What are some of the signs your friends’ mental health might be suffering?
“In my opinion, there are five red flags to watch out for. The first is that they’re avoiding social situations and the second that they’ve become quiet and withdrawn. They might also become flaky or try to cancel or change plans more often. Then if you do go out, you might notice they’re drinking more than normal and doing more extreme things, like using drugs. Finally, look out for any sudden changes in their weight.” – Emmy Brunner, psychotherapist & hypnotherapist & founder of The Recover Clinic
“Other signs of deteriorating mental health might include dramatic changes in sleep (not sleeping at all), speech (talking really fast or really slow), mood (very low or very high), appetite or personal care. If you work with them, you might notice a drop in their performance or some unusual, disordered thinking or times when they act out of character.” – Dr Mariam Adegoke, GP & founder of the Adegoke Wellness Clinic
Lockdown easing has prompted a lot of anxiety – how can you help friends struggling with the idea of returning to ‘normal’?
“The transition from being in lockdown to life returning to a ‘new normal’ is a process we are all going to have to adapt to. Giving people permission to take their time and to be mindful of meeting their needs is really important. Just bear in mind that pretending there’s nothing to worry about can be confusing and make it harder for people to be honest about what is really going on with them. When we minimise a problem, it can make it harder for someone to feel validated and as though their issues aren’t something to be taken seriously.” – Emmy
What are some of the different ways you might be able to help?
“Let your friend know you’re concerned about them and are here if they want to talk. But don’t push people to talk in detail about things that might be too triggering or challenging for them. If they open up at all, then this is a good thing. Let them know the ways that you are supporting your own wellbeing and ask if there is anything that they are doing that they are finding helpful. If they do want to talk, listen to what they are sharing and reflect back key pieces of information to ensure they feel heard. Finally, if you have immediate concerns about someone’s wellbeing, then contact 999 or take them to A&E. There are teams there that are trained to deal with people in acute distress.” – Emmy
“It’s so important to be yourself – remember, they are still the same friend you’ve always had, they’re just ill. If it was a physical health problem such as a heart attack or a stroke, you’d be focused on getting them the help they need. Mental health is no different. Start by listening and letting them know you care and are there for them. Don’t be afraid of saying the wrong thing, either – saying something is better than recognising a problem and saying or doing nothing.” – Dr Mariam
What if they say they don’t need help?
“Talk to them about how they feel and explore why they don’t want to seek help – there may be a reason that has a workable solution. Explain that you are worried for them and encourage them to seek help – you or a relative could go with them to see someone if going alone feels like too much. Sometimes people with deteriorating mental health don’t have insight into how sick they are and it takes someone else to recognise this. Other times they do, and they have capacity to make that decision, so your role in the latter scenario is to support their decision.” – Dr Mariam
If they seem happy to talk, what’s the best way to start a conversation?
“Begin the conversation in a space that feels quiet and safe. You don’t want distractions or for your friend to find it difficult to open up. You can communicate your concerns but take your time and allow your friend to share things at a pace that feels comfortable to them. Talking and opening up about our mental health struggles can be difficult and takes a lot of courage. Keep this in mind when talking to a friend about their mental wellbeing – this might be the first time they’ve ever shared these things with anyone.” – Emmy
“There’s no one-size-fits-all just as there is no wrong way (other than ignoring their mental health as being an issue). My advice would be don’t overthink it, you can start with something as simple as ‘How are you?’ And if they say fine, you can follow that up with ‘How are you really?’ Sometimes, people just knowing that you are there goes a long way.” – Dr Mariam
Any advice to ensure the chat is constructive?
“Be mindful that you are not in any way accusatory. If a friend has been unreliable or flaky, don’t focus on things that could potentially cause someone to take on a defensive stance. Start with saying how much you love and care for your friend and then leave space for them to share. The main focus should be about being there for your friend and as such, we need to be very much led by them.” – Emmy
“The focus should always be on listening rather than leading. You’re trying to gain an understanding of what they are going through in order to be there for them rather than imposing your beliefs around what you think might be going on. If they are ready to open up, you directing the conversation elsewhere could be a barrier to this.” – Dr Mariam
Why is it important not to try and ‘fix’ their problems?
“Many mental health problems share the same symptoms, so self-diagnosis runs the dangerous risk of missing small differences that help professionals distinguish one case from another. This can be dangerous if you misdiagnose bipolar disorder as personality disorder or PTSD as anxiety for example. It can mean people don’t get the right help and treatment they need. You could also diagnose a physical health problem such as hyperthyroidism as being a mental health problem and again, this can delay your friends from starting the right treatment.
Instead of trying to diagnose conditions, focus on encouraging them to seek help. There is no set threshold for how severe something needs to be before they contact their GP. Doctors usually want to know about persisting symptoms over two weeks but if you have concerns you can contact them any time. Furthermore, if symptoms are affecting day-to-day activities, a GP will be able to go through the available options. This doesn’t just mean medication or counselling; it could also include working with a social prescriber who can help your friend get involved in local groups depending on their hobbies.” – Dr Mariam
Is there any way to help them feel less anxious right now?
“Many of us learnt things about ourselves during lockdown, reminding ourselves that we need to follow our passions, prioritise our own needs and be kinder to ourselves are key things to focus on as we return to life. For many of us, it’s not about going back to life as it was, but rather, looking at ourselves and the world through a new lens. Be mindful of this when you’re talking to friends who aren’t sure about what their new identity might look like in this new world.” – Emmy
Are there any specific issues that should always be left to a professional?
“If someone is experiencing hallucinations (hearing or seeing things that aren’t there) or expressing strong beliefs that are not shared (i.e. they’re delusional), it’s important to seek help from a GP immediately as these can be symptoms of psychosis. Also, if someone is having suicidal thoughts or thoughts of harming themselves, it is important to tell someone. If they can’t wait to see a doctor, or are unable to keep themselves safe, they can contact The Samaritans, Shout, their local 24/7 mental health crisis line or 111 to get urgent support. For life threatening emergencies, call 999 and ask for an ambulance.” – Dr Mariam
Are there any organisations or resources which might be useful if a therapist is out of the question?
“Anyone can self-refer for NHS psychological therapies. To find out more about the service in your area, click here. While they are free, there are usually long waiting times. The charity Mind also provides advice and support to empower anyone experiencing a mental health problem and Kooth – a digital mental health and wellbeing service – is specifically designed for young people. As an online community, they provide free, safe and anonymous support. Calm (Campaign Against Living Miserably) also has trained staff that you can call or talk to online if you have hit a wall for whatever reason. Its number is 0800 58 58 58 and it is open daily, from 5pm-midnight.
“Other services mentioned already include The Samaritans (it’s a 24/7 helpline for anyone wanting to talk about mental health, no matter how big or small. Available at 116 123). Childline is also available online or on the phone, and they support people up to age 19 – plus, the number will not appear on your phone bill. Shout is a 24/7 text service which is free on all major mobile networks – just text 85258 if you are struggling to cope and need immediate help or text ‘YM’ if you're under 19.” – Dr Mariam
Finally, how do you ensure your own mental health doesn’t suffer as a result of helping someone else?
“Check in with yourself. Are you making time for you? It could be that you become more snappy, irritated or short with people when you’re nearing your limits – equally your mood may be lower, you may be feeling more overwhelmed or stressed. Or it may be that you are tired all the time and don’t have time to connect with people or any of the things you usually enjoy. Learn to listen to your body, recognising that when this is happening this is a sign you have been neglecting yourself and are nearing your limit. Remember, it’s okay to take a step back from other peoples’ problems, take a minute to switch the focus to prioritising your mental health – you can’t pour from an empty cup.” – Dr Mariam
Emmy Brunner is a psychotherapist and hypnotherapist, and founder of European outpatient service, The Recover Clinic. Her first book, Find your true voice launches this month, while those who are interested can check out her one-to-one coaching program and online course, From Lost to the River. Alternatively, visit her website here and Instagram here. Dr Mariam Adegoke is a registered GP and founder of the Adegoke Wellness Clinic