How can I help my friend?

September 27, 2012 3:36 PM

My friend is in a very bad way. She's had a painful breakup, and she has a long-term chronic illness that's tough to deal with. She's housebound, isolated, very unhappy and says she's thinking of suicide. What, if anything, can I do to help?

(To pre-empt the obvious - yes, I know to call an ambulance if she talks about planning suicide.)

I'm really, really worried about her, and I don't know what to do.

The breakup was a few weeks ago. It was a long-term relationship, and while it wasn't particularly acrimonious, it's obviously very painful. She's now living alone, which also makes things tougher. Most of her friends live some distance away (me included), her family aren't in the picture, and she isn't able to leave her house very much due to her illness. She is not able to work or study.

The illness itself is of long duration and has a lot of varied symptoms. She has fatigue, pain, and problems with concentration and vision/hearing among other things. She has a good doctor now and she has a diagnosis, but she's had a very hard time with the medical establishment, something that continues today with medical professionals accusing her of faking her symptoms, not taking her seriously and so on. She has a very antagonistic relationship with the medical profession in general, and finds hospitals and so on very stressful to the point of being traumatic. (Her current doctor has also suggested that some of her symptoms may be psychological in origin. I'm not remotely qualified to comment on that, but I am 100% sure that her symptoms are real and that she is very definitely ill, and certainly being under a lot of psychological stress like a breakup is going to make things worse.)

Since the breakup many of her symptoms have worsened. Without her partner there to do some of the practical and emotional support work, she is reliant on home carers and benefits - the benefits aren't enough (she is applying for more but the procedure is lengthy and stressful), and the home carers only visit several times a week, which seems to be far less than she needs. She says she is not eating, that she does not have the energy to cook properly and does not have the concentration to make sandwiches or eat snacks/cereal/microwave things, and is losing weight as a result. She says she is getting weaker and that she worries she will not be able to walk around her house without collapsing. She says she has times when she literally does not have the energy to turn over in bed.

She does have some forms of support. Her doctor is good, as mentioned above, and she has access to a phone counselling service she says is good, and to other support phone lines, which she says she has found useful for dealing with specific symptom-related things. I phone her to chat and talk to her online, as do other friends, and those times she seems ok - sad about the breakup, of course, but managing all right given her miserable situation. But then something else will happen - the other day she had an unexpected assessment visit from social services which ended with her calling the police, collapsing, getting taken to hospital by the police, having convulsions in the hospital and then getting accused of faking it by nurses - and she posts these awful painful messages on Facebook and so on, and it just seems like an avalanche of awfulness.

Tonight her ex phoned me because she'd called him, upset, saying she couldn't eat and couldn't take care of herself and was getting weaker and kept thinking about suicide. (He'd called the appropriate medical services before me - he was calling me because he knew I was going to visit her in the next few days.) I've spoken to her briefly tonight - I don't think she's in hospital - and she's not sure if she'll be up to a visit, but will try.

I just, I'm so worried for her. Things just seem to be getting worse and worse for her. Really she needs more practical support, but this doesn't seem available - social services won't visit her to cook for her multiple times a day, and she turned down some sort of crisis care deal they offered because she doesn't want strangers bathing her etc. (which I totally understand, but 'not bathing ever' doesn't seem like a great alternative). It really seems that she can't cope with living alone without support, but she sees any alternative to that as a sign that she'll never get better and will end up in a nursing home.

She has already done all the Googling you can possibly think of about what social services can provide, what kind of treatment is available to her, what her benefits situation is, and so on. She is well informed about her illness and her options. But I think she's just so wrapped up in misery at the moment that she can't see anything but despair, and then things get worse and worse. She is such a warm, kind, wonderful person, and she deserves so much better than this.

I would not be asking this, and sharing her details like this, unless I was really genuinely very worried about her and totally at a loss as to what to do to help her. I can see that she needs help beyond what she's getting, but I don't know what she needs or what the best way is to help her get it, and I am very, very worried that she will do something to harm herself. Is there anything I can do?

(If it is relevant, we are in the UK.)

posted by Catseye to health & fitness (8 answers total)

If you were in the US, I'd recommend a 72 hour psyche hold. Do you have something equivalent in the UK?

Also, is her physical condition such that she could be admitted to the hospital?

Unless you want to go, cook and care for her until she's in a better frame of mind (and being hungry, dehydrated, depressed and sick can account for the dispair she's imparting) she's in danger of doing harm to herself.

I know she doesn't like the hospital, but at this point, there's not really a choice.

You can't accomodate every problem that she has, she's going to have to cowboy up and go to the hosptial. There's nothing for it.
posted by Ruthless Bunny at 3:42 PM on September 27, 2012 [1 favorite]

You could help her understand that her illness and symptoms can be primarily physical in origin, AND that she may need emergency psychiatric health at this point.
posted by availablelight at 4:47 PM on September 27, 2012 [1 favorite]

What is your situation like? Would it be possible for her to visit you for a week or two, and get some of the support she needs? (If you feel up to it and feel that she wouldn't just be a leech.)
posted by ethidda at 5:06 PM on September 27, 2012

There should be things you can do to help with the food situation, which looks like the top priority item. Can you send her some reasonably healthy food that can be eaten right out of the package -- nuts? dried fruit? single-serve cereal in plastic bowls, with UHT milk? Even if it's just good candy, it might lift her spirits and give her some calories for energy. Can you find a local service or charity that would deliver some meals?


Perhaps you could send your friend a note in the mail every day for a little while, reminding her that these things are true (they are hard to see sometimes, but they are true):

1. The pain of the breakup WILL diminish over time. Living alone with a chronic illness is damn hard, but it's easier (and more pleasant) than living with a chronic illness AND a partner who makes things worse, which many do.

2. Now that she has a diagnosis and a good doctor, there is good reason to hope that her medical condition will improve, at least in some ways. Medicines and treatments that help, at least a bit, will be found.

3. As time passes, your friend will develop the strategies and skills she needs for living with her illness, and will learn about the resources that are available to help. It takes time to get them lined up, but it IS possible, and then things begin to get better.

4. Being sick, and needing help, does not in any way diminish her value as a person. It's not a reflection of any sort of failure. Asking and allowing other people to help is not an imposition. People love to help other people -- it makes them feel good.

Which all adds up to: Things will get easier with the passage of time; sometimes the best you can do is allow time to pass, and do its healing work.


And, is there anything at all your friend could do for you? listen to your problems? give you some advice? loan you a book? recommend a movie she liked? I've been in the position of feeling sick, helpless, worthless and hopeless, and nothing snaps me out of it like doing some little thing (tiny!) that helps someone else. Give her that chance if you can find a way that isn't too contrived.
posted by Corvid at 7:39 PM on September 27, 2012

This sounds like a terrible situation for you. I know a bit about what social services can provide, but it sounds like your friend is also knowledgeable about that so I don't want to make suggestions she's probably considered.

The visit that resulted in her calling the police and then collapsing sounds absolutely awful and as if she may not be able to think clearly about what's going on. Of course social workers do out of line things sometimes, but if she felt their actions justified calling the police, either she has an outrageously bad SW (not impossible of course) or she and social services have become oppositional to the point where they can't talk constructively with each other about assessments or plans.

Some things that occur to me that may be worth investigating:

1. An advocate - something like The Advocacy Project. I realise that one's probably not local to her, but Googling advocacy and her area should find something. Sounds like she needs someone to help her represent her needs to health and social services - to help her get more frequent visits from home carers, for instance. You could also think about offering to be with her at any further assessments or planning meetings - though do be careful about your own needs and how much you can afford to get involved (for instance, what would you do if you and she disagreed about your perception of a meeting or the value of the services she's being offered?).

2. Complaining to Social Services and Health. My experience is that people who complain get better services. The visit you describe should not have escalated in the way it did and it sounds like a complaint would be justified. She could for instance request a change of SW. Nurses should not be saying she's faking fits, and again a complaint would be justified, though I guess I feel maybe less useful in this case - she still has to work with SS so if they can learn from her complaint that would be helpful, whilst it sounds like the nurse thing may have been a random A&E situation that may not happen again. Having said that, I've known people get obsessed with complaints after making them - you'll know best whether this is something of which she might be at risk.

3. Counselling. I see that she is receiving telephone counselling. Do you think this is helping enough, or could you suggest that she investigates whether there are local charities that provide face to face counselling? I see too that getting out of the house to couselling might be difficult.

4. Your mention of her having convulsions in the hospital makes me wonder whether she has anxiety-induced fits (psychogenic non-epileptic seizures). If so, that may be worth investigating with her GP - apologies if the fits are part of her already-disagnosed condition. IANAD.

5. If she is depressed to the point of being in crisis but cannot face hospital, there may be a home treatment mental health team / intensive intervention team in her area. It's not clear from your message whether she's receiving any kind of mental health service - though I imagine she will have been offered one following her ex-partner's report to health services. Worth checking with her that she knows it's not necessarily a case of having to go into hospital to receive support. You don't say that she is on anti-depressants - again, I imagine this will be discussed with her following her ex-partner's contact with health.

Having made these rather minor suggestions - it does seem to me that there may not be much you can do apart from keeping in touch and listening to her pain when she's in a bad state. Others are right when they say things should improve as she gets over the breakup. Pain-filled messages on FB are very hard to bear, but presumably they make her feel better (she's putting some of the pain on to you by writing them).

I guess I also don't see in your message what she thinks about her situation. You say that most of the time she says she's managing ok and that she's well-informed about what her treatment options are. Are you able to talk to her about your concern? What does she say?

Finally, do look after yourself - this sounds so hard for you.
posted by paduasoy at 12:23 PM on September 28, 2012

I'm female, over 50, and have some similar-sounding medical issues. It's my experience and there is research that older women are often dismissed by the medical establishment. Nobody knows if chronic pain/fatigue causes the depression or if depression causes the pain/fatigue, but the depression, pain and fatigue are real, and absolutely deserve proper treatment. So you can listen to her complaints and support that as a concept. However, that won't fix her illness. She is probably advised to get exercise, and may not be. She should get decent nutrition. She should maximize caregiver time to keep herself and her home clean, have a schedule for medication and an exercise plan, and have good food available.

You can call her frequently. When a friend was badly depressed, I called her daily on my drive to work. 10 minutes - the part of the drive that was on a back road - and then I got off the phone. It helped her get moving in the morning. If another friend can call her, maybe on 'no-carer' days at lunchtime, and they could both eat a sandwich, talk about stuff, and then get back to their day.

The ex sounds pretty decent. If he can stop by once a week with a hot meal, or help do any lifting, or whatever, that would be great. If he does it the same day/time, it's more likely to be friendly that raise any hope of reunion. If she has a church affiliation, she could probably get some help and/or meals and some company.

Reassure her that you love/value her, and want her to be in this world, and would miss her terribly. Ask how you can help, and help in ways you can, and tell her you can't help in the ways you can't. Remind her to play music, get outside for a little sunshine and fresh air, and to do any tasks the doctor has set (stretching, hot bath, etc.).

I'll be honest, the "I can't/won't go to the hospital", and suicidal talk does sound like there may be some manipulation involved. It's healthy to help, but not to be manipulated. If she's suicidal, be open about your response, and if you need to call emergency services, don't hesitate. she's lucky to have loving friends like you.
posted by theora55 at 12:50 PM on September 28, 2012 [1 favorite]

Just a caution: please don't assume that your friend's resistance to going to hospital, or to use emergency services, is indicative of manipulation, or any other psychological strategy. It may be a very smart, and life-preserving, response for her in her particular circumstances.

This may be more true in the US than in the UK, but my experience living with a strange chronic illness has been that the very last thing I should do when I'm needing help is to go to the hospital. Hospital emergency services are good at dealing with broken bones, heart attacks, and strokes. Even when good intentions and honest efforts are made, hospitals are often quite dismal at handling the manifestations of chronic illness, especially if it's an illness that's not well understood.

It may be that your friend, who is apparently smart and well informed, has learned from experience that a visit to the hospital can do way more harm than good. Any time that a suffering person goes to someone and expresses or demonstrates a need for help, and their suffering is dismissed as not real or not important, serious harm has been done. This risk of harm is present in every interaction with a new potential "helper" who doesn't know the full context of the complaint. So unless your friend's condition is medically dire, her judgment about where to seek help (and where not) are worth respecting.

And, seeking help from religious groups is worth considering even if she has no affiliation. Some groups proselytize, or help only their own community, but there are many who genuinely just want to help anybody who needs help.
posted by Corvid at 2:06 PM on September 28, 2012

Thank you all, so much.

I visited her for a few hours today. Her ex ended up taking her to the hospital last night, but he was only there for a few hours and they were happy to let her go home, after setting up some in-home psychiatric services for her. (There is a waiting list for this; I'm not sure what's been arranged in the meantime, but something seems to have been). She says the hospital visit went okay and she seems glad about the psychiatric help, which is good.

I've offered some practical help re: going with her to medical appointments, and making some support-arranging phone calls whenever that's useful for her. (I don't think staying with me would be an option - she needs more peace and quiet than is available here, and isn't really up to travelling.) She says she has food in stock, but doesn't have much of an appetite at the moment (understandably) - she's trying to get enough to eat though. As of today there is the possibility of getting more support work hours in the future which would be good.

It was also good to speak to her about things other than her current awful situation, and share jokes about bad TV and so on. I've made it clear to her that I'm around to talk whenever she needs me, but it's good to know that she also wants to talk about things that make her laugh as well as discussing what she's going through now. I hope she'll be okay.
posted by Catseye at 2:33 PM on September 28, 2012