How can I help a friend with severe mental illness?
May 28, 2013 4:40 PM   Subscribe

I don't know what to say to her anymore.

"Sasha" is in her mid-fifties. She has had severe depression, mood swings, anger issues, anxiety attacks, hoarding, and PTSD for her entire adult life. She is also one of the smartest, most creative and fun people I have ever met. She's awesome.

She's also been a mentor to me. She taught me an obscure and hard-to-learn skill for which I am well-suited, and I now support myself with this skill.

In the decade that we have been very close friends, her mental health has been in a decline. When we met, she had all of the conditions I list above, but she also had a job and an apartment and a very full life. However, she never got more than minimal treatment for her mental health conditions. By "minimal treatment," I mean she had an absent doctor who prescribed her antidepressants and benzos with which she essentially self-medicated, though I don't think she's addicted to them per se. She takes the prescribed dose or maybe one extra pill.

She can no longer work. She hasn't had a job for maybe four years. She has federal disability money now, which is good. But her depression has occasionally merged into psychosis. She doesn't get out of bed and now she is gradually stopping eating. This is part of a pattern that has happened several times over the last few years, and becoming more frequent. Eventually she becomes suicidal or so psychotic or dehydrated that she has to go to an ER. Usually I tell her that she needs to go to the ER for about a week before she actually goes. She will stay in a psych ward for a few weeks and they will get her stable enough to send home, but not exactly hale and hearty. When she's home, she goes into a gradual decline again.

She is part of the public health care system now, which is better than average in our state (Massachusetts). She sees a doctor once a month and is on various meds that she takes irregularly and clearly aren't working anyway. I urge her to call him more and he doesn't return her calls. She could get another doctor, but she doesn't listen to me when I tell her she needs to hound her medical people to get the treatment she needs. I don't think she is being an effective advocate for herself. I don't think she can be.

She doesn't have any family that are in the picture, or who would be helpful or sympathetic if they were in the picture. I am essentially the first line of defense in her life, and I feel totally helpless. I no longer know what to say and she doesn't really listen to most of what I say anyway. We can still talk about TV shows and that sort of thing and have a good time. Should I just stick to that? Is there anything else I can do?

Any advice?
posted by anonymous to Human Relations (5 answers total)

This post was deleted for the following reason: poster's request -- LobsterMitten

You can be a friend. You can make sure she has your number, so that if she's institutionalized she can call you. You can make sure she knows she can count on you to feed her cat and water her plants if she decides she wants inpatient treatment.

Other than that, there's not much you can do.
posted by colin_l at 4:58 PM on May 28, 2013 [1 favorite]

However, she never got more than minimal treatment for her mental health conditions. By "minimal treatment," I mean she had an absent doctor who prescribed her antidepressants and benzos with which she essentially self-medicated, though I don't think she's addicted to them per se.

I could be totally reading this in and if so, I apologize. But in this sentence I think I feel a note of, "she's not trying hard enough to get treatment" or "she's acting more like an irresponsible drug addict than a responsible person who is caring for their health the best they can."

If she has a doctor who prescribed her medication, then she's not "self-medicating" and all the loaded things that are implied by that. She sought help properly, and is following her doctor's instructions as given - she's doing exactly what she is "supposed" to do. It's not her fault that she's receiving shitty care.

Seeing a doctor once a month, who doesn't return your calls, may be the very best care you can get if you are poor under the public health care system. Getting another doctor... who's to say another doctor in that system would be better? If she can't get out of bed, and she can't eat, there might not be too many ways for her to go doctor-shopping, anyhow.

Honestly, I would really suggest just being her friend. I think for a lot of people who are severely mentally ill, one of the hardest things about it is the loneliness, the isolation, the feeling that you are a useless burden who nobody wants to deal with, who is just dragging down everyone's life. And I think that creates a cycle where that feeling gets overwhelming and just makes the mental illness worse.

I think one of the best things you can do for her is just go spend time with her, hang out, watch TV and have a good time, like you mentioned. You can ask her if she needs help and give her what she asks for, if you're willing to.
posted by cairdeas at 5:10 PM on May 28, 2013 [3 favorites]

Her previous "absent" doctor gave her only minimal treatment? Her current doctor doesn't return her calls? (Perhaps she never even called them!) She takes the prescribed doses of her drugs or "maybe one extra pill"? I'm sorry, but do you have any PROOF of any of this, or are you just going on what your friend tells you? The fact that she *does* get better while she's in a psych ward and under a 24/7 watch, says to me that she chooses not to follow doctors' orders if she can possibly avoid doing so.

Pretty much all you can do for her is be a friend, and try to convince her to follow her prescriptions exactly.
posted by easily confused at 5:19 PM on May 28, 2013

Here is one place to start to look for resources for her. (I'm not in Massachusetts, but it looks legit.)

I am essentially the first line of defense in her life

Hopefully the link will help you find others to help advocate for her. Be a friend, as others have said, but remember to take care of yourself. Best of luck to you both.

Here is another online resource that may be of help.
posted by trip and a half at 5:33 PM on May 28, 2013

If she is not asking for your help, then your well-meaning advice is about as welcome as dieting advice when you are happy with the food choices you are making. She has been offered professional help several times while hospitalised and she is choosing to make her own decisions despite what you think of the consequences. Just be her friend.
posted by saucysault at 6:27 PM on May 28, 2013

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