Depression is a common mental health condition with a range of symptoms that can make it hard to go through the motions of daily life — which ultimately impacts both the person struggling with depression and their loved ones. One of the trademark challenges of depression is disconnection, which may lead to isolation or pulling away from friends. People with depression may appear difficult to support: this is a symptom of the condition and is not because they don’t want or deserve help.
If you have a friend with depression, you might not know how to help them. You aren’t their therapist, but you can still support them as they access professional care. Here are six ways to help your friend with depression or suicidal ideation.
1. Be open to talking about their depression
People with depression may find it difficult to talk about what they’re experiencing. This could be because the emotions are hard to put into words or because they’re afraid of other people’s responses — this is especially true for suicidal ideation. To show your friend that you’re open to talking about their mental health, create a nonjudgmental space for an open-ended, empathetic conversation. This is a time for them to express how they’re feeling, as well as a time for you to share how much you care about them.
When your friend is ready to talk about their depression, it’s important to make sure that they feel safe confiding in you. You can do this by showing nonverbal engagement, such as nodding along as they speak. You might also consider using one of the following techniques during the conversation:
- Validating: A validating statement is one that affirms that the way they are feeling is legitimate. An example would be, “After what you went through last month, it’s no wonder why you feel down!”
- Normalizing: When you normalize, you make it known that they aren’t alone in the way that they feel. While this conversation is about them and not other people, stating that other people also react similarly may help them discard any self-judgements that they feel. An example would be, “I think that lots of people feel exhausted when they go through similar situations.”
- Cheerleading: Just like it sounds, cheerleading is a way of being verbally supportive by expressing encouragement. An example would be, “You’ve worked so hard to take care of yourself, it’s pretty incredible!”
It may be helpful to prepare a few of these statements ahead of the conversation, just to be ready — these conversations are often quite difficult by nature of the topic. If you do find yourself without words, here’s an empathetic statement that communicates such: “Wow, I honestly don’t really know what to say. I’m just so glad that you told me and I’m here for you.”
2. Keep a few conversation openers up your sleeve for when you’re worried
Generally, it’s important to let your friend with depression open or lead the conversation when it comes to their symptoms. This way, they feel in-control and secure. However, if you notice that your friend is particularly struggling lately, you may want to check in with them to see what’s going on.
There are a many ways to open the conversation in a nonjudgmental, supportive way. Be sure to start the conversation in a safe place: somewhere quiet, comfortable, and away from other people. Picking the right time and place will depend on what’s natural for the two of you, but making sure that your friend is comfortable will only benefit the conversation.
Next, use a gentle, open-ended check-in question. Here are a few prompts that you might consider:
- “So how’s it going lately? I noticed that you were a bit more quiet than usual, and just wanted to make sure that you’re doing alright.”
- “How’re you doing with everything? I wanted to let you know that you can always talk to me, I’m here for you whenever you need.”
- “It’s been pretty difficult lately with everything going on in your life, how’re you feeling?”
- “Hey, this might be random, but I just want to tell you that I’m grateful for you and that I care about you. If you want to talk about anything, let me know, whatever you need.”
After you open the conversation, continue to be supportive by listening without interrupting and letting your friend talk about themselves without shifting any focus towards yourself. If they disclose anything that you find surprising, be sure to keep your reactions outwardly neutral so they don’t feel judged.
Remember, it’s taking courage for them to share, and that’s a testament to your close relationship.
3. Help connect them with a professional
As you support your friend with depression, it’s vital to connect them with a mental health professional. By speaking with a therapist, they’ll learn how to manage their condition from someone with professional training and experience. Therapists will use evidence-based approaches to treat their depression and provide appropriate guidance.
When the time is right, float the idea of therapy and encourage your friend to seek professional help. Keep in mind that this isn’t you shirking any friendship duties, as helping them access mental health treatment will be beneficial for both your friend and your relationship. Your responsibility remains as a friend, not as their therapist.
To further support your friend in their search for a therapist, consider researching therapists online together. Zencare makes finding a vetted therapist simple. On each therapist’s profile, you’ll be able to read about their specialities and watch an introductory video. In addition to Zencare, you might also ask around for local therapist recommendations and providing that information to your friend. Trusted recommendations can go a long way, especially with someone who is wary of starting therapy.
Therapy looks different for everyone, so make sure that you stay focused on what your friend needs. This includes therapy style, approach, and therapist personality. Your friend might want to find a provider who will help them with skills-building through cognitive behavioral therapy, or they might be more interested in connecting with a psychodynamic therapist to examine the origins of their depression. By engaging your friend in a discussion about what they prefer, you’ll be able to help them find a great fit.
4. Offer to help them with the logistics of treatment
Once you’ve narrowed down some options for therapists and the timing is right, offer to help your friend prepare! Here are a few ways to do that:
Figure out payment
Are they going through insurance, paying out of pocket, or using out-of-network benefits? Either way, your friend has options. Read up on these different payment methods in order to help your friend figure out the best way to afford therapy:
- Looking for a therapist who takes your friend's insurance is typically the lowest cost way to find a therapist, generally a $20-$50 copay; however, in large cities like NYC and Boston, therapists who take insurance may be booked out for weeks or months. Looking only within your health insurance network can significantly limit your pool of therapists to choose from. If you have a high deductible plan, you may have to pay the full therapist session fee anyway for until you meet that amount.
- Paying out of pocket means your friend will pay the therapist's full session fee, without the financial assistance of your health insurance plan. For example, your friend's therapist may charge $150 per session, in which case they would pay that amount after each appointment. This allows your friend to choose any therapist and prioritize fit and quality, rather than limit options by only searching among therapists who take their insurance.
- Using health insurance out-of-network benefits is a great way to keep the pool of therapists broad, while also getting some financial assistance from the health insurance company. Your friend pays the full price of their sessions upfront, and then (depending on their plan), receives a reimbursement via check from their insurance company.
Prepare for the initial phone call
The initial phone call is a great opportunity for your friend to assess fit with each therapist they're considering. Help them prepare for the call with the following:
Questions to ask each therapist:
- Does you have experience working with clients in similar situations or who have depression?
- Can you tell me about your approach to treating depression?
- When do you currently have openings in the week?
- Would I come in weekly for sessions? (Most therapists want to see clients with depression weekly, rather than biweekly or monthly, to ensure progress is being made, and the client's depression is improving.)
Questions the therapist might ask them:
- Tell me a bit about what you're going through.
- Have you been in therapy before?
- What has worked in the past, and what hasn’t?
Shopping around for therapists is essential in attaining the right therapeutic alliance. Having a conversation with your friend about how the interaction went after each new clinician may help them explore their personal preferences.
Know where to go, and what to do
Your friend may benefit from a checklist of what to know and where to go, like:
- Where is the office located?
- How would they make session payments? Does the therapist accept cash; is there a user portal where I enter my credit card information; or do I pay upfront every session?
- How long will the first session be? (Intakes are often longer, around 50-60 minutes.)
5. Help them create a safety plan if they experience suicidal ideation
Some people with depression struggle with thoughts of harming themselves. Whether they’re in therapy or not, if you hear them expressing these thoughts, it’s absolutely crucial to ensure their safety.
A helpful tool in this situation is a safety plan. A safety plan is a crisis prevention plan that identifies the triggers for harmful behaviors and offers written instructions for ensuring safety.
There are a few standard steps towards writing a safety plan. This safety plan is best created before a time of crisis but is also effective during periods of suicidal or self-harm ideation. Here are tips for writing a safety plan:
- Knowing the warning signs: How will your friend know when they’re headed into suicidal or self-harm ideation? These could be certain situations, places, thoughts, or physical or emotional feelings. When they notice these warning signs, it’s time to move onto the next step.
- Practice coping skills: Identify three coping skills to use when they experience a warning sign. Examples include mindful breathing, taking a walk, or having a cup of tea. Whatever helps your friend feel grounded, comfortable, or relaxed.
- Find distractions: Similar to coping skills, identify two people and three places that are good distractors. These are distractions that could shift your friend’s attention away from their harmful thoughts.
- Personal contacts: If their coping skills or distractions aren’t helpful in negating their feelings of suicide or self-harm, who are three people they can call to ask for help? Make sure your friend has easy access to their contact information.
- Professional contacts: Who are professional contacts that your friend can contact in an emergency? These could include hotlines, counseling centers, or a local hospital. The National Suicide Hotline (1-800-273-TALK) is a great resource to include in this list.
- Safe environment: In moments of crisis, the next step is to make sure that the environment is safe. This step includes throwing out any harmful substances or weapons that could be used for self-harm.
- Life worth living: Lastly, ask your friend to identify one thing that is worth living for.
Your friend can keep this document with them at all times, in case they feel a crisis coming up. They might also share it with their family, other friends, and their therapist. By having written instructions for what to do when they feel suicidal or self-harm ideation, they’ll know exactly what to do to stay safe.
6. Continue to be patient, encouraging, and compassionate — for both your friend and yourself
The best way to support your friend with depression is no doubt one that you’re already doing — being patient, encouraging, and compassionate with them, and yourself. By communicating that you care, you’re letting them know that you’re there for them.
Be sure to check in with yourself too. How does it feel to support your friend? Individuals with depression may be difficult to get to support in accessing treatment because of the impact that depression has on their motivation, so if you find yourself frustrated, remember to be patient and compassionate to yourself. Never lose sight of the fact that you’re doing a good thing by supporting your friend, but remember that each person is ultimately responsible for their own care, and you can't force someone to do something, like go to therapy, against their will.
Your mere presence and concern for your friend will help them as they go along their mental health journey. Your intentionality shows a huge strength of yours — caring for those around you and not being afraid to help them out when they feel down.