To listen, with nothing more attached, is a powerful help. How often you do feel really listened to?
Just let your friend talk. Make it clear they have your full attention: put your phone away, allow them to make eye contact with you, and give verbal and non-verbal feedback. Don’t be afraid of silence, and don’t feel the need to be constantly formulating some response or piece of advice. Just being allowed to describe your experience and your feelings is incredibly valuable for anyone, but especially those of us with mental illnesses.
I can’t stress enough the desperate importance of validation. It’s like oxygen to mentally ill people, and we typically don’t get a lot of it. I only realised this after I joined an online discussion forum for people with mental health issues and began to receive a torrent of validation.
‘You’re allowed to feel this way.’ ‘Your feelings are valid.’ ‘You feel angry about this and that’s ok.’ ‘That sounds really hard for you.’ ‘You and your feelings are acceptable.’ Say these things to people. We don’t need judgement; we judge ourselves already. We don’t need advice; if we do we’ll ask for it. We need you to say, ‘You are allowed to feel bad about this’. Even if you think our feelings are weird, illogical or wrong. Even if you think we are overreacting. Perhaps we are, but you telling us that won’t help us cope with the feelings. Validation will.
3. Educate yourself
If you want to support a person who has schizophrenia, read about schizophrenia. Seek out people’s experiences and have a look at the statistics. If you know that hardly anyone with schizophrenia is violent, you are much less likely to approach your friend fearfully. If you know that many people with depression feel suicidal, you are less likely to react with horror if your friend tells you they are feeling suicidal. If you know the common symptoms of a panic attack, you might be able to help your friend if they have one.
It’s easy to feel afraid, helpless and angry when you’re confronted with a problem you know very little about and self-education is easy these days. Just remember: your friend is still the one who knows best about their own experiences!
4. Give them control
However much you think you know about what’s best for your friend, you still need to allow them to control their own life. Don’t – I repeat, do not! – pressurise them to face solutions or take actions that they might not be ready for. There are countless reasons people might not want to get help, ranging from fear of invalidation to previous abuse by professionals and people in authority. By all means have options at your fingertips and bring them up, but if they aren’t willing to ask for help, then back off. Similarly, avoid trying to force them to make promises about, say, not drinking or self-harming, or restricting food – unless this is something they want to do. We are people, who are capable of making our own decisions and it’s important that we’re allowed to do this.
N.B. If your friend is a danger to other people, you should absolutely make sure the situation is dealt with appropriately no matter what they say. The same applies if they’re a danger to themselves, but please reserve this for suicidality or severe self-harm, and even then be wary. People can be more damaged than helped sometimes.
5. Ask how you can help
It seems obvious, but it’s astonishing how often people don’t think of it. Ask us, when we’re more stable, what are the best things you can do for us at the bad times. Everyone’s different and everyone will say different things. Perhaps you can make a plan for the bad times: ‘I will come round and bring you pizza and ice cream, take you to your psychiatrist appointment, and tell you that I love you ten thousand times’. When we’re having a bad time, ask us again – the answer could be different.
Don’t be surprised, though, if we haven’t got an answer. Maybe no one’s asked us this before; maybe we’ve never thought about it. Maybe we feel so rubbish that we can’t come up with an answer. You can always ask again after an interval if we don’t come back to you, and if we never think of anything specific that’s ok too: you can still listen, validate and be there. Oh, and if we do come up with something, make sure you actually do it (assuming you can)!
6. Be available
This one’s pretty self-explanatory: be there; actually physically there. If we need to talk; if we need you to come round; if we need you to go to an appointment with us. I don’t, of course, mean to the exclusion of all else. Be available to the amount that you can be. And, importantly, let us know when and how you are available. If you only have time to talk at weekends, or won’t be around for the next fortnight, make sure we know this, and be available when you’ve said you will (barring unexpected events, of course!). Actual physical presence is often desperately important to mentally ill people so if you can pop in or meet up, do it. It will make a huge difference.
7. Be prepared to make the effort to stay in contact
When you’ve got a mental illness, keeping in contact can be horribly hard work. Mental illness is tiring, so we’ve got less energy for everything else. The shame and stigma around mental illness can make it feel easier to let a friendship drop rather than explain everything or pretend that we are fine. Mental illnesses can distort reality; we may feel as though people are only pretending to like us, or find us boring, or don’t want to have to make the extra effort to talk to us, or think we are pretending, or a hundred other things – and it doesn’t help that these things are often true. People with mental illnesses may have suffered bad treatment or abuse from those we thought were friends in the past, making us instinctively back off when things get bad. People with anxiety often find leaving the house, or using the phone, or starting a conversation via any medium incredibly difficult.
For me, the very few old friends I have left are the ones who have persisted in keeping in contact with me even when they have to wait six months for me to reply to an email, or they are the one who starts the instant messenger conversation every single time. I cannot express strongly enough how grateful I am to those people.
8. Keep your expectations realistic
Many people with mental illnesses have them for their entire lives, or experience remissions and returns of the illness. Lots have experienced trauma and other difficulties. Don’t expect your friend’s mental illness to vanish within a couple of years, or at all. If it does, that’s great – and if it doesn’t return that’s even better. But often it won’t go. It may improve; your friend may learn to cope, or medication could help, but this doesn’t mean they don’t still need your support. A lot of medications have unpleasant side-effects, especially anti-psychotics, and these can be really hard to cope with.
Remember, too, that getting better doesn’t necessarily mean no longer having a mental illness. It can mean things like learning to cope with situations and feelings, identifying triggers, devising work-arounds. Harm reduction can also be a useful technique: instead of expecting someone to stop self-harming (for example), perhaps you might help them learn to do it more safely. This all, of course, ties in with giving your friend the agency: if they aren’t ready to take a step, they aren’t ready.
9. Help them find help if they want it
Lots of people do want to get help but don’t know what steps to take, or are afraid, or just need some support. If your friend is in this situation, do what you can to help them. Find out what kind of help might be available. Accompany them to their appointments, or offer them a lift. Be willing to talk over treatment options in a non-judgemental, non-advisory way. Encourage them to go to their appointments, take their medication, or take any other action they have decided upon. It’s ok, too, to have resources at your fingertips for the future, even if your friend isn’t willing to take them up right now.
10. Take care of yourself
No matter how much you want to help other people, you are the most important person for you to look after – and not just because you won’t be able to help others so effectively if you don’t, but because you are important.
Self care is different for everyone. Learn to listen to your body and your mind; identify the things that boost your mood and make you feel supported, and make sure they happen as much as is within your power. Identify the things that make you feel worse, too. For example, perhaps you realise that listening to someone talking about their self-harm makes you feel really, really awful: it’s ok for you to say “I want to support you, but I find this particular thing is really detrimental to my own wellbeing, so while I am totally on board to talk about everything else, could we please avoid this subject.” Having boundaries is helpful for everybody.