How to Help a Friend Who May Be Struggling with Mental Health Issues

Does my friend have a mental illness?

Hello, Doctor: I have a friend (A) born in 1978 who was very cheerful during college.
After graduating, she started working while preparing for the Western medicine licensing exam, but she failed three times.
In the workplace, it seems she experienced some harassment; according to A, her supervisor did not directly infringe upon her, but there were occasional inappropriate jokes.
The work environment was not very good, and about six months later, she realized it did not align with her interests and resigned.
She has maintained intermittent contact with friends around her and seemed fine.
Later, A planned to go to Australia for a working holiday (around March 2014), but she could not get her family's consent.
The last time we contacted A was during her grandfather's illness (May 2014), when she mentioned wanting to return to spend time with him as he might not have long to live.

A month later, we started losing contact with her; she did not respond to phone calls or messages.
Eventually, we discovered that she had locked herself in her room, only eating and showering at night.
It was reported that she had told her family she had plans for certain times, so her father believed she would come out at those times (A was 28 years old).
She would only emerge to eat or shower, keeping her door locked.
Friends who tried to visit received no response, and she was not very communicative.
This state has persisted for quite some time (although she did come out for a few days during which her family said she was joking and laughing with them, and she went for an interview but was unsuccessful, after which she isolated herself again.
Her family mentioned that she wanted to succeed before facing the world again, but she never disclosed what she was doing in her room).
Her father has always believed she had no issues and did not take her to see a doctor.
He mentioned that A had previously locked herself away for a week but then returned to normal, so he delayed seeking medical help for her.
We really want to help her but do not know where to start.
We want to understand the reasons behind her behavior, but we cannot communicate with her.
Doctor, do you have any suggestions on how we can approach our friend or encourage her to seek medical attention? We are afraid that taking action might worsen the situation, and we are uncertain if there are any underlying mental health issues...

Ye, 20~29 year old female. Ask Date: 2015/10/23

Dr. Ding Shuyan reply Psychiatry

Hello, generally speaking, even non-professionals can often recognize the possibility of mental illness, which indeed increases the likelihood of someone being unwell.
However, someone who stays at home all day and avoids social interactions may have a high chance of having a mental disorder.
With the advent of the internet, smartphones, and tablets, I cannot definitively say that such behavior indicates a problem.
The issue is that she still has parents and family members; even if there are various incomprehensible reasons for her reluctance to let outsiders show concern, our desire to help may put us in an awkward position.
If there are classmates who have previously interacted with her family and are familiar with them, it might be helpful to ask those classmates to visit her home and check in on her to see what assistance she might need.
Perhaps after some time, if she continues to withdraw, her family's attitude may change, and they may become willing to seek medical help for her.
In some cases, her family may still lack medical understanding and believe that she has no issues.
In such situations, it might be advisable to visit the local village chief or health center near her home to inquire if they are aware of her family situation and whether they could conduct a home visit to provide assistance.
However, this could potentially strain your relationship with her family, so it is important to consider whether this course of action is worthwhile.
Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2015/10/23

More Info

Helping a friend who may be struggling with mental health issues can be a challenging yet crucial endeavor. Your concern for your friend, A, is commendable, and it's important to approach the situation with sensitivity and understanding. Based on the information you've provided, it seems that A has been experiencing significant distress and withdrawal from social interactions, which can be indicative of underlying mental health issues such as depression or anxiety.

Understanding the Situation
A's history of being outgoing and then suddenly withdrawing from social interactions is a common pattern seen in individuals dealing with mental health challenges. The fact that she has isolated herself, only emerging for basic needs, suggests that she may be experiencing severe emotional distress. The previous experiences of workplace harassment and repeated failures in her medical exams could have contributed to her current state of mind. Additionally, the stress of her grandfather's illness may have compounded her feelings of helplessness and sadness.

Steps to Help Your Friend
1. Open Communication: While it may be difficult to engage A in conversation, it's essential to express your concern in a non-judgmental way. You might consider sending her a message or a letter expressing your feelings. Let her know that you care about her well-being and that you are there to listen whenever she feels ready to talk. Avoid pressuring her to respond immediately.

2. Encourage Professional Help: It’s crucial to gently encourage A to seek professional help. You can suggest that talking to a therapist or counselor might provide her with the support she needs. Frame it as a way to help her cope with her feelings rather than implying that she has a problem. If her family is resistant to the idea, you might consider discussing the benefits of therapy with them, emphasizing that mental health is just as important as physical health.

3. Involve Trusted Individuals: If there are other friends or family members who are close to A and share your concerns, consider discussing your worries with them. A united front can sometimes be more effective in encouraging someone to seek help.

4. Be Patient and Available: Recovery from mental health issues can be a slow process. Be patient with A and let her know that you are there for her without judgment. Sometimes, just knowing that someone cares can make a significant difference.

5. Educate Yourself: Understanding mental health issues can help you provide better support. Familiarize yourself with the signs of depression and anxiety, and learn about the resources available for mental health support. This knowledge can empower you to approach the situation more effectively.

6. Respect Her Space: While it’s important to reach out, it’s equally important to respect A’s need for space. If she is not ready to talk or engage, let her know that you are there when she is ready. Avoid overwhelming her with messages or visits if she is not responsive.

7. Suggest Activities: If A shows any willingness to engage, suggest low-pressure activities that she might enjoy, such as going for a walk, watching a movie, or doing a hobby together. These activities can help her feel connected without the pressure of deep conversations.

8. Monitor for Crisis Situations: If at any point you feel that A is in danger of harming herself or others, it is crucial to seek immediate help. This may involve contacting a mental health crisis line or emergency services.

Conclusion
Supporting a friend with potential mental health issues requires a delicate balance of empathy, patience, and encouragement. Your role as a supportive friend is invaluable, and by fostering open communication and encouraging professional help, you can help A navigate through this challenging time. Remember, while you can provide support, ultimately, the decision to seek help must come from her. Your concern and willingness to help can be a significant first step in her journey toward recovery.

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