How to Support Friends and Family Living with Mental Illness: A Guide

If you are reading this, congratulations! You are already on your way to potentially helping and supporting someone who is living with a mental illness. Below is a guide that has been divided into 4 sections that addresses what to do and what not to do and how you, as a friend or family member could help support someone starting from the beginning of a person’s recovery journey. Please note that I am not a mental health professional and these suggestions are based on research from organizations, academic institutions and my own experience. Everyone is different, so some of these tips are not applicable to every situation. This guide should not under any circumstances replace advice, evaluation and treatment by a qualified professional. For more information, resources have been linked below.

Note about medical professionals and treatment: sometimes experts don’t know what is best. It sometimes will take experimentation with different doctors, treatments, and medications. Although I do recommend that you book an appointment and/or see a qualified professional, if your friend/family member is unwilling to, I insist that their comfort and consent be the foremost priority and that you respect their decisions.

General tips

  1. Know the signs and symptoms. Identifying them earlier on can help alleviate tremendous suffering for the friend/family member and those around them. 
  2. If you are concerned about something, here are some conversation starters to understanding what is going on:
    1. “I’ve noticed that you’ve been ____. I’m worried about you so I was wondering if… 
      1. we could talk about what you are going through?”
      2. we could go see a doctor to make sure everything is ok?”
    2. “Hey, I noticed that you’ve been avoiding [insert action or location]. Can you share with me what caused the change?”
    3. “I wanted to check in with you because you have seemed pretty down lately.”
  3. If they do not want to talk to you, ask them if they are safe and how you can best support them and/or if there’s anything specific you could do to help. Let them know that you are here for them.
  4. If someone opens up to you about their experiences with mental illness/self-harm etc. do not panic nor judge them. How you react to what they say will impact how much they are willing to share and their decision to talk to you about it further in the future.
  5. Instead, listen.
    1. If they are uncomfortable talking at the moment and you recognize something is off, let them know that you are open to talking about it so that they may have the opportunity to share their thoughts and feelings. Assure them they can talk to you as much as or as little as they like whenever they are comfortable doing so.
    2. If they are comfortable, ask them what the feelings, thoughts or triggers to their condition are. Don’t pressure them into talking about something if they do not want to and understand that they might not tell you everything.
  6. If appropriate, encourage them to seek help. 
  7. Know your role. Your role is to help, not to cure them or treat them, so don’t attempt to go beyond the scope of your knowledge. Do not give medical advice unless you are a qualified healthcare provider.
  8. Research to better understand their condition if they mentioned one or if they are diagnosed with one. Doing so will help you get a better understanding of what to expect and how you can best support them. However, do NOT try to diagnose them or give them medical advice.
  9. Don’t argue, dismiss, question, belittle or criticize their feelings, and don’t compare their struggles to others. You cannot see a lot of what they are going through; accept the fact that you might never completely understand and that’s ok!
    1. Although sharing experiences can help, equating them doesn’t. 
  10. Focus on comforting and supporting their feelings and immediate needs.
  11. Don’t treat them differently! They are still the same person who is just battling a complex illness. Continue spending time together and keep doing the things you’d normally do together but as always, respect their decisions and boundaries.
    • Check in regularly! Even if they constantly decline or cancel plans or ghost your messages, still invite them or keep in contact anyways. Mental illness may make it very difficult to maintain a social life, but they really appreciate you for doing it regardless.
  12. Sometimes it may be very difficult to complete daily tasks and some may fear being seen as a burden. Offering to help or even helping out without being asked (within reason) would be much appreciated.
  13. “They’ve seemed to have relapsed. What should I do?”
    • Recovery is not linear. There will be good days and bad days and that’s ok! As someone who cares, you may be concerned, frustrated or hopeless when symptoms arise again. However, be patient and help them through that day. Understand that relapse does NOT erase recovery and progress.
  14. The tough love method is where one resorts to yelling, guilting, blaming, punishing or manipulating to inspire positive change. An example would be giving someone an ultimatum if they did not do their homework. However, this method is not efficient in helping someone with a mental illness and will not only backfire but potentially lead to further relapse. Therefore, despite your good intentions, refrain from doing the above-mentioned at all costs.
  15. If their condition is long-term but stable, accept their limitations and boundaries, and don’t shame/stigmatize them by telling them to become “normal”.
  16. Support doesn’t always have to be focused on the given mental illness. Spending time with them, going somewhere together etc. are also great ways to support someone.
  17. If possible, find or ask your healthcare provider, guidance counsellor, etc. to connect you to support programs, community groups and/or mental health organizations near you. With COVID-19, there may also be virtual support groups.
  18. Remind them that… (however only say these if you mean it)
    • They can get through this
    • You are proud of them. 
    • They matter to you!
    • They are not a burden.
    • They are so much more than their illness.
    • They are important to you.
    • You are here for them no matter what!
    • It is ok if they need some alone time.
    • They are so strong for fighting this everyday.
    • We are in this together.
    • *remind them of their strengths, positive traits, talents, accomplishments, etc.*
    • They have nothing to be ashamed of. 
    • There are brighter days ahead.
  19. Although it is important to normalize conversation surrounding mental health and mental illness, it is also important to avoid normalizing the use of medical terms pertaining to mental illness such as “OCD” or “depressed” to describe your daily life. In doing so, you minimize and dismiss the struggles of having a mental illness and can discourage someone from opening up about it.
  20. Take care of yourself as well! Be sure to check in with yourself on your mental, emotional and physical health to ensure that you do not fall into the trap of burnout. Set boundaries for yourself, practice self-care, and keep up with healthy habits.
  21. Resources:

Understanding mental illness

Eating Disorders (EDs)

  1. Know the signs and symptoms. Those who have eating disorders often have symptoms that develop over a period of time, and it is important to identify them as soon as possible for the best chance of recovery without lasting health consequences. Here are some of the lesser known ones that are not listed in the guide:
    • Appearance of thin light-coloured hairs across body
    • Sudden obsession with cooking, food, nutrition, exercising
    • Acne breakouts and other skin problems
    • Frequent feelings of bloating
      1. For a comprehensive list, please see this guide on how to discuss your concerns with your primary care provider. Identifying the symptoms and even giving your doctor this after completion will help them come up with the best possible plan of action. Feel free to add other signs that you are concerned about that may not be mentioned here.
      2. Another thing to note is that there is a spectrum of eating disorders and that sometimes someone may exhibit symptoms from several different EDs. It is also possible that it might not even be an eating disorder, but instead another health problem. Regardless, the next step you should take is the same.
  2. Take the first steps to starting a conversation by saying what you see and showing that you care. 
    1. Reference the general tips for more info 
  3. Talk to them about seeing a doctor and offer to book them an appointment (eg. family physician, pediatrician, psychiatrist, therapist, a specialist etc.). There are also free clinics available if they wish to see someone who is not their primary care provider. 
    • Inform the doctor beforehand of your concerns if you are booking an appointment.
    • Be sure to prepare a list of questions to ask and offer to accompany them, but let them choose what they are comfortable with.
    • Possible questions to ask:
      1. What should we do about this symptom?
      2. What should they eat? What should be cooked? What snacks to get? 
      3. Do they need any supplements?
      4. What are the next steps?
      5. How can we support them?
  4. What to expect at/after the doctor’s appointment? Your doctor will provide you with information on how to address the ED. They may also refer you to specialists/ED programs, have you buy certain supplements, and/or go for lab testing. You may also want to book your next appointment.
    • If asked to go for lab testing, ask which labs your doctor works with, if there are any food restrictions before or after testing, what to bring etc.
      1. Offer to accompany them through the lab testings as emotional support.
    • Try to follow the doctor’s instructions ASAP. The sooner you do so, the sooner they can start the recovery process.
  5. Arguing with them on what they should eat, telling them what might happen if they don’t do something, or threatening them are all counterproductive.
  6. Allow them to take part in the meal planning process and buy/make foods that they like!
  7. Be mindful of triggers. Avoid making comments on food, weight or dieting.
  8. Resources

Anxiety

  1. Get a better understanding of the spectrum of anxiety disorders. For more information, see Anxiety Canada and read more on anxiety disorders that primarily affect children and teens.
  2. Get a better understanding of how they want to be supported by not only having the difficult conversation, but also by taking note of triggers, habits/patterns on how they express their anxiety as well as what works best in a particular situation. Also, developing an understanding of their boundaries and what they are comfortable with is really important.
  3. Don’t force them to do something they are not comfortable with. Encourage them to talk it out with a psychiatrist or therapist to work on conquering their fears.
  4. If they are afraid of doing something, don’t do it for them but at the same time, don’t eliminate it. By taking over, you are inadvertently preventing them to overcome what they are avoiding and allowing the anxiety to further limit their capabilities. Instead, let them make their own decisions and provide reassurance. Be sure to emphasize their ability to cope with the given situation, rather than telling them that their fears will pass.
  5. Those with anxiety naturally deviate towards thinking about the worst case scenario. You can help them reframe their perspective by asking the following questions:
    1. What’s the worst that could happen?
    2. What’s the best that could happen?
    3. What’s the most realistic or likely thing that could happen?
  6. When anxious or overwhelmed, it is really difficult to word one’s thoughts/feelings so please be patient especially when they struggle to communicate what is going on or can’t seem to let go and live in the moment. In addition, don’t take things personally if they cancel plans or are irritable.
  7. If appropriate, share your plans with them and avoid last minute changes. Predictability and certainty will help them know what to expect and be more at ease.
  8. Although you have good intentions, telling them to try meditation or yoga is not really helpful. Anxiety is so much more complex than managing day-to-day stress so refrain from giving advice of that sort.
  9. Know what an anxiety attack looks like (this will vary from person to person):
    1. Shortness of breath, hyperventilation
    2. Shutting themselves out from everyone else, detachment from surroundings
    3. Trembling, shaking
    4. Nausea, stomach pains
  10. If having an anxiety attack:
    1. Don’t assume what they need. Ask instead.
    2. Stay with the person and remain calm.
    3. Use short concise sentences when communicating with them. 
  11. Resources

Depression

  1. Don’t jump to problem solving or to cheering them up. Although you have good intentions, it may come across as a dismissal of their feelings and struggles. Instead, acknowledge how difficult and painful it can be and be empathetic.
  2. Don’t minimize or compare their pain/struggles.
  3. Be patient. Recovery may require trial and error with different treatment options, doctors etc. and even successful treatment doesn’t make depression go away completely. Therefore setting unrealistic expectations will end up hurting both of you.
  4. Check in on them regularly and let them know that you are here for them if they ever want to talk.
  5. Empower them by reminding them that they can overcome it! See 9-12 and 16 in General Tips for things to do or not to do and for reminders. 
  6. Help with everyday tasks or offer to work on something together such as an assignment or some homework.
  7. Don’t take a stance on their treatment option (especially on medication). For some, medication may not be effective or may cause adverse side effects while for others, it might be tremendously helpful. In the end, it is their decision so respect what they choose. If they do choose to take medication or any other treatment option, do some research into it and/or remind them to stick with their treatment. If they feel it is ineffective, encourage them to talk to the health care provider and find an alternative option.
  8. Don’t take things personally if they become withdrawn, angry or uninterested. Recognize that you are frustrated with the illness and not with them.
  9. If they are at an immediate risk of suicide, don’t leave them alone. Ensure that they cannot access anything that may put them in danger, communicate your concerns with them and/or seek professional help.
  10. Resources:

Recovery from mental illness consists of a difficult journey of ups, downs, detours, and new routes, yet it is possible to live well. Providing support for someone is important, but with everything said, it is essential that you look after yourself as well. It may feel overwhelming, scary and frustrating at times, but everything will be ok. Thanks for reading!

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