How to Help a Friend Struggling With Mental Illness

Your friend is sad, anxious, depressed or withdrawn. And you're worried—rightly so. As friends, we have one another's backs; we are our own chosen families with tight bonds that can help carry us through the darkest days.

And sometimes those days can indeed get dark: One in five Americans struggle with mental health conditions, and millions are living with one. That can be very lonely and isolating, and friendships can be especially necessary, valuable and critical.

But it might be tough to know just what to do.

Common as it is, mental illness still carries much stigma and misunderstanding. Those on the outside might blame the person for their own mental condition. Is she just hungry for attention? Why doesn't he just snap out of it? She could help herself if she'd only try. Yes, these are common refrains.

It takes a friend to really help and understand.

It's normal for people to feel sad or anxious at times, but there are times when these feelings may signal that something more serious might be going on.

If someone is suffering from a mental illness, it's possible he or she doesn't feel comfortable, or able, to reach out to friends. From the National Alliance on Mental Illness, the nation's largest grassroots organization dedicated to helping Americans affected by mental illness, here are some ways to determine if your friend needs help:

• Is he withdrawing from social activities for longer than a few weeks?

• Does she cry easily and regularly?

• Does he feel tired much of the time?

• Is she trying to, or talking about, harming herself or ending her life?

• Is his behavior out of control, or is he taking dangerous risks?

• Does she have severe mood swings?

• Is he drinking to excess or using drugs?

• Is she agitated or having trouble concentrating or staying still?

Read more about Signs of Mental Illness.

It can be tough to know what to say, but remember that sometimes not talking and just offering a compassionate ear can be helpful, too. Your support and encouragement can make the difference between your friend feeling alone or feeling comforted and recognized and can empower her to speak out and to seek help.

Here are some ways to help:

• Share your concerns. Open up the conversation by saying something like, "Lately, I've been feeling concerned about you," or, "You've seemed troubled lately, and I wanted to check in with you to see how you're doing."

• Don't be afraid to tell her that you're afraid. Say, "It makes me feel frightened when you talk like this. Let's talk to someone about it."

• Ask your friend how you can best support her right now, or if she's thought about getting help. Assure her that although she may not believe it now, things will change and improve.

• Assure her she's not alone and that you're here for her. Tell her that while you might not be able to know exactly how she feels, you care about her and want to help.

Not everyone will be ready to talk about what they're experiencing or may not be ready to accept your help. This can't be forced. In the meantime, just be there so when your friend is ready to share, she can reach out.

You may be able to open a conversation by asking specific questions like, "Can I help you find mental health services and support or make an appointment for you?"

Check in with your friend regularly with calls or texts a few times a week. Follow up with her after her therapy appointments to let her know you're there.

Invite her to go out; even if she doesn't accept your invitation, she'll be likely to appreciate it.

Avoid sounding judgmental or critical. Don't say things like, "You'll get over it," or "Toughen up." Instead, let your friend know that she's not alone and she can get through this.

Remember that a conversation, a compassionate and open ear and your presence and loyalty can make a tremendous difference in someone's life when they are struggling with mental illness and going through a tough time.