Talking to: A friend about their mental health
Friendships can be tricky. For some of us, it can feel like an extension of family. If that’s the case, we might also then treat these relationships the same way we treat family and re-enact unhelpful ways of communication we learned growing up. We might avoid hard conversations, medicate together, let people cross our boundaries, or keep things “light.” When it comes to bringing up mental health with our friends it can feel uncomfortable, and one might think “it’s not my place.” However, the biggest mistake I see people make is just pretending their friend isn’t struggling, and perhaps talking about their friend’s behavior behind their backs, hoping it will go away, or they slowly just talk to their friend less and less. I want to share what I’ve learned to avoid and what’s been more helpful when a friend is struggling in the hopes that it provides some guidance for how to have these conversations.
Avoid: Listing off reasons the person should be grateful. This can sound like: “But aren’t you so grateful for your (house/ job/ loved ones)?”, “How could you be sad? You’ve got so much going for you!”
Yes, one can be grateful and still struggle with anxiety, depression, bipolar disorder, and substance use, etc.
Avoid: Offering to shop, drink, eat, date, or medicate the problem away. This can sound like: “Download your old dating apps, get a new outfit, and a new attitude.”, “You just need to get laid”, “Let’s go for a drink and get it off your mind”, “The best way to get over someone is to get under someone else.”, “You need to get out of the house, let’s go shopping.” Pop culture doesn’t help either- I recently heard a song lamenting that tattoos and tequila was their plan for getting over their ex. Often people in pain medicate in some way and offering to support your friend in this way can perpetuate this medicating cycle. While fun distractions are helpful sometimes, avoid this as your go to solution when trying to support someone. This often has to do more with OUR discomfort of seeing the person struggling and wanting to find a way to fix it.
Avoid: Speaking in absolutes about what someone should do. Speaking in absolutes and “shoulds” sounds like: “If you took medication I know you’d feel so much better.”, “You really should try this therapist, I know it would help.”, “If you exercised more it would help your insomnia so much!”, “You’re just anxious, it’s nothing serious, everyone gets anxiety.”, “What person doesn’t struggle with food? You’re normal.”, “I’m so ADD too! You should try this supplement I saw online.”
Avoid: Diagnosing them based on your own experience or what you’ve seen in the media. Many mental health diagnoses share symptoms and one person’s bipolar disorder may look like another person’s OCD or another diagnosis. People with the same diagnosis can present very differently. What’s true for one person may not be true for another. Mental health is nuanced and gets exaggerated or misrepresented in the media.
Avoid: Gossiping to your other friends, even in the interest of “being concerned for them.” If you’re truly worried about your friend’s safety and wellbeing, talk to them directly.
Avoid: Trying to get it perfect. Humans make mistakes and the only big mistake is not talking about the problem altogether.
Avoid: Minimizing. This can sound like: “You’re crazy! If I was your weight I’d be so happy!”, “Oh stop. Our childhood wasn’t that bad.”, “Everyone has problems. You should be grateful for what you have.”, “He’s just moody, everyone’s moody.”, “Everyone parties. He will grow out of it.”, “You’re crazy! It’s not even a big deal.”
Here’s what I’ve found to be more supportive:
Do: Listen without fixing. Listen without interrupting. Listen to understand rather than to have a response ready.
Do: Speak candidly about your own experiences if it is helpful to your friend. Some people may want to hear how you handled your struggles while others may view this as a “one up” or that you’re putting the attention back on yourself. The only sure way to know is to ask. This can sound like “Would it be helpful to hear about my experience with (Depression/Anxiety/Addiction/ADHD/Disordered Eating)?”, “I can relate to your struggles with alcohol. I started a program called SMART that’s been helping me. Do you want to hear more about it?”, “I can relate to your struggles with Bipolar disorder. My Dad was diagnosed with Bipolar 2. I can share about my experience if it would be helpful.”
Do: Offer to spend time with your friend. Distractions and medicators aren’t mental health treatment but activities like trying a new hobby or taking a class, playing a game or sport together, coming over and talking, going for a hike or walk, getting coffee or tea and giving someone your undivided attention may be a way to connect that doesn’t try to medicate the problem away through gaming, drinking, eating, shopping, etc.
Do: Open the conversation in a heartfelt way. If you notice your friend seems off, use “I” statements to reflect how you’re feeling and what you’re noticing. “I” statements mean expressing an emotion followed by an explanation or asking for what you need. “I” statements can sound like:
“I have felt worried about you lately, it seems like you’re reaching out less. Is there anything you want to talk about?”, “I’m concerned about you. I noticed your drinking has increased when I saw you the other night. I am here if you want to talk about it. I’ve been there too.”, “I feel worried when I don’t hear from you. Please let me know if you want to meet for a walk and catch up. I’d like to see you.”, “I’ve been scared to bring this up because I don’t know the best way but your health is more important than me getting it perfect. I want you to know I’m here if you ever want to talk about anything related to (food/depression/ medication/drinking).”
Do: Set boundaries if needed. “I care about our friendship but I can’t hang out anymore when you’re drinking. You say and do things out of character.”, “I want to be able to help keep you safe. If things get worse, who do I have your permission to call?”, “I don’t feel comfortable knowing I am the only person who knows this. Who else can we make sure knows you’re having suicidal thoughts?”
or “I want to be here for you and this feels like something I’m not equipped to handle alone. Can I sit with you while you call (agency/therapist)?”, “You deserve help from someone who knows more about this. Have you considered the possibility of a (sponsor/therapist/treatment center)?”, “I’m so glad you felt safe enough to share with me. I’m not equipped to handle this relapse. Does your sponsor/therapist/recovery coach know about this too?”
Do: Ask how you can support rather than assuming or trying to think of a solution on your own. “I might mess this up and please tell me if I do. I want to support you through this. Do you have an idea of what would be helpful from me?”, “Has anything been helpful in the past when you were struggling with this?”
Do: Know your limitations. You don’t have to navigate a crisis alone and shouldn’t. If you or someone you know has thoughts of death or suicide, call (800) 273-TALK (800-273-8255) or 911. You can also text DBSA to 741-741. If someone is having a psychiatric or substance related emergency, the quickest way to recieve help is to take your friend to an emergency room or call 911. The NC Good Samaritan Law protects individuals who experience a drug overdose or persons who witness an overdose and seek help for the victim. Individuals will not be prosecuted for possession of small amounts of drugs, paraphernalia, or underage drinking when seeking help.
Do: Make sure you’re taking care of yourself too. It can be difficult to love and care about someone who’s hurting. Attending a support group or educating yourself can be incredibly impactful. There are websites and support groups for most diagnoses these days. Some groups and pages that might help:
https://www.nami.org/Support-Education/Support-Groups
https://www.allianceforeatingdisorders.com/recovery-programs-and-support/
https://www.dbsalliance.org/support/for-fiends-family/how-to-help-someone-in-crisis/
Even as therapists, we don’t get it perfect. But what can make a difference is having the courage to reflect what we are seeing, express our concern, know our limitations, and have an open heart and mind about our client’s experiences.
With love and imperfection,
Jessica Evans, LCSW, LCAS