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My friend disappeared. I found out why years later when talking to another friend. He gave me a kind and brutal honesty, “I think you freaked him out, Jen.” During a time when my mind had caused me deep pain, my “friend” chose to walk out and talk behind my back. He must not have understood or known how to react.

As a therapist, I see the influence of friendships on people’s mental health every day. When someone is going through a difficult time with their mental health, having a person who’s there for them can make a huge difference. Research shows that the number of interactions with friends can forecast recovery in people experiencing a first episode of psychosis (Bjornstad et al., 2017). Yet, when your friend has a time of significant mental health difficulties, such as hearing voices, manic highs, or unusual beliefs, it can be tough to know how to show up for them.

What follows is a simple list of do’s and don’t. Ways that you can show up for a friend struggling with their mental health.

Do

Remember that your friend is still the same person.

While a person’s behaviors may change during a mental health crisis, mental illness does not change who a person is behind their eyes. When you can still do everything you’ve done before with your friends and have them be there like they always have been, it means a lot.

Don’t

Act as if your friend has changed.

After a mental health crisis, it’s normal to feel out of sorts. Your friend may act differently or need some time to adjust. This doesn’t mean that they are a different person. By not treating them differently, you can send a message of encouragement.

Do

Share resources.

If your friend is experiencing a mental health crisis, such as having thoughts of suicide, they may need more help. Offering resources such as the 24-hour 9-8-8 Suicide Prevention Lifeline can normalize these and let your friend know where to reach out.

Don’t

Leave your friend alone in a crisis.

Just like you wouldn’t leave your friend alone if they were having a heart attack, you shouldn’t leave your friend alone in a crisis. This does not mean that you are responsible for resolving their crisis. Still, offering them linkage to someone who can help, such as a crisis counselor, could save their life.

Do

Listen, if you have the capacity.

You don’t have to be a therapist to listen. It could mean a lot to your friend if you are willing to be there and hear them out. Even if you don’t understand fully what they are going through, a show of support will let them know that they are not alone.

Don’t

Try to be your friend’s therapist.

You can always get a new therapist; however, a specific friendship is irreplaceable. The role you play in your friend’s life is different from that of a therapist. It is certainly OK to listen to and validate their experiences. But if your friend needs more, leave that to their mental health providers.

Do

Seek to understand your friend’s experiences.

Sometimes during a mental health crisis, someone will share things that are difficult to understand. For example, someone having delusions might talk about things that seem untrue, such as a belief that they are a famous person or that their home has been linked with spy cameras. Whatever it may be, it’s OK to listen, show empathy, and understand that you may not fully be able to understand.

Don’t

Argue with your friend.

Sometimes a person will say or believe strange things when struggling with their mental health that they never would otherwise. For example, if your friend shares with you that they are being targeted by the government, it makes sense to be concerned. It could be tempting to tell them they aren’t and all the reasons for that. However, if they are experiencing a true delusion, this will only make them feel more alone.

Do

Appreciate your friend’s emotions and thoughts.

Everyone’s emotions are valid, including those of people experiencing mental health difficulties. Your friend will appreciate it when you show you care about their perspectives.

Don’t

Assume their emotions and thoughts are now just a part of their illness.

Going through mental health difficulties can be disorienting. At first, it may be difficult for your friend to tell between happiness and mania, sadness and depression, or typical worry and anxiety. Many times, individuals who have recently experienced a mental health crisis are dismissed. This hurts. Taking your friend’s ideas seriously lets them know that their voice still matters.

Closing Thoughts

When your friend is struggling with their mental health, it can present a significant challenge to the friendship. Creating compassionate boundaries is important to both your and their well-being in these times. Yet, if you can rise to the occasion, it could mean a lot to your friend.