onearetwoesses:

Speaking as someone who has dealt with mental illness personally for at least 7 years and who has self harmed on and off for that time, I want to give some advice to friends of people who are self-harming, suicidal, and/or suffering from a mental illness.

At the outset, I want to say that if your friend confides that they are feeling suicidal, do not panic. If they are telling you, it means they probably still see another option. Always remain nonjudgmental and mild. Do not react angrily or with accusations/ ridicule. Remember that you do not know your friend’s experience and that they are in dire need if they are considering suicide. Be gentle, compassionate, and clearly state your feelings. It is important to use very clear and sometimes wordy explanations of how you feel. If you are not very clear, you can easily be misinterpreted since your friend’s mindset is already greatly affected by depression/ hopelessness/ self loathing. Offer to stay with them (physically) if possible. There are also suicide hot-lines you can call for advice and that your friend can call. Make sure, in this case, to tell your friend that even if they do not see the possibility of a happier life, or even a life without unbearable suffering, that there are options and that you want to do whatever you can to help them try many different treatment plans.

The first general point that you should know is that there are resources online where you can learn about what your friend is experiencing (here and  here for a start). Look up their disorder or illness if you know what it is and find as much information as you can. Know that your friend may not necessarily have a mental illness, they may be reacting to outside stimuli. Generally, if someone is self harming or suicidal, even if they do not have major depression looking up depression can give you some insight into their experience. Personally, I know that this means a lot to someone who is struggling with self harm or a mental illness. It can be hard for your friend to answer your question “what can I do to help?” they may not know how to answer, since they may have no concept of what makes them feel better outside of self destructive habits. Letting someone know that you care enough about them to look up ways to help them without being asked, without having them hold your hand and ask, means a lot. It shows that you do not consider them a burden, that you are willing to put in the effort to support them.

Some more specific points about self harm: self harm (cutting, poisoning (this usually means overdosing at non fatal doses with medication), etc.) does not mean that your friend wants to die. In my experience, it is an effort to dull pain enough to avoid suicide (also look at the previous link to see what people who self-injure say about their reasons for doing so). It is a form of relief and a coping mechanism for people who practice it. This means that it can be extremely difficult to stop doing it or even that it is helpful to a person at a time of stress. If you know your friend is hurting themself, do NOT tell them that they have to stop, or force them to promise you to stop. Since it is one of the few things they have identified to give them relief, they may not be able to stop when they encounter a stressful situation of extreme sadness/depression/mood swings. Then, when they break the promise or “disappoint” you, they will feel even worse than before. In this state of depression, helplessness, and desperation, people usually feel worthless or even evil and malignant to the people around them. Their thoughts and feelings about themself may border on delusional with the extent of their self-hatred.

Therefore, it is very important to be gentle when expressing your concern. Some useful sentences are “I know that life is very hard for you right now,” “I know that self harm may give you temporary relief,” “I know you are in a lot of pain,” and “You are not selfish or a bad person for doing this”. When you have assured your friend that you are not judging them and that they are not a bad person, you can suggest therapy. In some situations, therapy may not be a viable option in this case the SAFE hotline (800) 366-8288 , and support groups are two free ways to get help. 

When suggesting that your friend start therapy it is important to understand that this is VERY difficult for someone who is severely depressed or dealing with a mental illness. One good example of how difficult it is from the perspective of someone with depression can be found here. It is very difficult to make a phone call or leave the house and finding a therapist is already a very demanding process. Make sure to tell your friend “I know that it is very difficult for you to seek help right now, it may feel pointless and like nothing will help now but I think you should give therapy a try.” Make sure to express how therapy has helped other people (I can attest to this!) and they may help you get a diagnosis and learn coping skills.

If your friend has tried therapy before and stopped, try to talk to them about why they stopped. If they didn’t like their therapist, that is very common. I, and many other people I know with mental illnesses, have gone through many therapists I didn’t like who were not helpful before finding someone who was helpful. Let your friend know that they can talk to multiple therapists and they do not have to stay with someone they do not feel comfortable with. They should not hesitate to find a new therapist. Also, for some people psycho-pharmaceuticals are necessary and therapy alone may not help. If they were in therapy previously and felt comfortable but didn’t see an improvement in their symptoms, you should recommend that they talk to their general practitioner, counselor (they can find free or cheap counselors at school if they are currently in school), or therapist. 

Another thing you can do to help are ask your friend if they would like you to look for therapists for them. In some cases, you may want to compile information about local therapists/ psychologists/ counselors/ and psychiatrists before asking your friend since they may reject the idea based on the thought that “therapy is too expensive” or that “it doesn’t matter” or “they shouldn’t go through all that trouble for me”. At this site you can search for therapists (and psychiatrists) by zip code, specialty, and insurance accepted. If your friend has insurance this can be very helpful. For people who do not have insurance you can try this resource. I haven’t used it but it may be helpful. If that isn’t helpful, use Google to look for “sliding scale therapy [your city/town/zipcode]”. Compiling information and getting cost estimates is one of the hardest parts when it comes to starting therapy and if you can help your friend do this or do this for them, it makes them much more likely to get help.

Final notes on what is note helpful and what is:

The attitude that your friend is simply “trying to get attention”, “dramatic”, or “selfish” is misguided. Even if your friend’s self harming behavior is not the result of a mental illness, it is indicative of a serious problem. They would not be going to the lengths of hurting themself when there is so much stigma and shame around those behaviors if there wasn’t a serious problem they were seeking relief from.

Eluding to how hard it is for you to “deal with” your friend’s depression, self harm, or talk of suicide, is more damaging than helpful. This reinforces the common belief that they are a waste of life or that they don’t deserve help. Instead, express how you truly care about them and want to stick by them. (Don’t make any promises you can’t keep like “I’ll always be here”, you cannot be sure that you will be able to do that indefinitely) Let them know that you are worried about them and think there is a better life possible for them. Stay away from expressing your pain about their illness/ habits, it is easily misconstrued in the depressed mind to mean something like “I am inconveniencing and hurting the people around me, I should be alone forever.”

Never act as though therapy or medication will “fix” the problem. These things take a lot of time. Some people cannot find relief (although you should encourage your friend to exhaust the possibilities). Even after starting medication, possibly even after medication seems to be helping, it can simply stop working. With therapy, it is common to uncover a lot of hurt and gets worse before it gets better. Make sure your friend knows that you support them throughout their treatment and are not done supporting them when they start therapy or medication.

Do not treat your friend as if they “are not trying to help themself.” If you do not have experience with mental illness you probably do not know how thoroughly it affects functioning. It distorts your thoughts in such an extreme way as to make it extremely difficult to accept and seek help. Be persistent in your contact with your friend, they may try to shut you out (as a result of feeling like a burden or like they are ruining your life, to avoid treatment), but it is important that you gently remind them that you care about them and want to help them have a happier life in any way, within your boundaries ,that you can. It is also helpful, if your friend is too anxious or depressed to leave the house, to offer to visit them instead of meeting outside their home. Accept that they may not feel up to hanging out, do not pressure them to do so, and understand that they may have difficulty communicating their needs to you so it is important that you remain non judgmental and mild tempered in these interactions. 

If you have read all this, your friend is lucky to have you. If you need anymore resources or help communicating with your friend, my ask is always open. This article is mostly geared towards situations that do not have some very noteworthy roadblocks like being under 18 or living with parents who are not supportive but I will tackle those in another post. Also, taking care of yourself is also important and I will address that in another post as well.