What to Do When a Friend Is Struggling with Their Mental Health

Handling our own mental health can be hard enough, but the stress, uncertainty, and feelings of helplessness that can come with the realization that someone we care about is struggling can, at times, feel even harder. If you’re not a mental health professional yourself, it can feel so challenging to walk the tightrope of not overstepping boundaries while offering the support you know they need, while also making sure that your own cup remains full. All in all, it can feel like trying to assemble IKEA furniture without the instructions. So today, let’s talk about how to navigate this particularly delicate situation with empathy, understanding, and practical steps.

Identifying the Signs

Like all good, fictionalized therapists have said in TV shows immemorial, the first step towards fixing a problem is recognizing there is one. While most of us don’t actually say that (well, not too often, anyway), it’s not off the mark. But given the rise of rather extreme memes and hyperbolic social media posts about mental health struggles, recognizing that the people we care about are struggling can be a bit like spotting hidden treasures in grandma’s attic: sometimes, you need to look closely.

  • Has your friend been withdrawing from social activities they used to enjoy? 
  • Are they ignoring messages or responding with more “viewed” or “liked” responses rather than actually engaging with you? 
  • Are they showing sudden mood swings or changes in their behavior; even ones that may seem “fun,” like drinking or “partying” just a bit more than usual? 

These could be signs that something might be amiss. 

Starting the Conversation

So, now the big question: how do you broach the subject with your friend? It can feel a bit like preparing for the big presentation at work: you want to get it right and it feels like you’ve only got one shot. So, start by taking a breath and reminding yourself that this isn’t a once-and-done situation. You can normalize connecting about mental health in a low-key and relaxed way. First, begin by choosing a comfortable and private setting. Express your concern in a direct, but nonjudgmental way. You could say something like, "Hey, I've noticed you seem a bit down lately, and I’d love to hear how you are."

Don’t be surprised if their first response is to brush it off, make a joke, or give a stock “I’m fine.” While it’s essential to respect their boundaries, this is a great time for a compassionate follow-up. It can be as simple as: “No, really, I’d love to hear what’s going on” or, if you want the advanced therapist trick, sometimes the best response is…nothing. Just try to remain silent (this is what relationship experts mean when they talk about “holding space”). Just keep looking at them and, with your silence, give them a few moments to collect themselves and see what might come out.

If they continue to balk, or assert their “fineness,” let them know you’re happy to hear that, and that you're there for them whenever they need. After that, just step back into your normal relational dance, connecting and showing up for them as usual. Sometimes, like a plant needing water, people just need a little time before they’re ready to open up.

Listening with Empathy

When your friend does decide to open up, it's crucial to listen actively and empathetically. Think of it as being the best audience at a stand-up comedy show—attentive, supportive, and listening way more than talking. Validate their feelings without judgment and avoid offering solutions unless they specifically ask for advice. Remember, the goal here is to get them talking and opening up about their inner world, not to take their problems away (as much as we might like to!).

Here's a practical tool: engage with active listening with a skill called paraphrasing. Start with the phrase “so, what I’m hearing is…” and then repeating what your friend says in your own words. A paraphrase will generally be a simple repeating of the specific details of their story, and it shows that you're truly engaged and want to understand their perspective. For example, "So, what I'm hearing is that you've been feeling overwhelmed at work?" This is a profound skill that can pay amazing dividends in all of your relationships.

Busting Myths and Stigma

Talking about mental health and personal struggles is much, much easier than it was even just 10 years ago, but remember that there remain tons of myths and stigma around acknowledging our mental health challenges. While true across the board, this social pressure towards silence is particularly pernicious for those who identify as men. Help your friend understand that seeking help isn't a sign of weakness but a courageous step towards healing. Bust the myths and stigma surrounding mental health together.

Promoting Self-Care

Self-care is a major buzzword these days and with a multi-billion dollar “self-care” industry shilling an ever-expanding list of products and activities you “have” to try or you’re just not doing it right (I’m looking at you, cold plunge…), self-care can feel like just another item on our collective “to-do” list. This can feel overwhelming at best and cause increased self-blame and self-criticism at worst.  Chances are, your friend knows they need more sleep, or a walk in nature. When our mental health is suffering, finding the motivation to actually do it is the problem. So be a bridge to their self-care by encouraging them to join you on yours. Invite them for a walk at the park, a home-made spa day, or a cozy Friday night sleepover complete with “Netflix and Naps.”  Don’t just remind them it’s important to stay hydrated on a hot day, actually bring them a glass of water and help yourself to one at the same time! Self-care doesn’t have to be a solo activity; in fact, it’s often best when it’s shared. 

Encouraging Professional Help

Of course, sometimes a friend's mental health struggles may require more support than you can provide. That's when it's essential to gently suggest seeking professional help. Just like you'd recommend a mechanic if you saw your friend’s check engine light was on, reminding them that help is out there and, in some cases, even suggesting specific practices or clinicians you’ve found online can be the nudge they need to take this incredibly important step (personal bias duly noted!).

You could say, "I really care about you, and I think speaking to a therapist could be incredibly helpful. They're experts in this stuff." Offer to help them find resources or accompany them to appointments if they need that little extra nudge.

Being Patient and Persistent

Mental health journeys are often winding roads; be patient and persistent in your support. Check in on your friend regularly, even if it's just a simple text to let them know you're thinking of them or a meme that made you laugh. Feelings of isolation and loneliness can lead to less interaction with those we care about which spiral into, you guessed it, more isolation and loneliness. Never underestimate how much showing up consistently in even small and subtle ways can have significant impacts on those we care about.

But remember, you can't pour from an empty cup. Take care of your own mental health too. It's like they say on airplanes: secure your oxygen mask before assisting others. And if you’re concerned about a friend’s mental health, or your own, click here to connect with one of our amazing therapists ready to help you on your journey. Or book an appointment with me in North Carolina. 

Lifeologie has resources to help support your mental health. Read more about signs and symptoms of struggling with depression in our blog about SAD personas, check out our resources on grief, depression and loss and learn more about how to handle stress and anxiety.

About Richard Aab

Richard Aab, LCMHCA, has a BFA in Theatre from NYU and received his Clinical Mental Health Counselor, M.Ed. (Master’s in Education) from North Carolina State University. He is a Licensed Clinical Mental Health Counselor Associate (LCMHC-A) and Nationally Certified Counselor (NCC). Richard has a deep commitment to working with individuals overcoming developmental and childhood trauma, and he combines cutting-edge, neuroscientific research with traditional existential and behavioral therapeutic modalities. He is supervised by Elizabeth Grady, LCMHCS, and sees adult clients by telehealth.

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