How to help a friend with mental health problems

March 20, 2007 5:45 AM

How can I help a friend with mental illness?

I have a friend who has been struggling with mental health issues since his mid-20s. He was originally diagnosed as manic depressive, hospitalized for a time, and had been doing better for a couple of years. Late last year, he started sending out long, rambling emails to his entire address book about the Dalai Lama. On the phone, he talks a mile a minute and often sounds paranoid and delusional. His current diagnosis is bipolar disorder, but I doubt he’s taking medication. I saw him about a month ago and he definitely seems crazy- living out of his car, wearing tons of layers of clothing, doing strange things like taking off his shoes and rubbing lotion on his feet in the middle of a restaurant. I’m worried that his situation will go from bad to worse (a cop pulled a gun on him last week). But what can I do? Some mutual friends have tried to talk to him and convince him to seek help, to no avail. His former roommates tried to get him committed, and that definitely did not go over well. I’ve thought about contacting his family, but I don’t want to stress them out more than they already are. For now, I’m just trying to be supportive and express my concern in a “hey man, everything OK?” way, rather than in a “You need help! Why aren’t you taking your meds?” way. I know that there probably isn’t much I can do, but I would appreciate advice from anyone who has dealt with mental illness themselves or in their friends or family.

posted by anonymous to human relations (16 comments total)

I'm certainly no expert in this area and haven't been through this sort of thing myself, but my gut feel would be that, as you say, there is not much you can do beyond being there for him if he needs it.

He's going to have to want to help himself and trying to force a solution on him is just going to cause resentment and more problems.

Is there a mental health charity where you are that you could talk to about your friend? They might be able to offer some more constructive advice.
posted by jontyjago at 6:02 AM on March 20, 2007

If someone is this far gone, I don't know how you could not contact his family.
posted by sneakin at 6:06 AM on March 20, 2007

You don't say where you are. There may be a provision for community emergency petitions for psychiatric evaluation where you live. You could call a local mental health clinic and ask, or 311.

I would contact his family. They may be stressed out but are likely to be more stressed out if he gets shot. They may have greater access to compelling care, or at least evaluation, than you do.

Neither option is likely to protect your friendship, but it seems, from your description, more important to protect your friend.

There is nothing you can do on your own in this case, as you describe it. His diagnosis matters not at all, his behavior clearly indicates severe mental distress which it's the province of a professional to treat.
posted by OmieWise at 6:06 AM on March 20, 2007

I’ve thought about contacting his family, but I don’t want to stress them out more than they already are.

Stress them out. You need to contact them. He needs to get help whether it's by choice or not. His family will have the best chance of being able to force him into care.

I know you want to be the supportive friend, but in this case, to really help your friend, you are going to have to go beyond his wishes to do what's best for him.

Good luck...I am really sorry you have to deal with this. I hope he can get the help he needs.
posted by tastybrains at 6:15 AM on March 20, 2007 [1 favorite]

Think about it this way: If that cop had shot and killed your friend, what would you be now wishing you had done? "Stressed out" the family? Asked him why he's not taking his meds? What are you going to regret not trying after it's too late? Do that thing now.
posted by DU at 6:22 AM on March 20, 2007

Unfortunately (or fortunately, depending on how you look at it), Massachusetts is one of a minority of states which does not have a clear process for statutory involuntary commitment of mentally ill persons. A person in Massachusetts can't be compelled by the civil courts to take psychicatric medications as a condition of remaining free in society, although in Western Massachusetts, a defacto "system" of treating people who have repeated run-ins with police has developed, under the state's guardianship laws. so to a great extent, it seems to depend on local conditions, how your friend may be treated in the health and legal systems.

But unless your friend is presenting a clear and present danger to himself or others, he can't be compelled to do the things that might be most useful in helping him normalize his behaviors. The prospect of a police officer pulling his weapon on your friend is troubling, and I would hope that the officer did this as a precautionary move in assessing your friend's situation, rather than in self-defense. Police generally have a well described protocol for unholstering weapons, but some jurisdictions do so early in an investigative or possible arrest situation, so that the officer is in a clear posture, with full control of their weapon, before closely approaching a subject who may appear to be acting strangely.

Unfortunately, it seems that people with bi-polar disease are unlikely to remain medication compliant for long periods on their own. Their disease works against them in both the maniac and depressive phases, for different behavioral reasons, and the greater the severity of the their symptoms, generally, the less likely they are to obtain and take medications, and make and keep the supervisory psychiatric appointments necessary for medication supervision and adjustment.

You, as a friend, can continue to talk with them, and encourage them to go to psychiatric appointments and to obtain and take prescribed medications. You could offer to provide transportation to such appointments, if that is an issue. You could learn the names of any psychiatrists or other doctors who are supervising or treating your friend, and offer them informational statements about your friend's condition, but they probably won't be able to comment to you about his condition, diagnosis, or treatment, due to confidentiality restrictions. You could visit NAMI chapter meetings in your area to learn about the disease, and seek local advice about community treatment alternatives. And I agree that you should, if are truly concerned about your friend's well being, be in touch with his family members, who may have guardianship responsibilities under state laws, or be involved in administering benefits for him under SSI or similar programs which can provide medications and treatment he needs.
posted by paulsc at 6:31 AM on March 20, 2007 [1 favorite]

First of all, bless for caring enough about your friend for posting this question and for treating him with respect and concern.

I agree with everyone who says to please, please contact his family. They may be stressed out, but they are far better off knowing what's going on than not knowing. The more information they have, the better they will be able to help him. He may have had problems in the past and they may not know that he is having a resurgence, you just don't know. If his condition is severe enough that he had a gun pulled on him, it is time to escalate this. As you know, his safety is at risk. If his family doesn't seem to be taking this seriously, please encourage your friend to see a counselor. You can even offer to go with him. What area are you in? Maybe we can help you find some local phone numbers where you can get professional advice.

Also, the other thing you can do, is to maintain your friendship with him. I have someone close to me who has mental health issues and a lot of their friends abandoned them. That's a really crushing blow for somebody to have to deal with, on top of the torment they are already going through. It's good that you're not judging him and that you're approaching him from such a place of compassion. You don't want to be patronizing, but at the same time, you can let him know that you are available if he needs to talk. He may get angry with you or even scared of you at times, but try not to take that personally. Also, make sure you have someone to talk to, because this can be scary and painful for you, too.

On preview, paulsc has given you some very good advice.
posted by diamondsky at 6:36 AM on March 20, 2007

Defintely contact the family. I doubt they'll feel anything other than relief that someone else is concerned about him.

FWIW, a friend with serious bipolar illness who wouldn't take his meds is one of the most frustrating things I've ever had to deal with. Sometimes it was just a money issue that kept him from refilling his prescription or seeing a doctor, so maybe you or the family can help if that's the case here. Otherwise, just keep caring by expressing concern and acceptance no matter what, and by doing little things for him. Whenever I saw my friend, I'd give him a banana. It seemed to help both of us.
posted by mediareport at 7:40 AM on March 20, 2007

Btw, the friend is doing much better. Keep in mind that it can work out, despite the serious trouble with the illness you're seeing now.
posted by mediareport at 7:41 AM on March 20, 2007

Aside:

it seems that people with bi-polar disease are unlikely to remain medication compliant for long periods on their own. Their disease works against them in both the maniac and depressive phases, for different behavioral reasons, and the greater the severity of the their symptoms, generally, the less likely they are to obtain and take medications, and make and keep the supervisory psychiatric appointments necessary for medication supervision and adjustment.

This is a huge overstatement. It is true that some people with bipolar disorder don't always take medications or comply with prescribed treatments for a wide range of reasons. (Also true for non-psychiatric conditions like diabetes.) At the same time many many people with bipolar disorder manage their conditions through depressions and manias by using medications, therapy, regular sleep, and whatever else is useful to them (yoga, exercise, whatever). One of the greatest obstacles faced by people with psychiatric conditions is the chronic view that: 'those people are like this, do this, don't do that,' without being seen as individuals.

End aside.

I like the idea of contacting the community mental health agency. They may have a mobile unit that checks in regularly with people who are out in the street or in their cars. They might be able to keep an eye on him, offer care, establish a relationship.
posted by ClaudiaCenter at 9:02 AM on March 20, 2007

The family is probably already stressed out in a "is our son still alive" way, I'm sure they will feel better to know that you want to help him.

The most practical, immediate thing you can do now to help is try to keep track of where to find your friend, learn about any places he hangs out or parks his car at.

I had a parent call me once because their daughter had used my phone months before to call them. They would have been greatly relived to know their daughter was even seen alive and out of jail at that point. You might decrease the family's stress by contacting them.
posted by yohko at 9:09 AM on March 20, 2007

There may be a back door to mental health services for your friend through homeless services. Why don't you call someone at Father Bill's and tell them this same story. They may be able to provide some services to him, or they could at least refer you to someone who can.

From their site:

Health Care
In collaboration with Boston Health Care for the Homeless (BHCH), guests have access to medical care. BCHC provides basic nursing services to the homeless with an on-site registered nurse. A BHCH physician makes weekly visits to the shelter.

Mental Health Services
In collaboration with Tri-City Mental Health, guests have access to shelter-based clinicians who are available for clinical assessments and evaluations.

Outreach Case Management
In collaboration with Tri-City Mental Health, case managers take to the streets to initiate contact with homeless individuals who are resistant to entering a shelte
posted by The Straightener at 9:20 AM on March 20, 2007

(btw manic depression and bipolar disorder are the same illness.)

Contact his family.

BTW for many of us bipolars, we quit taking our medicine because the side effects are too troublesome, and/or we are feeling much better "and don't need them anymore." That latter reason is actually a part of the illness.

(Meanwhile, my brother-in-law is right this minute sitting in the hospital, yet again, because he keeps stopping his meds and drinking. It's like a stinking revolving door. He's in Washington State and the laws must be different, as I don't know that he'd do this voluntarily. )

Oh, and do keep track of your friend-what goes up MUST come down and he should be headed to depressionville soon.
posted by konolia at 9:40 AM on March 20, 2007

Medications are a red herring in the same way that purported diagnosis is. Precisely because your concern is for your friends well-being, you should pay attention to that as an indicator of how your friend is doing. Given the response rates for medications they shouldn't be required, and, regardless, reading between the lines of your post it's clear that you are neither an MD, a pharmacologist, nor a pharmaceutical rep, suggesting that you can have no direct stake in whether or not your friend takes medications.

What you do have a stake in is the quality of your friend's life, as well as his behavior. You've described someone who is indeed a danger to himself. Mass does have an emergency petition law, and there may be a unit that responds to situations like this in the city of Boston. I know there is in my city, and they can and do compel transportation to an ER for a psych eval, which might lead to a period of involuntary commitment.
posted by OmieWise at 9:42 AM on March 20, 2007

I have bipolar disorder. It's hard to see outside yourself with this illness, and see how your actions affect others. It may be hard for your friend to understand why he'd need medication, he may think that he's doing ok and everyone should leave him alone.

It took me 4 years and many different meds to find the right med. The average time it takes currently for a bipolar person to find the right meds to be mostly stable is 7 years. Right now, the psychiatry of treating bipolar is still in its infancy. If your friend took meds that didn't work or had bad side effects, he may have been discouraged to try different meds.

I agree that you should contact the family. This person needs help, and though they can't be forced to help themselves, perhaps a few more voices in the choir will get them to attempt to be stable. But know that people aren't perfect, the treatment isn't perfect, there's only so much you can do and only so much that our current medicines will work.
posted by veronitron at 9:56 AM on March 20, 2007 [1 favorite]

You didn't say whether or not the diagnosis is coming from your friend or another souce. I personally know someone with scyzophrenia (sp?) who will tell you she is bi-polar. Some of the behavior you are describing sounds more like scyzophrenia.
posted by rcavett at 4:56 PM on March 21, 2007