When someone you love is struggling with a mental illness, it can be hard to know what to say or do. All you want to do is take away the pain.

Every situation is different but there are a few things you can do to help no matter what the situation:

1. Voice your support and concern

Bringing up your concern and willingness to support someone who has let you know that they are struggling with a mental illness is important. It will not make them worse. When you show your concern by noting the things that you find worrying, be sure to check that you are communicating compassion and not judgement. For example.

“I’m worried about you, you haven’t been out of the house in a long time. That’s not like you.” versus “Why don’t you ever go out. Of course you aren’t going to feel good if you spend all day in the house.”

See Advice about Giving Advice – 8 tips

2. Do some research on the illness

Don’t assume that depression just means sad or that anxiety just means worrying too much. There is a lot more to it and many aspects of each of these disorders that you may have considered. See Depression Vs Grief – When You’re Down, A Good Time to Panic and Borderline Personality Disorder (BPD) – The New Hysteria.

For more information on mental illnesses check out Check out the Canadian Mental Health Association. Also check out Manitoba Schizophrenia Society, Eating Disorders Manitoba, Anxiety Disorders Association of Manitoba and Mood Disorders Association of Manitoba.

For Mental Health Resources in Winnipeg check out MH Resources Wpg.

3. Let others decide for themselves about medication

You can offer support for an individuals choice and ideas for consideration but ultimately, they need to weight the pros and cons of medication for their own lives and bodies. If they don’t know what to do, you might check out my post See Mental Health & Medication and suggest it to them.

4. Responding to threats of self harm, suicide or homicide

Never assume that a threat of self harm, suicide or homicide is an empty threat. All threats must be taken seriously.  Some people speak about these kinds of threats as possibly being “Just a cry for attention.” That they may very well be, but people have killed themselves and some have killed others in an attempt to get the attention they needed. They may have needed medical attention or the emotional attentiveness of friends and family or the attention of a mental health professional.

Needing attention is a justifiable need. 

No one can know the intention of the person making the threat. Sometimes the individual may not intend to carry it out but may do so accidentally or impulsively. I repeat, all threats must be taken seriously and outside help engaged. 

If this happens repeatedly, it can be tempting to ignore it. This is not advisable. Someone who is making this threat needs to know that if they are threatening to harm themselves or other, then, they will require professional evaluation.* 

Also check out How to Reduce Suicides – A Guide for Everyone.

5. Be honest about your boundaries and limitations

No one person can be all that another person needs. If the person struggling states that they can only talk to you and no one else understands, agreeing to be their only support will not benefit either of you. You will not be able to be there 24/7, you will not have all the energy, expertise or availability to be able to do this.

It takes a village to support someone in need.

You do not need to feel guilty about setting boundaries on your time, or on the types of support you are able/willing to give. You might be a able to provide practical help such as childcare, rides, helping with household chores. You might bring groceries or provide financial help You might be able to offer emotional support through texting, visits, or going for walks. You might be able to provide information based on your own area of expertise or connections. You do not have to do it all, all of the time. You will need to talk about back up plans for when you are not available. You do not have to be responsible for making back up plans, but may need to advise that your loved one be prepared for the fact that you will not always be available. 

See also Where Do I Draw the Line?

6. Check your own biases about mental illness

Consider the question of recovery. Many people talk about having had depression and no longer having it. I’ve not yet heard anyone talk about having had schizophrenia and no longer having it. I have, however, met individuals who spoke about their past struggles with things like audio hallucinations and paranoia, who no longer struggle with this, due to medication and/or talk therapy. They are no longer struggling with their mental illness, they are simply living with it. All symptoms which are classified as mental illness can be experienced in various intensities and may vary over time. means

 You cannot make assumptions about another person’s mental health, based on a one time diagnosis or experience of illness.

Check out Mental Illness – A Relationship Story.

7. Consider levels of insight/judgement

This is a tricky area. If an individual is exhibiting specific symptoms of a particular type of mental illness and is minimizing or ignoring them, there are several possibilities: 

• You may be reading the situation differently than them. They may be more likely to know the context of their situation which may justify their behaviours and symptoms in ways that you are not aware of.
• Their symptoms are preventing them from seeing the seriousness of their situation. For example, in BiPolar 1, a person experiencing mania, which may include being awake for several days, engaging in uncharacteristically risky behaviors, such as spending a lot of money, driving very fast, having grandiose ideas about their own abilities or importance, may not see these things as problematic, as they may be experiencing a euphoric feeling that they can do anything.* In these cases, if they are putting themselves and others at risk in uncharacteristic ways, they may be experiencing impaired judgement due to their illness.

*Note: this euphoric feeling does not accompany all manic episodes.

• When an individual is experiencing heightened paranoia, as in the case of some forms of schizophrenia it may be difficult for that individual to imagine that their fears are unfounded and that behaviours such as not eating due to fear of contamination of their food (for example) will cause them more harm than the imagined contamination.
• When someone is  experiencing a depressive episode with suicidal thoughts, they may be convinced that others will be better off with out them. 

Whatever the situation, if an individual is at risk of harming themselves or others, do your best to convince them to see a doctor.

Simply disagreeing and arguing about their perspective will not likely lead to a good outcome.

You don’t have to agree and you can make them aware of your perspective, but they need to know that you are on their side and that you will not reject them if they don’t agree with you. If they are willing to see a doctor, or talk to a professional, even if it’s only to help you fell better, you might ask if you can accompany them, and, if they are willing to have you in the room for the appointment, to see what recommendations are made that you might be able to support them in following through on. If they do not want you along, you may call the doctor or leave a message regarding you concerns as collateral for the health care professional to take into consideration in their assessment of the individual. 

NOTE: if the person is over 18 you will not be given information about their condition, treatment or any recommendations given, without the consent of the individual.

If your loved one is exhibiting some of the above characteristics, is not showing insight into their condition and is not willing to access medical or mental health treatment, you can of course call 911 if they are immediate risk to harm themselves or others, or call Manitoba Crisis Services if you are unsure of the level of risk.

Police or crisis services may recommend that you consider filling out a Form 1 at the Law Courts (York St) in Winnipeg, depending on the situation. This form asks you to indicates the symptoms you’ve observed, how recently you’ve seen this person (it must be very recent). Indication that they have refused a medical examination and that there is imminant risk of harm to themselves or others if they do not receive a medical examination urgently. For more information about this see Manitoba Mental Health Act.

This is a very extreme measure and a difficult one to make, as a friend or family member as it involves removing the freedom to choose to seek medical/mental health treatment. There is much controversy about this part of our mental health system. The laws are strict about this for a reason and that is to protect the freedom of individuals until it puts themselves or others at risk of harm. 

Not all concerned individuals are able to get help for their loved ones for a variety of reasons. Sometimes I talk to parents of adult children who are distressed about their children’s condition and want intervention. The law permits intervention only when an individual is at immediate risk of harm to themselves or others.

For example, no one can legally stop an adult from using drugs if they chose to do so. Adults are allowed to make mistakes.

8. Remember,you are not in control of the outcome

You can contribute to a good outcome with your support, by promoting resources and by expression hope and love, but you need to know that you cannot control the outcome of a situation involving another person’s illness. There are too many variables at play. Humans do not live in laboratories. One regrettable comment or action on your part will not be the deciding factor on whether someone recovers or not, in the same way that a kind word will not be the only factor contributing whether someone recovers or not. 

We have power to act and and to influenced but we do not have all the power. 

9. Care for Yourself

There are limits to what you can do and what the system can do, but there may be more resources than you are aware of. You can benefit from supports for yourself and may find that you gain more insight into your role as a loving friend or family member and better tools to support them. Talk to a counsellor. Take some time away. Check out What do You Really Need? – A 6 Step Complete Self-Care Assessment Guide.