How can I support my friend through a mental health crisis?
July 28, 2017 7:52 AM Subscribe
A good friend of mine (T) has been sleeping on my sofa for the past week. They're unemployed and without a firm place to stay, and while they're generally in a stable place they've had a couple of dissociative episodes. What's the best way I, a non-professional, can help them get themselves together?
I know the best advice is "encourage them to get help," and I'm already doing that as best I can. We're in the UK, and while the NHS is a tremendous resource, mental health provisions are stretched at best and essentially unreachable at worst. T isn't great about talking to doctors, but not terrible. Assume we're pursuing this as hard as we can. T has been diagnosed with major depressive disorder, and is apparently close to being bipolar, but doesn't quite meet certain criteria. They have medication, but I don't know what, and I'm not sure if they're regularly taking it. They attempted suicide by overdose about six weeks ago. I'm satisfied that they're not a danger to others, but I don't know if I'm convinced they're not a danger to themselves.
We've also got a housemate moving out soon - I and the other remaining housemate have offered to cover rent for the month of August if T wants the room, to give T some stability, but we can't afford to cover their rent indefinitely, and we've told them as much. Rent is pretty cheap for the area, but neither I nor my other housemate make a lot of money.
What can I do to encourage T to get the help they need? I don't know how far to push on "you should go to the doctor" and "have you been looking for jobs" - my gut feeling is that that would be counterproductive.
If T doesn't get help, and ends up not being able to pay rent, what should I do? I care a lot about their well-being, but we really can't afford to keep paying the rent, utilities and buying food for them. I'm not concerned about them refusing to leave, but I am concerned about what would happen to them if they did - before they were staying with me, they were living in their car, and I don't think that would be a good option going forward. We're all in our mid-twenties, and while they have a supportive friend group, none of us really make enough money to look after them long-term. They don't have a good relationship with their parents.
I know the best advice is "encourage them to get help," and I'm already doing that as best I can. We're in the UK, and while the NHS is a tremendous resource, mental health provisions are stretched at best and essentially unreachable at worst. T isn't great about talking to doctors, but not terrible. Assume we're pursuing this as hard as we can. T has been diagnosed with major depressive disorder, and is apparently close to being bipolar, but doesn't quite meet certain criteria. They have medication, but I don't know what, and I'm not sure if they're regularly taking it. They attempted suicide by overdose about six weeks ago. I'm satisfied that they're not a danger to others, but I don't know if I'm convinced they're not a danger to themselves.
We've also got a housemate moving out soon - I and the other remaining housemate have offered to cover rent for the month of August if T wants the room, to give T some stability, but we can't afford to cover their rent indefinitely, and we've told them as much. Rent is pretty cheap for the area, but neither I nor my other housemate make a lot of money.
What can I do to encourage T to get the help they need? I don't know how far to push on "you should go to the doctor" and "have you been looking for jobs" - my gut feeling is that that would be counterproductive.
If T doesn't get help, and ends up not being able to pay rent, what should I do? I care a lot about their well-being, but we really can't afford to keep paying the rent, utilities and buying food for them. I'm not concerned about them refusing to leave, but I am concerned about what would happen to them if they did - before they were staying with me, they were living in their car, and I don't think that would be a good option going forward. We're all in our mid-twenties, and while they have a supportive friend group, none of us really make enough money to look after them long-term. They don't have a good relationship with their parents.
Yeah - my takeaway from what you've written is that you don't really think this person is functioning enough to get and keep a job, but you also don't think they're drawing on all available resources.
To the extent that's an accurate summary, I basically agree with ozgirlabroad that the most helpful thing you can do is probably to make tapping into those resources less overwhelming. I've used the NHS but not for mental health care - if there are applications, can you hand-hold T through those?
There's are reasons they're not going to the doc (to take one piece), one of the reasons is most likely feeling overwhelmed, and in a lot of ways that's the probably one of the only places you can help beyond what you are now.
posted by PMdixon at 8:28 AM on July 28, 2017
To the extent that's an accurate summary, I basically agree with ozgirlabroad that the most helpful thing you can do is probably to make tapping into those resources less overwhelming. I've used the NHS but not for mental health care - if there are applications, can you hand-hold T through those?
There's are reasons they're not going to the doc (to take one piece), one of the reasons is most likely feeling overwhelmed, and in a lot of ways that's the probably one of the only places you can help beyond what you are now.
posted by PMdixon at 8:28 AM on July 28, 2017
If you want to do that you can also help T navigate the benefit system, help work out what they are entitled to and make sure they have applied and are getting all of that.
For example, it used to be the case that if T is not related to you or housemate they could formally rent that room and the rent was covered by benefits. But it is years since I had to look into this in the UK so this specific option may no longer exist. But T should get some benefits including something that allows them to live somewhere.
posted by koahiatamadl at 8:49 AM on July 28, 2017 [1 favorite]
For example, it used to be the case that if T is not related to you or housemate they could formally rent that room and the rent was covered by benefits. But it is years since I had to look into this in the UK so this specific option may no longer exist. But T should get some benefits including something that allows them to live somewhere.
posted by koahiatamadl at 8:49 AM on July 28, 2017 [1 favorite]
I can't speak to navigating the NHS specifically as I'm not from the UK, but the ideas about finding someone whose actual job it is to help navigate the red tape of the system is the best idea, whatever form that takes for you. The hardest part of seeking care is that it's a labyrinth, but that's not something you or T can figure out alone. Wherever T got the medication from could be a place to start. Finding out what the meds are is important to, in terms of side effects and what effect not taking them consistently has on mood.
On a personal level, it's likely T has a lot of unexpressed guilt or feelings of being a burden to you, from depression, and just from the situation of having a friend put you up for a while when you're having a hard time. I think it's important to reassure them that isn't the case, if that is something they need. It sounds like you have a strong, valuable friendship and although friendship can't figure out benefits eligibility it's such a huge piece of the puzzle especially if they're not close to their family.
posted by colorblock sock at 12:34 PM on July 28, 2017
On a personal level, it's likely T has a lot of unexpressed guilt or feelings of being a burden to you, from depression, and just from the situation of having a friend put you up for a while when you're having a hard time. I think it's important to reassure them that isn't the case, if that is something they need. It sounds like you have a strong, valuable friendship and although friendship can't figure out benefits eligibility it's such a huge piece of the puzzle especially if they're not close to their family.
posted by colorblock sock at 12:34 PM on July 28, 2017
Are there any mental health charities in your area? They might be able to help you/your friend navigate the NHS services; talk through how best to make the services work to your advantage eg. how best to try and access the servies of a CPN; whether there are services in your area that aren't necessarily promoted by GPs; know of local counselling services etc.
They might also have social sessions or group sessions that your friend could go to, which would make you feel less like you're the only person responsible for them.
Personally I wouldn't hold back on emphasising how important it is to stick with meds and keep going back to the doctor, especially if suicide is a risk - and it's really hard to know if someone is contemplating suicide.
Lastly, and worth spelling out because it's sometimes hard to take this step but important to know - if you do ever think things are so serious that they're beyond what you can deal with, you can call 999 and say your friend is having a mental health crisis. They don't have to be physically ill - a mental health emergency is also an emergency.
posted by penguin pie at 3:05 PM on July 28, 2017
They might also have social sessions or group sessions that your friend could go to, which would make you feel less like you're the only person responsible for them.
Personally I wouldn't hold back on emphasising how important it is to stick with meds and keep going back to the doctor, especially if suicide is a risk - and it's really hard to know if someone is contemplating suicide.
Lastly, and worth spelling out because it's sometimes hard to take this step but important to know - if you do ever think things are so serious that they're beyond what you can deal with, you can call 999 and say your friend is having a mental health crisis. They don't have to be physically ill - a mental health emergency is also an emergency.
posted by penguin pie at 3:05 PM on July 28, 2017
Thank you for helping your friend. You're right that with the NHS the way it is now, you can't rely on help being available or enough. This is a dystopian situation where we need to look after each other and keep each other safe.
I agree that housing benefit etc. is the best plan for covering the rent. Your friend may also be able to apply for PIP, although that's a tremendous stress in itself. A few years ago I'd have recommended the Citizens' Advice Bureau for benefits advice, but we don't even have that any more. However, your local branch of MIND should have people who can give your friend a hand with working out what set of benefits they would be eligible for and with filling out the paperwork. Otherwise, maybe you and your other housemate could sit down with your friend and try to figure it out together. Don't rely on them being able to do it alone - it's hard at the best of times, even when your brain's not fogged with depression. Be aware that getting something like PIP can take a really long time - my housemate just got assessed as qualifying for the higher rate after having been refused altogether and going through numerous appeals. Housing benefit or ESA may take less time, but be prepared for a bit of a gap - applying right now in the hope of getting money by the end of August would be wise.
I agree with you that nagging them about going to the doctor or looking for jobs isn't going to do any good and may well do some harm. It's not as if mental wellness somehow magically arises out of going back and forth to the GP, anyway. Your friend probably needs therapy but is unlikely to be able to access it within a sensible timescale. Try to do nice things with them, and tell them regularly what you value about them as a friend. That'll be more help to them than being told to take their meds - they're unlikely to take them simply on your say-so.
You can definitely call 999 for a mental health crisis, but if you can get your friend to just get a bus/taxi to an A&E that may honestly be less stressful. Either way there will probably be a lot of waiting, but a lot of the time the ambulance will just deposit you at A&E where you'll have to wait anyway. In A&E, be sure to ask for the psychiatric liason team.
You should probably work out for yourself what your threshold is for going over your friend's head and getting a section - it's not a likely outcome but it's a horrible enough situation that you might not be thinking clearly and may be grateful for previous forward planning. My own housemate who had to deal with this advises that if you're not comfortable leaving the person in the house alone for a few hours at a time, then it's too much for you to deal with and they need to be in hospital or another supportive environment. The Maytree in London offer a sanctuary for those who need high support outside of a hospital setting.
Again, thank you, you're taking a good course of action. Feeling connected to people and valued is one of the most protective factors in a mental health sense, as is having a secure and safe environment. Just being cared about is worth more than anything. You can get through this together.
posted by Acheman at 2:38 AM on July 29, 2017 [1 favorite]
I agree that housing benefit etc. is the best plan for covering the rent. Your friend may also be able to apply for PIP, although that's a tremendous stress in itself. A few years ago I'd have recommended the Citizens' Advice Bureau for benefits advice, but we don't even have that any more. However, your local branch of MIND should have people who can give your friend a hand with working out what set of benefits they would be eligible for and with filling out the paperwork. Otherwise, maybe you and your other housemate could sit down with your friend and try to figure it out together. Don't rely on them being able to do it alone - it's hard at the best of times, even when your brain's not fogged with depression. Be aware that getting something like PIP can take a really long time - my housemate just got assessed as qualifying for the higher rate after having been refused altogether and going through numerous appeals. Housing benefit or ESA may take less time, but be prepared for a bit of a gap - applying right now in the hope of getting money by the end of August would be wise.
I agree with you that nagging them about going to the doctor or looking for jobs isn't going to do any good and may well do some harm. It's not as if mental wellness somehow magically arises out of going back and forth to the GP, anyway. Your friend probably needs therapy but is unlikely to be able to access it within a sensible timescale. Try to do nice things with them, and tell them regularly what you value about them as a friend. That'll be more help to them than being told to take their meds - they're unlikely to take them simply on your say-so.
You can definitely call 999 for a mental health crisis, but if you can get your friend to just get a bus/taxi to an A&E that may honestly be less stressful. Either way there will probably be a lot of waiting, but a lot of the time the ambulance will just deposit you at A&E where you'll have to wait anyway. In A&E, be sure to ask for the psychiatric liason team.
You should probably work out for yourself what your threshold is for going over your friend's head and getting a section - it's not a likely outcome but it's a horrible enough situation that you might not be thinking clearly and may be grateful for previous forward planning. My own housemate who had to deal with this advises that if you're not comfortable leaving the person in the house alone for a few hours at a time, then it's too much for you to deal with and they need to be in hospital or another supportive environment. The Maytree in London offer a sanctuary for those who need high support outside of a hospital setting.
Again, thank you, you're taking a good course of action. Feeling connected to people and valued is one of the most protective factors in a mental health sense, as is having a secure and safe environment. Just being cared about is worth more than anything. You can get through this together.
posted by Acheman at 2:38 AM on July 29, 2017 [1 favorite]
Regarding your worries about T taking meds or seeking out care, one thing I've found helpful with friends is to sit down and have a gentle but full discussion about what your friend would find most supportive. I've used I-statements when I've been in similar situations, like starting the conversation with "I want to be sure that I'm supporting you as well as I am able, but I'm not sure how I'm doing or what to do. Can we talk about this?" Maybe not right then, but schedule a specific time. Maybe outside of your flat if you think T might be worried that they are a burden. I try to continue with my I-statements and being non-judgemental, as well as listening fully and actively, of course.
In my case, my friends who I've had such conversations with are mostly women who have been brought up to put others' well being ahead of their own, often to an unhealthy degree. They feel guilty about having needs, and worry about being a burden. So although I ultimately remain focused on their situation and needs, and do not offload any of my actual fears onto them - it seems to be reassuring to them that I be confident and competent and a stable, dependable presence in their lives, in particular - framing the discussion as asking them to help me (to help them) has been useful for us in getting around that part of their brain that tells them that they are unworthy of help or too burdensome.
It sounds like you and your friend group in general may already have similar communication habits, so it may just be a matter of setting a time to have the conversation and keeping focused on getting the answers that you need. These may include:
* "Can you tell me more about the medications you've been prescribed? What are you on? How do they make you feel? Do you take them regularly? It looks from the outside like you feel better when you do take them regularly; what sort of systems have you set up for yourself to help ensure that happens, even on bad days? Hmm, for [specific challenge that friend has identified, eg. maybe taking meds every day is stressful because just thinking about the mental health issue is stressful, so they avoid it], would it help if I [specific suggestion, eg., ask daily if you've taken your meds, with both of us keeping in mind of course that I'm your friend, not your doctor, so I'm not going to ask more than once, or nag you about it.- the choice to take meds or not is yours]?"
* "What other supports, from NHS, disability or other social safety net programs, etc., are available to you? Is it okay if I look into more options? What would make accessing those programs easier? Could I [more specific suggestions in response to specific challenges identified by friend]?" If T brings up feeling like they are a burden on you by staying in your couch/rent free, a useful response might be along the lines of, "I care about you and am happy to do what I can to help you be well. I promise to be honest with you about my limitations, so that you don't have to worry about that. You know, we could look into applying for a housing allowance for you to officially rent X's room after they move out, though? That way you can be here with us friends as long as you need to be. And we'd feel better knowing you are safely housed."
Having those sort of conversations (during an ongoing situation but outside of any specific crisis) has been quite helpful, both for me, and for the friends I've been able to be a support to. Even though it was difficult to figure out how to start the conversation the first time I had one, and in all cases I'm nervous about saying the wrong thing, it seems to have taken some worry off of my friends, as well (for all the above-mentioned reasons: it demonstrates to them that I'm dependable and competent, that I will take care of myself along with helping them so they worry less about being a burden, that I'm making specific plans to be a supportive person in their life for a longer haul so they worry less about driving me away or me flaking or disappearing after they let themselves trust and rely on me, etc.).
posted by eviemath at 6:01 AM on July 29, 2017 [1 favorite]
In my case, my friends who I've had such conversations with are mostly women who have been brought up to put others' well being ahead of their own, often to an unhealthy degree. They feel guilty about having needs, and worry about being a burden. So although I ultimately remain focused on their situation and needs, and do not offload any of my actual fears onto them - it seems to be reassuring to them that I be confident and competent and a stable, dependable presence in their lives, in particular - framing the discussion as asking them to help me (to help them) has been useful for us in getting around that part of their brain that tells them that they are unworthy of help or too burdensome.
It sounds like you and your friend group in general may already have similar communication habits, so it may just be a matter of setting a time to have the conversation and keeping focused on getting the answers that you need. These may include:
* "Can you tell me more about the medications you've been prescribed? What are you on? How do they make you feel? Do you take them regularly? It looks from the outside like you feel better when you do take them regularly; what sort of systems have you set up for yourself to help ensure that happens, even on bad days? Hmm, for [specific challenge that friend has identified, eg. maybe taking meds every day is stressful because just thinking about the mental health issue is stressful, so they avoid it], would it help if I [specific suggestion, eg., ask daily if you've taken your meds, with both of us keeping in mind of course that I'm your friend, not your doctor, so I'm not going to ask more than once, or nag you about it.- the choice to take meds or not is yours]?"
* "What other supports, from NHS, disability or other social safety net programs, etc., are available to you? Is it okay if I look into more options? What would make accessing those programs easier? Could I [more specific suggestions in response to specific challenges identified by friend]?" If T brings up feeling like they are a burden on you by staying in your couch/rent free, a useful response might be along the lines of, "I care about you and am happy to do what I can to help you be well. I promise to be honest with you about my limitations, so that you don't have to worry about that. You know, we could look into applying for a housing allowance for you to officially rent X's room after they move out, though? That way you can be here with us friends as long as you need to be. And we'd feel better knowing you are safely housed."
Having those sort of conversations (during an ongoing situation but outside of any specific crisis) has been quite helpful, both for me, and for the friends I've been able to be a support to. Even though it was difficult to figure out how to start the conversation the first time I had one, and in all cases I'm nervous about saying the wrong thing, it seems to have taken some worry off of my friends, as well (for all the above-mentioned reasons: it demonstrates to them that I'm dependable and competent, that I will take care of myself along with helping them so they worry less about being a burden, that I'm making specific plans to be a supportive person in their life for a longer haul so they worry less about driving me away or me flaking or disappearing after they let themselves trust and rely on me, etc.).
posted by eviemath at 6:01 AM on July 29, 2017 [1 favorite]
Also, make sure that you have your own supports in place! Be aware of your own boundaries, stress levels, and mental health needs. Getting immediate needs met in a specific crisis (dissociative episode, suicide attempt) is important, but overall, consistency and dependability seem to count for a lot in terms of how safe and supported my friends have felt. And you can only provide that if you are also taking care of yourself.
posted by eviemath at 6:08 AM on July 29, 2017 [1 favorite]
posted by eviemath at 6:08 AM on July 29, 2017 [1 favorite]
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posted by ozgirlabroad at 8:02 AM on July 28, 2017 [10 favorites]