Mental Health issues

January 18, 2006 7:32 PM

A friend of mine is having mental health issues. How can I best help them?

It seems to me that a friend of me is having some serious mental health issues, including paranoia and obsessive behaviour. They're having trouble trusting people and are relying on me for advice and assistance.

I've been trying to help them understand that their concerns are not based in reality. I don't have much confidence this will work at this point.

Is it worth continuing this line? If not, what can I do to help them?

posted by anonymous to health (7 comments total)

Gently but firmly encourage them to see a doctor. Gently, because you don't want them to start thinking you're one of the people who's out to get them, but firmly because it sounds like it's really, really necessary. From your brief description, it doesn't seem like they're going to get better with just encouragement and support from you.

Do your best to be there for your friend, but keep in mind that you can't be your friend's therapist. You don't want to get so bogged down in other people's issues that you neglect your own life.
posted by Gator at 7:56 PM on January 18, 2006

Do your best to get them to see a doc but don't be hard on yourself if he or she refuses.

Sometimes when my issues are flaring up I go thru something similar and use my trusted friends as a sounding board, but I have to tell you that it's hard to comprehend that your own brain is lying to you.

It's tough. At the very least keep doing what you are doing-it won't hurt and very well may help in the long run.
posted by konolia at 8:10 PM on January 18, 2006

Don't be argumentative with them. You can be comforting without validating their paranoia. "I'm doing my best to understand what you're feeling. It must be scary to have these thoughts. I'd like to help you feel better - I have a list of counselors in your area and I think you might really benefit from talking to a professional who can better help you manage your situation."
posted by Saucy Intruder at 8:10 PM on January 18, 2006

I'll echo Saucy Intruder, to some extent. Compassion is the way to go, and avoid arguments. Keep the conversation focused on their needs and feelings, not their actions and your worries. Internal stimuli can be extraordinarily frightening, and though the person very likely wants the disturbing thoughts to go away, their mind won't let them trust others to help them. The person is likely not worried about the consequences of not getting treatment, but rather about what's going on at the moment. Your goal shouldn't simply be to get the person help so that things don't go worse in the future; it should be to relieve the suffering that currently exists. And never forget that what a person's mind experiences is completely real to them.

This is a small point, but one thing I would recommend--particularly if your conversation starts to get tense--is to avoid phrases like "I think" (but at the same time don't become accusatory). They can refocus the conversation on you. At least, that's what my training says. Going back to the previous point, don't say things like "I think that you've been acting strangely, and I'm worried that things might not be going well," but rather something like, "You seem to be scared these days. Can you think of any ways we can help you to not be afraid?"
posted by dsword at 8:38 PM on January 18, 2006

Having been in several similar situations myself, I have to say that one thing you should not do is allow your friend to continue using you as his/her sole support outlet, especially if you have your own issues to deal with/other pressing concerns. Though you clearly care about your friend, one of the best things you can do for him/her is to make sure s/he gets outside assistance to work through these issues. Gently attempting to convince him/her to seek treatment, perhaps using yourself as an example if you've ever been through a similar period and sought treatment, is the way to go here.
posted by limeonaire at 10:29 PM on January 18, 2006

IANAD, but I care for a mentally ill relative. What advice I can offer is pertinent to most areas of the U.S., insofar as I am familiar with the legal and health care systems here.

Your actions should be guided by the severity of your friend's condition, but it is often difficult for lay persons to make an accurate assessment of mental illness. And it is also possible that your friend's problems are caused by, or exacerbated by, other issues of which you may not be aware, such as drug use, or situational sleep disturbance. (Many people suffering mental problems attempt to self-medicate with alcohol or street drugs in an attempt to alleviate their symptoms, which can complicate the underlying problem they are trying to relieve.) That said, if your friend is still responsive to you in conversation, and can be persuaded to seek help, I agree with the approaches previously suggested by others here. It may help if you offer to go with them to an evaluation facility, even an ER, particularly if they are fearful. The sooner, the better for your friend.

But if you have recently become concerned enough to post this question, perhaps you have seen some significant short term changes which alarm you. In that case, your friend may already be at a point beyond being able to cooperate in getting treatment, even with your help. In that situation, you need to determine if your friend is in a state which could be considered "a danger to himself/herself or others," or is experiencing hallucinations, hearing voices, or having compulsive ideations, particularly with a religious focus. You can ask them about their thoughts and fears, and if they are having any thoughts of hurting themselves or others. If they express such things to you, and you feel this is true, you have, at least here in the U.S., a basis for calling the authorities on behalf of your friend, and relating the answers your friend has given which provide the basis of your concern. Generally, that would trigger a visit by the police, or social workers, either of whom could ask a few questions. If they determine that your friend is having hallucinations, or is expressing suicidal or homicidal threats, they have a basis for taking your friend into protective custody, and escorting them to an evaluation facility. That usually results in a 24 to 48 hour observation period, and an interview with a psychiatrist.

If the condition is obvious, a further period of hospitalization may result, while medications are administered. Or, your friend might be released immediately with prescriptions, and a referral to outpatient treatment, depending on the severity of the symptoms, and the jurisdiction in which this occurs.

It is a big step to make such a call. But if you don't, and your friend can't, there is a statistically significant chance that without treatment more serious outcomes can occur. In the worst case, the rate of suicide for people experiencing schizophrenic symptoms, or psychotic episodes is more than 10 times that of the general populace, and the rate of significant self-injury is higher yet, from failed suicide attempts, or violent interactions with others, whom they mistakenly believe they are protecting from their imagined fears. Yet, even knowing this, you may be very reluctant still to involve the authorities, not knowing if you really have a full understanding of the situation, or if you believe that "turning in" your friend might expose them to legal problems related to drugs, etc. And it is understandable that you might feel that doing this is likely to make your friend cut you off, which would further alienate them from help at a time they most need your friendship and support.

Ultimately, it is a judgement call on your part. It's not an easy situation, and with the bare minimum of information you've given us, I don't presume to advise you how best to proceed. But remaining in contact with your friend, and perhaps making contact with the police and mental health facilities in your area, to ask for guidelines and procedures, as you see what happens in the next few days, could help you prepare to make whatever decision you feel will be appropriate. It is common that people having psychotic episodes, or active auditory or visual hallucinations show marked deteroration in short periods, due to sleep disturbance. If you see sudden changes such as a lack of personal hygiene, attention to housekeeping, muttering, marked change of appetite or food preference, or facial or body movements that are repetitive and/or seemingly involuntary, it may help to make written notes of what you observe, so that you can accurately relate what you've seen to professionals.

That you are seeking advice, even here, and not turning away from your troubled friend is commendable. So many find it far easier to distance themselves from mental illness than to remain involved with those who suffer from it, and I hope you will resolve to continue to try and help your friend, as best you can.
posted by paulsc at 2:04 AM on January 19, 2006

Ditto to everything paulsc said. The trouble with paranoia is that it makes people to unlikely to trust authority figures like doctors, which makes it difficult to get them help. Having someone committed involuntarily is a very difficult thing to do (on a personal level, not a practical one). Do anything you can get them help before it gets to that point. If they are having trouble sleeping, for example, try to get them to see a doctor about that. Any pretext that works. If your friends behavior is as bad as you describe it, a doctor should notice it and steer your friend towards treatment.
posted by Lazlo Hollyfeld at 6:51 AM on January 19, 2006