Be there for them

It can be difficult to know what to do when a friend or family member is going through a tough time.
It’s important to remember to continue reinforcing that you care and love them. Let them know you are always there for them and desire to understand what they’re going through. You always want to provide a listening ear and a shoulder to lean on.

You don’t need to be an expert to help a friend. 

How Can I Help?

Although we shouldn’t expect to get into specific details about what they’re doing in treatment (as that may be too personal, unless they want to share with you), we can ask about their experience.

• Was their first appointment how they expected?
• Did they like who they spoke to?
• How are they feeling now?

You can ask in what ways they’d like you to support them during their treatment. Just like when we initially bring up our concerns, we want to ensure we have these discussions in a safe place at an appropriate time. Don’t only ask them questions —  that may come across as prying. Share what’s going on in your life, too, and continue inviting them to do activities or get together.

REMEMBER: WE’RE IN THIS TOGETHER

Supporting Their Journey

Remember that mental health recovery is often an ongoing journey. Learn more below about what you can do at different stages of your friend or family member’s mental health journey.

During Counseling

Mental health counselors are licensed professionals who treat the cognitive, behavioral, and emotional aspects of mental health and substance use conditions in a variety of settings.

how do I ask how it’s going?

It can be hard to figure out how to ask your friend how counseling is going without sounding like you’re checking up on them and policing their behavior. Here are some ways to finesse the situation.

• Ask if they’d like you to check in
  It’s simple. It’s direct. And even if they say no at the moment, let them know they can change their mind anytime.
• Tell them you’re going to check in
  This is basically the same thing as asking, except it’s for your friends who you know won’t want to be an imposition.

“I’m going to keep checking in about how things are going at counseling. Just let me know if I’m getting on your nerves.”

• Open with a safe question asked in a safe place
  When you check in, try to start with an easy opening question. As always, have the conversation in a place where you’ll have some privacy.

Hey, how was your first trip to counseling? Was it like you thought it would be?

• Reinforce your desire to understand
  As you ask deeper questions, reinforce that you’re doing it so that you can better understand what they’re going through. Your friend doesn’t want to think you’re feeding off the drama of it, so reassure them you’re not. It also helps to drop in a qualifier every once in a while to soften your questioning.

You don’t have to answer this if you don’t want to…

when they stop going to counseling

People stop going to counseling for so many different reasons, from not feeling comfortable with their counselor, to running out of free or covered sessions, to completing their course of needed treatment – and every reason in between. Here are some tips for when they stop going.

• Be there and be open
  We can’t emphasize enough how important it is to keep the door open to your friends. Regardless of why they’ve stopped going to counseling, maintain openness and recognition that you know their journey will continue and you will be there to help understand.
• Pry delicately
  Sometimes, it’s going to take a little bit of prying to figure out why they’ve stopped going unless they’ve successfully completed counseling or hit a session limit. Other, more personal, reasons for discontinuing may require persistent, innocuous questioning.

How are things going with your counselor? Are you clicking?

What’s it like having to fit your counseling appointments into your daily life?

• Reaffirm their courage and persistence
  Regardless of why they discontinued, let them know how glad you are they had the courage to seek help. If you admire that courage, tell them so. Positive reinforcement goes a long way.
• If they didn’t click with their counselor…
  Take their word for it. They know better than you what they need in a counselor. So, if it wasn’t working for them, it wasn’t working for them. Accept that truth and ask if there are any other ways you can support them.

• • Many people see several different counselors before they find someone who works well with them. It’s normal not to end up with the right person on the first try, just in the same way you wouldn’t expect to marry the first person you dated. However, it can be discouraging to come to this realization.
  • If it’s not working out, it is perfectly okay for your friend to find another counselor. They won’t hurt their counselor’s feelings.
  • Finding a new therapist can be exhausting. As a friend, the most helpful thing you can do is proceed to give them alternatives and support their decisions.
• Give them alternatives
  Many people in distress find it hard enough to seek help the first time. But, if they don’t like their counselor or they are in some other way dissatisfied with their first experience, it’s that much harder to muster the energy and hope necessary to try again. As a friend, it can be helpful to validate their experience and offer help with next steps.
  • Maybe you want to plan a night in with your friend to look through Psychology Today’s database of providers – it allows you to see their picture, read about their specialty areas and approach to work, note what insurance they take, and more.
  • Once you have a list of options, sit down with your friend, express your willingness to help, and help them while they call to set up an initial appointment. You might even offer to go with them if you both feel comfortable with that.
  • Ultimately, if your friend is choosing to take a break from searching or counseling, you will need to respect their decision. It can be helpful to share that you understand where they’re coming from, even if you don’t agree, and that you will be there for them if they are ever interested in restarting counseling.
• Help with understanding payment options
  If treatment is covered by you friend’s insurance plan, help them find the mental health section of their policy and check to see whether pre-authorization for mental health treatment is required. Some insurance companies bury pre-authorization requirements in their policies as a way to create a loophole for not paying for a consumer’s mental health and addiction treatment.
  • After the passage of the Affordable Care Act (ACA), most insurance providers should have abolished lifetime limits on mental health and substance abuse treatment coverages. Yet, some people have to leave counseling because they don’t have insurance or because their insurance provider is not ACA compliant. Find more information on how health insurance works at Mental Health America, including copays, types of plans, deductibles, and more.
  • If a friend can no longer afford treatment or has run out of covered counseling sessions, searching for “[your state] counseling/therapy funding” could be helpful in finding non-profits in your area that are specifically for helping individual’s fund their mental health care. You can also try to find therapists that work on a “sliding scale” which means that they are willing to adjust their out-of-pocket rates to work with your budget.

During Intensive Outpatient Treatment

Intensive outpatient mental health treatment, sometimes known as a partial program or day program, is a more intensive treatment option than regular individual counseling or psychiatric appointments. Typically, these programs integrate several kinds of treatment options including individual therapy, group therapy, behavior modification, art therapy, music therapy, yoga and meditation, and even animal therapy. These programs will typically require a client/patient to attend daily (full days or half days) for a set amount of time. For people who need professional support and monitoring for more hours out of the day in order to stabilize their condition or maintain the early stages of recovery, outpatient treatment can be a great option.

how to relate

Intensive outpatient treatment programs get their name from the fact that clients only spend part of their days at the treatment facility. This is in contrast to inpatient treatment, wherein clients live at the facility and are monitored 24/7. Some students will leave campus for a semester or two in order to put their energy into a program (and other restorative pursuits). Others will maintain their student status and attend outpatient treatment part of the day, as well as regularly attend and complete classes.

Here are some broad suggestions for things to keep in mind when a friend is completing outpatient treatment:

• Admit you can’t relate (probably)
  Unless you have been there, you probably can’t relate. So, be honest that you probably won’t be able to understand, but you’re open to hearing as much as they’d like you to know.
• Ask them what would be helpful
  Do they need you to listen and provide direct support? Put those great active listening skills to use! Remind them you can be their source for the news they’re missing by not being on campus as regularly. Conversely, they may want to just sit in silence and enjoy your presence without any expectations. They’re likely doing a lot of talking and processing in therapy. Don’t hesitate to ask directly whether they want to talk about the treatment process and their program, whether they want to talk about other things all together, or whether they want to sit in silence (or maybe in front of Netflix or an Xbox).
• Keep telling them things about your life, too
  If you would have usually rushed to tell them about a problem you’re having, a great date you went on, or a class you’re taking, don’t stop doing that. The fact that your friend is a little bit disconnected from campus life doesn’t make them any less of an outlet or resource. In fact, it may make them even more credible on some issues.
• Care packages
  Make sure your friend knows they’re not forgotten while they’re doing the hard work of treatment. Consider having all of their friends sign a card, get them a book they’d find inspiring, or send them a package of completely disparate things like stuffed animals, comic books, puzzle books, etc.
• Keep showing up
  You might have to get creative about how to see and connect with your friend. Outpatient treatment is often a huge commitment – they’re doing good, hard work for hours a day and may even have homework in addition. They’ll likely be busy and exhausted. If you can, offer to do the work of traveling to them. Maybe they can only see you for very brief hang outs, even as little as 15 minutes. Perhaps, you might try a video call if you can’t connect in person.

how do I keep them included?

• Ask how they’d like to be included in the lives of their friends despite their busy schedule and/or distance from campus
  Simple as that. What kinds of things do they want updates on? What would they rather not know about? What kinds of outings might they be able to join you for? Do they want to have a movie night online? Watch movies or YouTube videos, play games, and more together from anywhere using apps like Hyperbeam, Rave, or Kosmi.
• Keep inviting them to standard friend outings and events
  Even if they can’t come, it’s always nice to be invited and feel like people haven’t severed ties. No matter who you are or what you’re going through, it’s nice to feel like you belong and that you’re genuinely missed.
• Keep sharing information and asking their advice
  Keep the relationship open in both directions so that they feel like they can lend friendship and support to you, too.

when they stop going

People quit going to outpatient for a million different reasons, from not feeling comfortable with the program, to running out of covered sessions, to completing their course of needed treatment and every reason in between. Here are some tips for when they stop going.

• If they completed the program, celebrate it!
  If they completed their outpatient treatment program, that’s cause for celebration! Ask them how they would like to celebrate this big milestone and achievement worthy of recognition.
• Be there and ask how you can support them best
  Whether they completed the program or quit a bit early, ask how you can continue to provide support in the way they need.
• Check in with them periodically
  This is garden variety good friend stuff. Generally, people will check in a lot and offer to help in the month after someone begins treatment for any illness, and then people adjust and kind of forget about it. Keep checking in. Keep offering to cook them food or run an errand for them while you’re out. Whatever it may be, it goes a long way.
• If they left, ask how you can help them explore other options
  Outpatient treatment programs are not one-size-fits-all. Your friend gets to be the authority on whether a treatment program was helping. If it wasn’t, trust them, accept that fact, and move forward.
  • Many people in distress find it hard enough to seek help the first time. But if they didn’t like their first program, it’s that much harder to muster the energy and hope necessary to try again. As a friend, do as much as you can to push them toward a fresh start.
  • Track down a list of other providers and programs that accept your friend’s insurance or offer services on a sliding scale. Call them or check their website to find out if they’re taking new clients.
  • Once you have a list of options, sit down with your friend, express your willingness to help, and help them call to set up a next initial meeting. You might even offer to go with them to check it out and register if you both feel comfortable with that.
• Helping with payment
  Some treatment providers do not take insurance or are considered “out-of-network” by some insurance plans. Friends should check into this before seeking treatment. Otherwise, they may run out of money to pay for their services out-of-pocket very quickly.
  • If your friend is covered by an insurance plan, help them find the mental health section of their policy and check to see whether preauthorization for mental health treatment is required. Some insurance companies bury preauthorization requirements in their policies as a way to create a loophole for paying for a consumer’s mental health and addiction treatment.
  • After the passage of the Affordable Care Act (ACA), most insurance providers should have abolished lifetime limits on mental health and substance abuse treatment coverages. Yet, some people have to leave counseling because they don’t have insurance or because their insurance provider is not ACA compliant. Find more information on how health insurance works at Mental Health America, including copays, types of plans, deductibles, and more.
  • If a friend can no longer afford treatment or has run out of covered counseling sessions, searching for “[your state] counseling/therapy funding” could be helpful in finding non-profits in your area that are specifically for helping individual’s fund their mental health care. You can also try to find therapists that work on a “sliding scale” which means that they are willing to adjust their out-of-pocket rates to work with your budget.

During Hospital Stays

Not everyone who needs or wants therapy will ever need to be hospitalized (a.k.a. inpatient treatment), but some will — and that’s okay. Going to a hospital is simply what you do to get the right level of care when in crisis. The goal of inpatient treatment is always to get your friend stable enough to continue their treatment in the community.

you just have to be there

Let’s stop pretending we’re all comfortable being in a hospital or treatment facility when nearly none of us are — whether patient or visitor.

It’s not a natural environment and it can feel like a completely foreign country where we don’t know the language. It’s not somewhere most people inherently want to go or stay, even if they recognize the importance of being there for their own or a loved one’s health and safety.

Remember, you don’t have to pretend to like the hospital environment — you just have to be there.

holding their place on campus

For inpatient mental health treatment, patients live at the treatment facility 24/7 and most often need to take a leave from their studies to complete a course of inpatient treatment.

Here are some ideas for holding your friend’s place on campus while they’re gone:

• Think ahead about what it might be like when they return
  Preparing yourself emotionally and thinking about how your boundaries might have to grow and change is important.
• Keep a list of keywords or phrases
  These represent information or stories that will be essential for them to know when they return.
• Factor them into future planning whenever possible!
  Having something to look forward to goes a long way.
• Stay in touch
  This can be hard depending on the restrictions of the treatment facility. Find out what kinds of restrictions there are on phone calls and determine whether email might be a good medium.
• Don’t take it personally if you haven’t heard from them in a while
  Let your friend know that you understand none of this is about you, and you’ll be there when they need you. Reassure them that you’re fine, and help relieve some of the guilt they might have for being out of touch.

when they return to campus

It can be a little awkward for everyone when someone returns from time away in treatment. Just accept it and move on. Do your best to catch your friend up, check in with them about how they’re doing and what their comfort level is with various situations. If they aren’t able to jump into the typical campus “going out” scene, get creative and do something fun and that’s safe for everyone.

• Welcome them back and keep inviting them to do things
  We’re not talking about scheduling big, exciting, out-of-the-ordinary events. Invite them to a meal or movie. Invite them to binge watch a TV show. They don’t have to accept all of the offers, but they will understand that you want them to be included.
• Make sure they’re plugged into resources
  Are they connected to the providers/clinical care they need now that they’re back on campus? Have they visited the disability services office/coordinator on campus? That office might have some valuable resources to offer. Some schools have special programs, resources, or even support groups for students returning to campus from leave. Investigate all the possible available resources and help your friend get connected to them.
• Avoid difficult situations together
  If you’re concerned about putting them in a difficult situation, particularly with alcohol or drugs, tell them honestly that you’re concerned or consider not going. Critical note: Don’t make them feel like you changed your plans because of them!
• Check in and ask what they want to do
  They may not want to do anything that requires talking — treatment may have them all talked out. If they’re having trouble offering up an activity, give them some options that range in the level of necessary engagement.
• Don’t expect miracles
  All of us have fluctuations in our mental health, and it’s normal for people to take steps forward and steps back during their recovery journeys.
• Reinforce their courage
  Not everyone seeks help and does the work of treatment, because it takes courage and persistence. Reinforce how courageous they are and what you admire about them.

During Recovery

When it comes to mental illness, recovery can mean different things. For some people, it will mean no longer having symptoms of their mental health condition. For others, it will mean managing their symptoms, regaining control of their life, and learning new ways to live the life they want.

how to start the conversation

It can be hard to figure out how to ask your friend how their recovery is going without feeling like you’re going to somehow bring up bad feelings or make them feel like they’re being watched super closely. The truth is, you’re probably way more uncomfortable than they’ll ever be about it.

Here are a few tips:

• Ask if they’d like you to check in and how much is too much
  It’s simple. It’s direct. And even if they say no at the moment, let them know they can change their mind anytime.
• Tell them you’re going to check in
  This is basically the same thing as asking, except it’s for your friends who you know won’t want to be an imposition.

“I’m going to keep checking in about how things are going. Just let me know if I’m getting on your nerves.”

• Open with a safe question asked in a safe place
  When you check in, try to start with an easy opener question. As always, have the conversation in a place where you have a little privacy.

Hey, how have you been feeling?

• Reinforce your desire to understand
  As you ask deeper and deeper questions, reinforce that you’re doing it so that you can better understand their recovery process. Your friend will likely be glad that you’re asking and wanting to be supportive. It also helps to drop in a qualifier phrase every once in awhile.

You don’t have to answer this if you don’t want to…

• Be there for the highs and lows
  Your friend is likely to have good days and bad days, good weeks and bad weeks, good months and bad months in recovery. Most mental health disorders are lifelong conditions, but with proper ongoing treatment and services, 70-90 percent of people experience significant reduction of symptoms and improved quality of life.

• • Be there to help your friend get through the tough times and celebrate the good times.
  • When they hit a rough patch, remind them about the progress they’ve made and keep them hopeful about all the skills, tools, and patience they’ve gained to get themselves to a bright patch again.
• Remember: Recovery is different for everyone
  No two paths through recovery look alike, and they are rarely linear. Continuing to gently check in is important — even five or 10 years later.

restoring humanity

Most of the time, people who are in recovery from a mental illness have spent a lot of time being treated like an illness instead of a person. They are often seen as only “bipolar,” or “depressive,” or “alcoholic,” or “bulimic,” oftentimes throughout their treatment process. So, when you decide to support them on their path to health and wellness, one of the first things you need to do is restore their humanity.

• Don’t pretend it didn’t happen
  You know they’ve been struggling with their mental health. They know that you know. So why ignore it and act like everything is, and has always been, totally fine? Tell them you’re open to hearing more about what has been going on, catch them up on things they might have missed, and check in with them when you think, “Hey, I wonder how they’re doing.”
• Remember: Your friend still wants to be involved in your life
  If you used to ask your friend for advice, continue to do that. If you used to invite them to movies or concerts, continue to do that. If you have drama going on in your life, vent to them about it. The thing about a lot of common mental illnesses is that when people reach the recovery stage, they have a tendency to be even more insightful and empathic, and most of all, they want to get back on a path of feeling like themselves again. So, help them practice at being the fun, generous, engaging, authentic human they always have been but haven’t always been able to see.
• Resist the urge to hold a grudge
  Yes, many mental illnesses cause people to withdraw from friendships, be irritable, and make others worry about their safety and well-being. And all of that can be really taxing for friends — no matter how superheroic they may act. It would be easy to keep holding a grudge about who they were when they were struggling, but try not to. Over the course of their recovery, elements of your friend as you always knew them will begin to reappear. Encourage that. Reward that.
• Watch movies or play video games
  Sometimes, there’s this tendency for friends to want to keep their friends in recovery busy all of the time — doing things they used to enjoy — especially toward the beginning of their recovery journey. Pump the brakes a little, though. At the beginning, and throughout the recovery journey, doing something passive like watching a movie or playing video games can be just as valuable. Often, when we engage in these kinds of activities together we remember something funny to share, we make jokes, we make fun of each other a little bit — we are our most authentic selves. So, fire up Netflix and the Xbox.
• Don’t push or pull
  It’s super cool when any friend is willing to walk alongside someone in recovery, but sometimes we struggle with trying to push or pull them along too quickly. There’s no deadline for reaching the point of “getting better.” It takes as long as it takes, and it’s a process. Don’t beat yourself up if you feel yourself pushing or pulling, but definitely stop, take a breath, and remember that your only job is to walk alongside them. It’s the only way you’ll be able to help them if they stumble.
• Be exactly who you are
  If you’ve been reading these resources, then you’re a good and true friend. Your compassion and empathy are off the charts. You’re a superhero. You don’t have to pretend to be someone you’re not for your friend’s benefit. You benefit them most by being exactly who you are, showing them your flaws, apologizing when you screw up, and walking beside them all along the way. You’re incredible, and we’re so glad your friend has you.

if they relapse

Relapse is common to many types of illnesses. Yet, we tend to attach moral judgment when people with mental illnesses relapse, as though it’s a character flaw if they aren’t able to sustain their recovery flawlessly. Here’s the thing: if we want to be good friends, we can’t see relapse this way.

• Relapse is a side effect of the recovery process
  Recovery is difficult and exhausting. It often requires a total reprogramming of the way someone has interacted with the world for a while now. What’s more, it often involves the rebuilding of old relationships, grief over those that are irreparable, and the development of new ones.
  • We are most vulnerable to relapse when we are most exhausted — that’s when the triggers sneak in. Instead of thinking about relapse as “back to square one,” think about it as a point far down your friend’s recovery path.
  • Think of it as an obstacle you expected to encounter along the way. Help them recognize it, get their footing (and the professional support they need), and move forward.
• “You should know better” isn’t helpful
  Sure, many of us who struggle with a mental illness should be able to spot the signs of relapse better than anyone and intervene on our own behalf before it gets too bad. And sometimes we do this flawlessly. Other times, we want to believe that our depression, anxiety, or eating disorder is gone for good — that the negative way we’re feeling in that moment won’t last. So, we put off asking for help. A good friend checks in regularly, asks about symptoms, reserves judgment, and helps steer the conversation toward what the best next steps might be.
• Take care of yourself
  If you’ve been closely connected to your friend’s journey so far, you might have a lot of feelings about relapse. You might be angry or feel your sense of hope shaken. Do you, and your friend, a favor and make sure you’re getting the support you need to deal with these emotions, reactions, and challenges. Don’t hesitate to make yourself an appointment with a counselor or therapist.
• Get in touch with hope again
  Many people have been where you and your friend are now. See if you can connect them with someone living well with the same situation your friend is facing and made it through to the other side — through relapse AND recovery again.
  • Maybe it’s a professor on your campus or a friend in your community.
  • You might find this person through a support group like Alcoholics Anonymous (A.A.) or Al-Anon/Alateen.
• Be there
  Relapses can be little blips, or they can be significant setbacks. Either way, your friend will need you. Use the other resources in this toolkit to be there when the darkness of a mental illness creeps back in and remind your friend that you’ll be there for them no matter what, all they need to do is reach out.

Discussing Disclosure

When your friend changes their routines in order to accommodate counseling appointments, they might feel the need to make a decision about who they’re going to tell and who they’d like to keep at arm’s length. Here are some tips for guiding the conversation.

• Who else do they want to know?
  Help them develop a list of people who they’d like to tell about their situation, what their goals are in telling them, and how they expect that person to respond. This will help both of you understand who is be safe to approach and able to provide positive benefit to your friend’s treatment and recovery process.
• How should they share?
  Figure out the best method of telling the story given the outlets they have available. Face-to-face is often best, but it isn’t always possible. Phone calls can be good, too. If they want to write it, encourage an email over a text and remind them that communicating tone is going to be just as important as the facts of the story.
• Who do they not want to tell and how can you help them keep it private?
  People get to disclose their mental health struggle in their own time, to the people they choose. It’s not up to anyone else to out them unless expressly requested to do so. If there needs to be a cover story, make sure they’re consistent, and do your best not to say anything that would out them against their wishes.
• Maintaining trust: Not outing them
  A big part of maintaining your friend’s trust around disclosure is demonstrating that you won’t out them. Try to resist doing so at all costs.

I don’t know. Maybe you should ask them.

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The content on this site is intended for educational purposes only and should not take the place of talking with your doctor or healthcare professional. It should not be used for diagnosing or treating a health problem or disease. If you have any questions about your medical condition, talk to your healthcare professional.