Friendship and mental health
Our friendships are among the most valuable relationships we have. We gain in various ways from different friendships. We may talk to friends in confidence about things we wouldn't discuss with our families. Our friends may annoy us, but they can also keep us going.
Friendship is a crucial element in protecting our mental health. We need to talk to our friends and we want to listen when our friends want to talk to us. Our friends can keep us grounded and can help us get things in perspective. It is worth putting effort into maintaining our friendships and making new friends. Friends form one of the foundations of our ability to cope with the problems that life throws at us.
"The best thing my friend did for me was that they just accepted me as I was."
"They kept coming to see me even though I didn't seem to want them and they made me laugh."
Why is friendship important when someone is unwell?
When someone has a mental health problem or is experiencing mental distress, it is important to try to keep friendships going, even though people with mental health problems often want to see their friends less than usual.
Friendship can play a key role in helping someone live with or recover from a mental health problem and overcome the isolation that often comes with it. It's natural to worry when a friend is troubled and most of us don't want to give up on a friend in distress, however difficult it may be to support them. Many people who do manage to keep their friendship going feel that it's stronger as a result.
Friendships work both ways. A mental health problem doesn't mean that you're never able to support or laugh with someone else.
"My friend helped me to get a grip on myself by making it clear it wasn't acceptable or safe for me to allow my condition to dominate my life."
How does mental ill health affect friendships?
- People with more severe forms of mental illness have smaller social networks than others and have more family members than friends in their social circle.
- People with smaller social networks, with fewer intimate relationships, find it more difficult to manage social situations.
- People with more long-lasting mental health problems often have relationships mainly with other people with mental health problems.
- People with mental health problems often anticipate rejection from other people because of the stigma associated with mental health. They may avoid social contact, as a form of 'self-stigma'.
How can friendships change?
"She has just been diagnosed as being bi-polar. When she drinks she gets very upset and angry so we rarely invite her to join us when alcohol is involved. I also make more of an effort to listen."
Friendships change and sometimes they fade away or end abruptly. You may want to take time to reflect on each of your friendships and what they offer you.
You are an active partner in your friendships. If a friendship is not beneficial to both of you, you have the power to negotiate changes to the activities you have always done together. On some occasions, you may decide that it's best for a friendship to end.
If a friend no longer contacts you, it's understandable to feel rejected, but you are not responsible for other people's reaction to your problems. If one person ends your friendship, it doesn't mean that others will do the same.
If you are the friend of someone experiencing mental health problems who seems to be withdrawing from your friendship, try to understand what your friend may be going through. Their difficulties may be only temporary. Give them the space they need and make sure they know how they can contact you at a later date if they decide to get back in touch.
Should I tell my friend about my problem?
Some people never make it past the first hurdle: talking about the fact that they are experiencing mental distress. If you have a mental health problem, you may feel ashamed of 'admitting' to it. You may feel that you are bothering your friend or fear being labelled.
You don't have to tell your friends - and you certainly don't have to tell everyone. There is no need to tell anyone about what you are experiencing if you don't feel comfortable with it. Some people find it helpful to draw up a balance sheet of the pros and cons of telling or not telling people about their problem.
Tough as it can be, talking to close friends can be important for both of you. Even if you don't talk about it again, having the issue out in the open means that you don't have to worry about mentioning it by accident or 'explain away' medication or appointments. It may also make clear why you may be behaving in a particular way or why you don't want to go out or talk to them much.
"I wanted my friends to know so they ... would cut me some slack if I behaved oddly ... don't think I'm just ignoring them ... could help me."
How do I tell my friend?
Pick a friend you trust as the first person you tell. Work out how to talk about your mental health problem in a way that will make it as easy as possible for both of you to avoid embarrassment.
You may want to practise your opening sentence or you may want to play it by ear. Choose a time and a place where you will both feel comfortable. You may want to think about whether:
- the place is quiet or noisy, indoors or outside
- you are on your own or among other people, for instance in a pub or cafe
- you are doing an activity together, such as going for a walk, or just sitting down for a chat.
You could phone or write to your friend, but if you do, try and talk to them face to face afterwards as well.
Some people react dramatically to news like this. Be ready for your friend to be shocked or not to take it in at first. Although mental health problems are common, this may be the first time they've heard someone talk about having one.
They may feel awkward and not know how to respond. This may be because they feel so worried about you or perhaps your news has struck a chord with something in their own life. They may even suggest that you're fine and just need to 'pull yourself together'.
Most people don't know very much about mental health issues so it may be a good idea to tell your friend about the problem itself, but don't overwhelm them. Take it one step at a time.
How should I respond to hearing about my friend's problem?
If you're the friend of someone with a mental health problem, you may be concerned about them. The most important thing is to tell them that you're still their friend. If your friend is comfortable with being touched, a hug shows that you care about them and that you accept them whatever problems they are having.
"My friend asked me questions, didn't just assume things, she really wanted to know."
Take your cue from your friend. Are they comfortable with questions or would they rather talk about something else? Don't promise things you may not be able to deliver. How can you help them best?
How can I support my friend?
"My friend realised I had taken an overdose and rang for an ambulance... but has never judged me or criticised my action."
People with mental health problems often need different things from their friends at different times and friends show their support in different ways.
"They let me know I could call them whenever I needed to."
If you're the friend, the most valuable support you can provide is just being there to talk and listen. People really appreciate that their friends have made time to contact them, visit them and invite them round.
Mental health problems are so misunderstood that someone who acknowledges your problem, continues to accept you and treats you with compassion is doing something extremely important to aid your recovery.
"My friend phoned me, talked to me about normal stuff, sent me letters, took me out sometimes."
Your friend isn't looking for another mental health professional and should expect nothing more than your affection and your support as a friend. Some people with mental health problems want to go on being as 'normal' as possible with their friends and that may mean continuing to laugh and have fun together. They don't want to be identified by their problem, even if you need to adapt some of the activities you used to do together.
"I didn't know how often to ask 'how she was' (especially in front of other people)."
However, someone who insists that they're 'fine' may actually be in a pretty bad way. They may just need to talk or they may need professional help. Men are often particularly reluctant to talk about emotional issues.
Practical help can be valuable, too. Cleaning, shopping and basic household tasks can seem impossible to someone who is having a difficult time. Many people really appreciate friends who help them manage their finances or take them to appointments - or indeed just take them out. Another form of practical help is by tracking down information - for example about therapies, organisations and services.
If you feel more comfortable offering practical help than emotional support, explain this to your friend. It is important that you acknowledge their distress, even if you don't talk about it much.
Understanding your limits
If you're miserable, suicidal, confused or having mood swings, you're not likely to be your 'usual self'. It's intensely frustrating - for you, and for everyone around you - to realise that you don't feel up to doing the things you used to take for granted such as going to work, seeing your friends, getting exercise or playing with your children.
If you can't go out - or you can't get out of bed - you become increasingly isolated and perhaps hard to be with. And if you show other symptoms like hearing voices or you're convinced that someone is doing you down, it's hard for you to talk to other people and it's very hard for them to talk to you.
"I gave my friend a lot of support and at times felt close to burning out. Now that my friend has recovered we are closer than before. However, I worry that I might not be able to cope with another episode."
Friends who do hang on in there can feel out of their depth, frustrated or emotionally drained. You may feel that the person you used to know has changed and so has the balance of who needs whom in the friendship.
"It is difficult to manage the friendship so it still feels balanced."
Some people reach the point where, instead of being a friend, they feel they've become more of a carer. You may feel responsible for your friend and worry about what would happen if you weren't around. It can be painful and embarrassing - on both sides - to admit that this is happening and it can be hard to get the balance back, even if your friend's mental health improves. But you don't need to cope alone and setting clear limits to the support you can give is not the same as rejecting your friend.
Mental Health First Aid
These are five steps that research shows can help people with mental health problems:
- Assess risk of suicide or self-harm
- Listen non-judgmentally
- Give reassurance and information
- Encourage the person to get appropriate professional help
- Encourage self-help strategies.
Others sources of support
If you have a mental health problem and you're worried that you're making too many demands on your friend, one of the most important things you can do is thank them. Make it clear - in words or actions - that you appreciate what they are doing for you.
Your friendship may change for a while or it may change permanently. However, it doesn't have to vanish. Nor does it have to take over your life. Underneath everything that is going on, you're still the people who became friends in the first place. We all have our ups and downs and need the support of our friends.
Friendship is worth sticking with
If you don't want to turn to your friends, or your friends just don't want to listen or you want to take some of the pressure off them, there are other forms of informal help.
Self-help and peer support groups are often useful. You may have little in common with everyone else in the room, but you will share one thing.
You could join a group centred around an activity: a book group, a chess club or an exercise class.
If you don't want to join a group, try going to places where there are lots of people. You could go to your local library. Leisure centres usually have cafés. You don't have to talk to other people if you don't want to, but will be in company while you sit with a drink and a newspaper for a while.
If you've got internet access, online communities can also be supportive, whether or not they are focused around mental health problems. It can be reassuring to know that this is an arena where nobody knows anything about your personal life.