loved one can make a positive difference. Having support is often a factor in whether someone seeks treatment. With support and treatment, people living with mental illness or other mental health struggles can manage their symptoms and live full lives.2
Unfortunately, though, up to 75 percent of people in North America and Europe don’t seek professional help because of the fear of being judged negatively because of their struggles.3
For people with mental illness, the help and assistance of caring individuals:1
- Can be reassuring and confidence-building as it communicates that someone in this world thinks they’re worthy
- Helps neutralize the stinging effects of the stigma and sense of shame often faced by people experiencing mental health issues
- Acts as a safety net that can “catch” them when they stumble
- Can be life-saving in times of crisis
For people with a friend or family member with mental illness, the question often isn’t whether to help them but when and how to do so.
How Will I Know When to Help?
Chances are, you know your friend or family member quite well. When you begin to notice that their behavior and/or emotions have changed and that this change is long-lasting, becoming a pattern rather than just an off day or two, it may be time to approach them.
What changes might signal a problem? While each mental disorder has its own distinct set of signs and symptoms, there are general red flags that often indicate that someone’s mental health may be faltering.
Signs that someone needs help include:4
- Frequent displays of negative emotions (such as sadness or anger) for no apparent reason…
- …or the opposite, appearing emotionally numb
- Heightened sensitivity to stress, often seeming frazzled and on-edge
- Sudden loss of interest in people, places, and activities they used to enjoy, often resulting in social withdrawal and isolation
- Increased absences from school or missing work
- Changes in eating or sleeping habits
- A pervasive sense of hopelessness
Also, be on the lookout for signs like difficulty concentrating, memory problems, mood swings, increased substance use, and/or self-harm.5 Be aware that people sometimes attempt to hide evidence of self-harm with clothing; if your loved one is suddenly wearing long sleeves or noticeably covering areas of their body they didn’t used to protect, they might be hurting themselves.
Some serious mental illnesses involve psychosis. If you notice any of the following signs of psychosis, start having conversations right away:6
- Focusing on unusual ideas or beliefs
- Increased suspiciousness of others, a sense that others are watching them or out to get them (paranoia)
- Hearing or seeing things that others can’t
- Believing that they’re receiving special messages (on billboards, in magazines, through television, etc.)
- Extreme isolation
A good time to step in is if you notice many of these symptoms happening frequently or lasting more than a couple weeks. Often, the most helpful thing to do is to gently start a conversation.
How to Talk About Mental Health With a Loved One
Knowing what to say and how to say it can be difficult. After all, you want to help, not cause further problems or push your loved one away. The Cleveland Clinic advises that one of the most important elements in conversations about mental health is compassion.6 This involves openness and a willingness to listen without judging or criticizing.
It helps to see your loved one as a whole person, not just as their illness or symptoms to avoid, which can inadvertently convey that you think they’re broken and need to be fixed.7 When you approach your loved one with empathy and patience, you’re likely to build trust and encourage them to open up.
Organizations such as the American Psychological Association,2 Mental Health.gov,8 and Mental Health America9 offer consistent and reliable tips for talking to loved ones of any age about their mental health.
These groups offer some dos and don’ts for talking about mental health:
Do:
- Be intentional about timing, avoiding times when your loved one is tired or frustrated
- Choose a comfortable, private location
- Use “I” statements rather than “you” statements to avoid making them feel criticized or cornered (“I’ve noticed that you’ve been spending a lot of time alone lately and I’m wondering if you’re doing okay” is more compassionate and inviting than “You don’t seem to want to be around me anymore. Is something wrong?”)
- Listen fully, giving the person your complete attention and avoiding interrupting with advice
- Ask questions to encourage conversation, and do so in a supportive, non-accusatory way (“What is it like for you when you have to miss work?” is more helpful than “Why are you missing so much work?”)
- Keep the conversation in the present rather than dragging up issues from the past
- Normalize their experience to let them know that they’re not alone (without switching the focus of the conversation to you, you can briefly mention a struggle you’ve had or share some statistics you’ve looked up ahead of time)
- Be straightforward and keep thing simple to avoid overwhelming them
- Watch for their reactions, and if they seem upset or resistant keep the conversation short (you can revisit it again a different day)
- Emphasize that you care about them and want to be supportive in a way that would be helpful to them
Don’t:
- Dismiss, brush off, or minimize their experiences (by telling them it’s all in their head or they should just snap out of it, for instance)…
- …but also don’t catastrophize and magnify problems, potentially causing more anxiety and even panic
- Become emotional (if you find yourself becoming anxious, angry, or sad, admit it and suggest a break so you can calm down and be more present for them)
- Argue
- Blame them or others
- Compare them to others
- Use “shoulds” or “shouldn’ts” (for example, telling them that they “should” get help sounds forceful and can shut down communication)
- Assume that you know what your loved one needs (they’re more likely to be open to your help and support if you ask them what would be helpful)
The Mental Health Foundation10 advises against placing too much emphasis on trying to diagnose what is wrong. You don’t have to label or even try to figure out their issue; instead, just listen to their experiences and how their symptoms are impacting their life. Further, avoid begging your loved one to get help or threatening them with consequences for not seeking help.11
If your loved one is having a hard time articulating what’s bothering them, you might suggest that they take an online mental health screening test, such as those offered by Mental Health America.12 They can then share their result with you as well as use it as a tool when meeting with their doctor or mental health professional.
One of the most important things to convey when talking to your loved one about their mental health struggles is a sense of hope.2 Let them know that treatment is available and that even though some illnesses are permanent, they can improve and experience mental health and wellbeing in spite of challenges.
What Can I Do to Help?
Deciding that you want to help is the easy part of the process. Knowing what you want to do, what you can do that will help rather than push your loved one further away, is much harder to determine. The best place to start is with a willingness to listen and asking them what they need.
Often, people are hesitant to reach out to offer support because they worry that they don’t have enough information about mental health issues to be useful. That’s a legitimate concern and one that you can put to rest. You don’t have to be an expert to help a loved one with a mental illness or any other mental health challenge; in fact, you don’t have to have a single answer or solution but simply a willingness to listen.13
Talking with your loved one and fully listening without judging, criticizing, or giving advice is enough in the beginning. As the process of finding and receiving treatment continues, you can learn more about your loved one’s symptoms and diagnosis to help them better understand their experiences and to discover what specific actions can help. Mental health organizations online and in communities are excellent resources, often providing free information, classes, and support groups for people with mental health issues and the friends and family who support them.
Another key component in knowing how to help someone is to simply ask them what they need. It can be frustrating and heart wrenching to watch someone you care about struggle. As an outside observer, it can seem like you know what would help them. Remember that experiencing mental illness doesn’t mean that your loved one isn’t an independent person with their own unique desires, needs, and approach to problem-solving. The best way to help someone is to be supportive in a way that is meaningful to them, and the way to discover that is to ask.
Let your loved one guide you in the exact type of help you provide. In general, think in terms of offering emotional support and practical support. The following ideas can help you and your loved one determine what specific measures would be most helpful.
What Emotional Support Can I Offer?
Emotional support involves being present, open, and accepting of your loved one to help them feel less alone and afraid.
Some ways to be emotionally supportive include:
- Providing reassurance, reminding them that this illness doesn’t define them and that treatment can help them overcome or manage their symptoms and reclaim their lives
- Remind them that they’re not alone, that you and others are their for them
- Remind them that they have many strengths and gifts
- Remain calm even when they aren’t
- Stay in contact and continue to invite them to do things with you (they may decline your offers because of their urge to withdraw and isolate, but continuing to check-in and provide opportunities communicates that you’re not giving up on them)
- Offer to attend family therapy with them
What Practical Support Can I Offer?
Practical support involves actions that facilitate their healing. Ways to offer this type of help include:
- Helping them find a therapist and make appointments
- Brainstorming with them and writing down questions for doctors and therapists
- Attending appointments with them and taking notes to review with them later
- Assisting with transportation, either giving them rides to and from appointments or helping them obtain a bus pass and learn how to use the public transportation system
- Connecting them with local mental health organizations and support groups (you can offer to attend support groups with them, too)
- Offer to do daily tasks such as grocery shopping, cleaning, or helping with child care (often, something as simple as calling them and saying, “Hey, I’m at the store right now. What can I grab for you?” is extremely helpful and doesn’t make them feel like a burden)
- Picking up prescriptions, organizing medication, and helping them make a schedule to stick to
What if My Loved One Doesn’t Want My Help?
It can be hurtful when a loved one resists your support. It can also be upsetting because you know that with help, they’ll get better. The bad news is that you can’t force someone to seek or accept help. Trying to pressure them into doing so can alienate them and damage your relationship.14 The good news is that even if your loved one resists your help, there are still little things you can do.
Things you can do when a loved one doesn’t want your help include:
- Telling them that you are there for them when they are ready
- Conveying that they are important to you, that you love them completely, and that you’re on their side and are not out to “fix” them
- Educating yourself about their symptoms so you know what to expect and how to respond
- Remaining calm rather than reacting in anger or other negative emotions (it might help to remind yourself that they might have reasons for resisting that you aren’t aware of)
- Giving them resources and information, such as links to websites or brochures and other educational materials from local mental health organizations (don’t try to force it on them but simply have it present)
Your best tool when a loved one resists is patience. Sometimes, what someone needs most is space and time. Providing that is supportive and helpful in and of itself.
What Should I Do in an Emergency or Crisis?
Seeing a loved one in crisis, harming themselves or talking about harming themselves, including suicide, is terrifying. Know that directly asking them if they are thinking about ending their life will not cause them to do so.15 Being direct will help you get them the help they need faster.
Knowing the warning signs of suicide risk can help you know when to take action. If you or someone you know shows several of these warning signs then it is time to take action.
These signs include:16
- Appearing depressed or sad most of the time (Untreated depression is the number one cause for suicide)
- Talking or writing about death or suicide
- Withdrawing from family and friends
- Feeling hopeless
- Feeling helpless
- Feeling strong anger or rage
- Feeling trapped—like there is no way out of a situation
- Experiencing dramatic mood changes
- Abusing drugs or alcohol
- Exhibiting a change in personality
- Acting impulsively
- Losing interest in most activities
- Experiencing a change in sleeping habits
- Experiencing a change in eating habits
- Losing interest in most activities
- Performing poorly at work or in school
- Giving away prized possessions
- Writing a will
- Feeling excessive guilt or shame
- Acting recklessly
Helpful resources for suicide information and help include:
How Do I Respond to Someone Who Is Suicidal?
The above organizations, as well as credible resources like the Mayo Clinic,17 are consistent in their recommendations.
Take these steps if your loved one is in crisis and exhibiting strong or erratic emotions and behaviors:
- Ask if they are thinking about harming or killing themselves (or someone else—follow these steps whether your loved one is threatening themselves or another person)
- Stay with them and remove anything they may use to hurt themselves
- Call 911 or take them to the nearest emergency room
While you wait for emergency responders, simply listen to your loved one. Ask them about their thoughts and emotions, and empathize. If you have access to a phone or the Internet, connect them to a crisis center. There are numerous centers available.
Two prominent suicide hotlines are:
- The National Suicide Prevention Lifeline (1-800-273-8255)
- Crisis Text Line (Text “Home” or “MHA” to 741741)
Make Sure You’re Caring for Yourself, Too
First and foremost, give yourself a break. You alone are not responsible for your loved one’s mental health. Of course you play an important role in their life, but resist the urge to take complete charge of your loved one, their illness, and their treatment. Helicopter care (hovering over someone, trying to force certain actions) isn’t good for you or your loved one. Be confident in the knowledge that the emotional support and practical help you are able to give is enough, and trust in your loved one’s ability to do things for themselves.
Setting boundaries will help you maintain your own mental health:
- Acknowledge and allow your own reactions (feelings of stress, anxiety, guilt, fear, anger, and sadness are normal and not a sign that you are an uncaring person)2
- Know and honor your limits by doing what you can and letting others, such as mental health professionals, do their part
- Avoid taking your loved one’s negative reactions personally by remembering that mental illness involves thoughts, feelings, and behaviors that interfere in the way someone interacts in the world
- Give yourself permission to be your own person, pursue your own interests, and take breaks—being there for someone does not mean being available 24/7
Many people who are helping loved ones through mental health challenges find caregiver support groups to be outstanding resources for themselves. Sharing stories, challenges, and tips with others in a similar position can help you thrive during this challenging time.
Many mental health organizations offer support groups for individuals living with mental illness as well as for their family members or friends, including:
- National Alliance on Mental Illness (NAMI)
- Mental Health America (MHA)
- Depression and Bipolar Support Alliance
Note that with the restrictions imposed due to the current COVID-19 crisis, some support groups aren’t meeting in person but are continuing to hold meetings through online platforms like Zoom. Use the above links to find local offices, and then contact them to see how they’re handling support groups.
An important takeaway is that mental illness doesn’t have to ruin lives. Treatment and support resources are available, and people can and do overcome difficulties to live full and satisfying lives.
Additional Resources for Helping a Friend of Loved One
- National Alliance on Mental Illness: How to Love Someone with a Mental Illness
- MentalHealth.gov
- Bring Change to Mind
- Substance Abuse and Mental Health Services Administration
