Lots of people claim to care about mental illness, but not everyone can or will do something about it.

If you really want to help someone with mental health problems, here’s how.

Look for the signs

If someone is mentally ill, they will probably do their best to hide it. This is particularly true if you only see your friend at work, on the school run, or on Facebook.

But there are signs you can look for. In real life, they include:

  • Seeming distant or distracted
  • Red or wet eyes, or a red nose
  • Detatched or even uncaring – some depressives feel numb rather than sad
  • Angry or irritable, especially when it seems disproportionate to the problem
  • Change in appearance. Not washing hair, body or clothes are the ones you might think of, but sometimes an apparently positive change in appearance can signal a problem. Too much make-up, for example, might be literally covering something up.
  • Seeming nervous or worried – this is a sign of anxiety, particularly if the worry seems out of proportion to the problem
  • Being “off” – you might not be able to put your finger on it but if something seems off about your friend, your instinct is probably right

And the most obvious one of course, is your friend appearing down, or sad, or depressed. They might do a brilliant job of hiding it though, which is why you need to see if there’s anything else off about them.

Online, look out for:

  • Posting of memes or pictures about mental illness – this can be an indirect call for help
  • Posting seemingly positive “inspirational” pictures or memes. These can sometimes be an effort to make themselves feel better.
  • Saying they’ve had a bad day or need a hug
  • “Vaguebooking” – alluding to a problem without saying exactly what it is
  • Attention-seeking. People complain about attention-seeking on social media but your friend might have a valid need for that attention. And help.

Ask someone how they are

They will probably say they’re fine. Most of us are conditioned to do that. So ask again. Ask if they are really fine. Mention if you noticed that they seem a bit off or distant. Or not quite their usual self.

You might be afraid of doing this – afraid of offending or thinking there’s a problem if there’s nothing wrong. The reality is, if there’s no problem with their mental health there is normally something else going on that’s the cause of their change in character. They might be stressed, they might be genuinely distracted about something, or they might simply be tired. They will probably appreciate you asking in any case.

If you can, ask them privately. In real life, try to find a space where you can chat without anyone else too near, preferably without making a big deal about it. Send a text if you like – it might be easier for them to talk via text rather than in real life. Online, send a private message rather than post publicly.

Listen

You might not want to start a conversation with your friend because you don’t know what to do or say. The good news, is that you don’t have to do or say anything. You just have to listen.

In counselling and therapy training, they teach you “active listening”. You listen, nod and occasionally ask for clarification. You might say “I’m sorry to hear that” or “that must have been hard.”

You don’t need to offer advice or an opinion. You just need to let them talk. If they ask for advice, you can reflect the question back to them by asking “What do you think you should do?”

Don’t worry about saying the wrong thing. Just listen.

Be willing to put up with mess

This is a big one.

I went to a talk about anxiety recently and the speaker mentioned how a lot of people are willing to engage with mental health training and so on, but very few are willing to hang around someone who’s in real distress or who is having a panic attack.

It’s not pretty. You’re not a bad person for not wanting to deal with a bawling person or someone huffing and saying they can’t breathe. It’s our natural instinct to turn away from things that might be painful. We might be afraid or embarrassed. We might not know what to do.

It can be messy and uncomfortable. If your friend cries, there’s going to be snot and noise. People will stare at you. If they have a panic attack, they might make loud wheezing noises. Or, they might freeze and it will be weird. They might clutch your hand and not let go, and you won’t like it because their hand is sweaty and it’s also starting to hurt a bit.

They might want you to hug them and you don’t want to touch them. You might want to hug them but they can’t be touched, so you don’t know what to do with your hands and you feel like a bit of a useless idiot.

Do you know what? That’s all fine. It’s fine that your friend is embarrassing and it’s fine that you’re embarrassed. It’s fine that there’s snot everywhere and your only tissue is soaking and crumpled. It’s fine that it’s all a bit weird and you don’t know what to do. It won’t last forever.

The important thing is that you are there.

Refer them to services

You’re not a counsellor or a therapist.

You’re not trained to deal with whatever mental health issues your friend is having. You can listen, but you can’t give them professional help.

First of all, you’re not qualified and your friend deserves to have someone who can give them proper mental health care.

Secondly, you need to look after yourself. You can’t be a good friend if your friend is treating you like a counsellor all the time. You need to protect your friendship if you care about your friend, and that means it being a two-way relationship – maybe not now, but some of the time.

It takes emotional energy to listen to someone’s problems. If you’re an empath – like an emotional sponge – you will tend to soak up other people’s feelings and they become your own.

If your friend is not already receiving mental health support, encourage them to get it. You can even offer to go to the GP with them if they need that. If they can afford to get a private counsellor or therapist, offer to help them find one through this directory (your friend should always go with someone who is registered).

Ask your friend for something

This is a bit of an odd one.

A lot of people who have had long-term mental health issues are used to being dependent on other people. Everyone else is doing things for them, helping them or listening to them. They sometimes don’t get an opportunity to do something positive for someone else.

Asking your friend to do something for you – something small which won’t cause them a lot of stress or take a lot of time – might help them feel useful. It might help their confidence – knowing they can have a positive impact on someone else.

You don’t have to ask them to anything big or difficult. Ask them to do something they’re good at – or ask for advice, particularly if it’s something they know a lot about. Most people love to be asked for advice, it makes them feel special and important, which is probably something your friend badly needs.

And when they’ve helped you, or you’ve taken their advice, make sure you tell them how useful it was.

Take any mention of suicide seriously

Finally, if they so much as mention suicide, wanting to die, feeling like dying and so on, you must take it seriously.

I know you don’t want to. You want to say to yourself that they don’t really mean it. But the reality is that if someone mentions wanting to kill themselves there is a genuine risk that they might do it.

First of all, make sure they know you heard them and you are taking it seriously.

Secondly, contact a professional for advice.

You or your friend can call the Samaritans on 116 123.

You can also call the NHS out of hours services on 111.

If you think there is a true emergency, call 999 or take your friend to A&E. Your friend could be sectioned (held in a medical facility against their will) if the medical professionals believe there is a danger to their life. But they will be safe.

Your friend might be angry with you “interfering” but they will still be alive.

Finally: thank you

You might not get any thanks from your friend – some people with mental health problems are necessarily quite self-involved (they have to be for their survival).

But I want to thank you. By reading this, and wanting to do the right thing, you’re making a genuine difference to someone else’s life.

You can donate to the Samaritans here.