Friend With Mental Health Issues Asked Me For Help - But I am Clueless What To Do

[RuamRudy]

A bit of background: I live in Manila but work on a 4wk/4wk rotation in the middle east – relevant because I have just arrived back and, well, hopefully the following will make it clear.

 

This may sound a bit vague because I don’t want to put too much detail into this as I feel it is disrespectful of his privacy, but I have a friend in Manila in his mid 20s who is going through a very tough time mentally. He has told me that he has attempted suicide several times over the past year, and is still experiencing long bouts of deep depression and suicidal thoughts.

 

He is from the US but has lived in Philippines for about 5 or 6 years.  He originally arrived on a university scholarship but that fell apart and he is now working freelance in his field. Because his studies failed (and other reasons not particularly relevant to this), he has been pretty much ostracized by his family back in the US and therefore has no support network there. He also feels that he cannot return to the US, and is determined to remain in Philippines. For most of the time in Manila he has been living with his Filipino girlfriend and I think his social life pretty much revolved around hers, but his erratic behavior and their shared money problems has led her to leave him last month, seemingly for good. He now remains holed up in their bedsit and seems to be isolating himself from the world.

 

His money problems stem from his inexperience in business. He has a viable service to offer and has a number of clients, but he started with a bad business model that ended up costing him lots of cash. Several of his clients took advantage of this and his confidence collapsed. Now he has managed to ditch the bad clients and is trying to get out of the deep rut he is in, but he is struggling to stay motivated and to pull himself out of the misery he is in, and he frequently refers to himself as a failure.

 

I only became aware of all this in the past month because, while I said he was a friend, he has never been a close friend but more of an acquaintance. He approached me when he was really low, and he told me in detail about the hell he has been going through. I listened as best as I could, and I empathized, but I am so far out of my depth that I really don’t know what else to do. I have literally zero experience in mental health issues, and I really don’t know what to say or do that will help him.

 

I have paid his rent for this month so he can at least breathe a bit while he sorts out his paying clients and hopefully earns some income, and I managed to encourage him to see a counselor, but I have now returned to the Middle East and he still messages me that he is feeling low and having suicidal thoughts. I am going to be here for another 4 weeks and I am worried that he may try to take his own life again.

 

I have been trying to encourage him to focus on his business – I have offered to help him create a business plan that would better prepare his business for growth, and he seems to show a bit of intermittent, short lived enthusiasm, but frequently reverts back to a depressive state.

 

Is there anything I should be doing other than blindly interacting with him? I am trying to be supportive, but I feel that my efforts are mere platitudes – for instance, I know he can present a strong, impressive presence when he tries, and that is one of the reasons people want him to work for them, but how many times can I tell him this before it loses its impact, especially as he has so many self doubts? I simply don’t know what else to say to him other than encourage him to continue with the counseling.

[malagateddy]

R/r..is there no Samaritans organisation he can contact?


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[RuamRudy]

1 minute ago, malagateddy said:

R/r..is there no Samaritans organisation he can contact?


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I checked on Mental Health resources and there are actually several free or very low cost counseling services in Manila, but he told me that he had already tried some of them and they were no use to him. The counselor he saw is the brother of one of his clients, and he said that the session he attended helped him think more clearly about his issues, but despite my gently nagging, he has not booked a follow up appointment. It is almost like an intense ennui has a grip of him.

 

To be honest, he is both proud and stubborn, which I think is part of the problem - reaching out to me was clearly a huge thing for him as he had been struggling with this almost alone for over a year. 

[KarlS]

Listen and be supportive but do not allow yourself to be  manipulated by an attention seeking person. If he has got MH issues you should encourage him to seek professional help.

[malagateddy]

Surely he must know other people apart from yourself..surely someone can take him by the scruff of the neck back to see the same guy??

I checked on Mental Health resources and there are actually several free or very low cost counseling services in Manila, but he told me that he had already tried some of them and they were no use to him. The counselor he saw is the brother of one of his clients, and he said that the session he attended helped him think more clearly about his issues, but despite my gently nagging, he has not booked a follow up appointment. It is almost like an intense ennui has a grip of him.
 
To be honest, he is both proud and stubborn, which I think is part of the problem - reaching out to me was clearly a huge thing for him as he had been struggling with this almost alone for over a year. 

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[malagateddy]

R/r..surely there's an expsts forum over there where you could post and hopefully get help for him?

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[RuamRudy]

1 minute ago, malagateddy said:

Surely he must know other people apart from yourself..surely someone can take him by the scruff of the neck back to see the same guy??

 

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I honestly don't think he has - the fact that he came to me suggests to me that he has few other friends he could trust, because we were never close in the past.

 

My gut feelings are along the lines of your too, Teddy - I generally put my head down and slog on, so my innate response would to shake him and tell him to man up, but I understand now that this is not a lack of backbone or moral fibre, but something much more serious. 

[malagateddy]

Tell him to help himself by booking a follow up..if he does the good..if not..well..not much you can do..he must mske the move.

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[Katia]

He needs professional help, period.  You can support him, but you can't be his therapist.  I had a friend try this on me once, and I and the other friend she approached told her gently that if she wanted to see someone, we would be supportive and even go with her to the appointment, but she needed real help and we couldn't be her counselors.  Never heard anything about it after that.

 

You're not a psychologist (I assume), you're not trained in mental health work, it is neither your job nor your place to have to be his therapist, and he should not expect you to be.  If he won't take steps to help himself, there is nothing you can do; you can't drag him to see someone (and if you did, he'd just hate you and/or possibly become dependent on you; he's not a child and you're not his parent).  Let him know you're there for him, but you won't take the place of professional mental help.

 

It's not about "manning up"-- mental illness isn't like that; it's not a weakness or moral failing.  And that's precisely why he may not be able to do this alone, without someone *qualified* to help him.

[AlexRich]

I think the best thing you could do for him is try to reconnect him with his family in the US. Ask if you can email a family member and explain his predicament. They would have to be particularly hard hearted not to help him. It’s difficult to battle depression and keep motivated to run a struggling business. There is a limit to how much you can help him, but it is decent of you to do so. His mind is full of fog, you need to help him gain some clarity. No one in their twenties is a failure, he has another 50 years ahead of him to create a successful life. 

 

 

 

 

 

[Sheryl]

He needs professional help. Both counselling and medication.

 

He should see a pyschiatrist. Unfortunately I cannot suggest a specific one  as I am not familiar with health services in the Philippines.

 

Once stabilized on antidepressents his negativity may ease up a bit making him more amenable to trying counseling again.

 

If money is a major concern,  the National Center for Mental Health in Mandaluyong is a government facility and would be low in cost. It has an emergency room which may be worth mentioning to him in case things get really bad.

 

http://www.ncmh.gov.ph/

 

Also make sure he has the phone number of Hopeline, which is a suicide prevention/mental health crisis  hotline. They can also help with referrals to psychologists.

http://www.ngf-hope.org/contact-us/

[canthai55]

Sounds a lot like my Brother. Suffers from being BiPolar. Old term Manic/Depressive.

When on his meds he is lethargic. When off his meds he is Manic but feels better.

Hard Row to Hoe I tell 'Ya

40+ years - no success in getting him 'Normal" - whatever that is.

[brokenbone]

i think he was really stupid to move when he didnt have a secure income in the first instance,

he should be sent back to US, get a job and get a life,

hopefully he has grown up not to believe in santa so he wont

try again without money to back it up

[Will E Vormer]

Difficult! He has to make a plan. Maybe sit down with him and do a plan of action, so he has a goal and A, B ,C depending on the outcome, one being that if he cant make things work, he goes back to US and sorts himself out.

Altho who pays for the flight ticket..

Surely he must have someone at home in US who can help?

[SteveK]

It sounds like you are already doing a great deal for him - listening to him and helping with his rent is very generous of you. Depression is really rough, and the Western way of dealing with it through medication is not particularly effective. What is effective for depression is finding something wholesome and healthy to spend your time on, something in which you can develop and regain a little self-esteem, in his case this could well mean turning his business around and overseeing it develop into something successful.

 

In the meantime there are some key things which will make a difference:

 

1 - Make sure that he is sleeping properly

2 - Stay off alcohol

3 - Eat a healthy diet

4 - Take 20 minutes every day of exercise

5 - Spend time with friends where possible

 

I've seen people languishing for years, if not decades, trying every antidepressant under the sun, but it was clear that they weren't taking good care of themselves and were just hoping that the drugs would help. Tackling depression is a multi-pronged approach and requires some commitment from the patient. If he can get into a healthy daily routine, and get his business off the ground, then I am sure that he will start to get better.

 

Depression doesn't go away overnight - he will be looking at 6-9 months to recover if he is really suicidal, he would almost certainly get better care in the US than in the Philippines, but then that may mean that he has to give up on his business aspirations, so it's a very hard one. And there is nothing more demoralising and patronising to a person suffering with depression than being told to "just pull yourself together" or, even worse, to "man up". Depression is a horrible, horrible illness, I've met people who have been barely able to get out of bed for months on end.

Edited March 13, 2019 by pr9spk

[tutsiwarrior]

early 80s and I had a close friend that flipped, he had been acting weird and then lost his job as a disk drive controls engineer after an 'incident' at work...I went by his house to see how he was and he had smashed up his TV as he thought that the announcers were talking about him...I totally freaked (but stayed outwardly calm) and we had a mutual friend who was a trained therapist and I went and got him and he managed to get him to a doc and get the required meds and stayed with him until he got them going and stabilized...

 

with regard to the OP's concern and his attempts to help his friend I never felt so helpless and inadequate in my life...our friend was never able to work again and drank himself to death a few years later...

 

there's only so much that you can do...

 

 

[1FinickyOne]

Sorry to say but he is self-destructive and will probably find a way to screw up any business plan he applies.

 

Throughout my life I have had 3 very very close long time friends kill themselves. It was never a surprise. There was never anything that I could have done differently to prevent it. 

 

Your friend needs to seek professional help and get proper meds... and even then, maybe. 

[kingstonkid]

OP

I speak from experience with depression and suicide.  There is only so much you can do and you are doing it.  Give him a place to vent.  Make an agreement with him that every day he sends you an email of what he did that day.  Talk to him about it as a friend.  make suggestions only.

 

He needs professional help and as you have agreed that is not you.

 

Taking him to an emergency room is not a choice unless you are sure he is suicidal they will lock him up and I am not sure of the procedures to get him out or how good the care would be.  It is a choice though if he gets really bad.

 

The best choice is the counsellor and meds.  They work together there is no either or.  You need the meds to stabilize you and your need the counsellor for guidance and a listening post.  The counsellor that he went to seems to have helped a little so again suggest that he go back.

 

If he does not seek help there is nothing you can do so at that point you may have to cut yourself out of the picture.  It is a harsh thing but you can not help someone that will not help themselves.

[soistalker]

 

Get him to watch some Jordon Peterson videos on YouTube. Dr. Peterson is a psychology professor at the university of Toronto. He has a lot of videos of self-help, particularly for men. One video in particular has helped me. He talks about how to make small, incremental changes to oneself. And this is a way to positive change.

 

[Brayka]

I also have a friend like him. And altough I worked for 40 years in that branche, it wasn’t working for the best.

i adviced him to go back to his family in the USA, many months after I succeeded,and he went back for a couple of months to his roots, it’s important because they let you know who you are.

But...now he is back, and we’ll see what’s happening in the future. Because it’s a beast that returns the moment you’re weak or have problems.

Try to convince your friend to go back to his roots, he need to evaluate how and what, together with medication, maybe it helps.

professional help is always a must. And remember you can’t avoid that he does stupid things. Don’t blame yourself when you did what is in your possibilities.

good luck

[Ninni]

Do your best, that's all you can give as a friend! Go "over his head" if you think you have to! He needs PROFFS to take care of him, you can't!. 

I would like to have a friend like you! 

 

[Proboscis]

14 hours ago, Katia said:

He needs professional help, period.  You can support him, but you can't be his therapist.  I had a friend try this on me once, and I and the other friend she approached told her gently that if she wanted to see someone, we would be supportive and even go with her to the appointment, but she needed real help and we couldn't be her counselors.  Never heard anything about it after that.

 

You're not a psychologist (I assume), you're not trained in mental health work, it is neither your job nor your place to have to be his therapist, and he should not expect you to be.  If he won't take steps to help himself, there is nothing you can do; you can't drag him to see someone (and if you did, he'd just hate you and/or possibly become dependent on you; he's not a child and you're not his parent).  Let him know you're there for him, but you won't take the place of professional mental help.

 

It's not about "manning up"-- mental illness isn't like that; it's not a weakness or moral failing.  And that's precisely why he may not be able to do this alone, without someone *qualified* to help him.

It this person is really suffering from a mental illness, they should be under the care of a professional, a therapist. They might also need medication. None of this you can personally provide as you are not a therapist and do not have prescribing powers.

 

I would make all your help conditional on this person attending a reputable therapist (one that is properly cerified). There are two reasons for this:

1. It could be that your friend is being highly manipulative and just planning to live off you for as long as it lasts. Maybe he managed that with his girlfriend too. Maybe the whole story about this qualification and business is also a lie. Just saying . . . 

2. People are often afraid of treatment and if you keep helping but they don't get treatment, the "cure" never happens. You then become part of the problem as you make the situation bearable enough for them not to go for treatment.

 

As I always add to any reply to a poster who is asking for advice to do with health/medical issues, go to a professional. Even on the offchance you find someone on this forum with the right speciality, they will never provide medical advice without seeing the patient. As I always say, patient has to be seen by doctor, or in this case Therapist.

[KKr]

the only one who can give help to a depressed person is the person himself, is what a person who has been severely depressed told me.

if there is no desire to improve, and just attention seeking to confirm the developing behavioural pattern, then I am afraid your time is, albeit well-spent, not leading to results.

Your friend should go see a doc, get some meds, analyse what has gone wrong, learn from that, and get on with his life.

wish you wisdom and patience should you, without experience, try to replace a psychiatric counsellor .

[RJRS1301]

16 hours ago, Katia said:

He needs professional help, period.  You can support him, but you can't be his therapist.  I had a friend try this on me once, and I and the other friend she approached told her gently that if she wanted to see someone, we would be supportive and even go with her to the appointment, but she needed real help and we couldn't be her counselors.  Never heard anything about it after that.

 

You're not a psychologist (I assume), you're not trained in mental health work, it is neither your job nor your place to have to be his therapist, and he should not expect you to be.  If he won't take steps to help himself, there is nothing you can do; you can't drag him to see someone (and if you did, he'd just hate you and/or possibly become dependent on you; he's not a child and you're not his parent).  Let him know you're there for him, but you won't take the place of professional mental help.

 

It's not about "manning up"-- mental illness isn't like that; it's not a weakness or moral failing.  And that's precisely why he may not be able to do this alone, without someone *qualified* to help him.

I agree with all which you have said. Very skilled options you have offered

 

The OP can only be supportive and offer assistance when able to do so.

Do not get sucked into being a financial backstop. 

The friend needs to continue to seek professional help and possibly a business mentor. 

 

[johnnybangkok]

I think most of the people on this thread have given you a the best advice which is to seek professional help asap but I will add another point which is to not give up on him.

A close friend of mine suffered from depression and over many, many years he lied, cheated and generally buggered up his life to the point where most of his friends and family had given up on him. A couple of us stuck with him though until it got so bad that even we thought a bit of 'tough love' might do the trick; so we cut all communications with him 'for his own good'.

Two weeks later he killed himself.

I live with that awful decision every day and the guilt is unbearable at times. If I could go back and change that decision I would in a heartbeat, but I can't and it's done now.  

You sound like a really nice guy and you've already done so much for him and I know this sounds unfair considering he's not even a really close friend of yours but he cannot be left to his own devises. Get in contact with the family and try and get him home (this sounds to me like the best plan) or if that fails get him to a proper psychiatrist who can judge whether he really is a threat to himself. He can then judge whether he needs to be sectioned for his own good (I'm really not sure you would have the authority for this as it's usually only family that can do this but it's worth a shot) or maybe he will refer him to the US embassy. All of this would be made a lot easier if he was back home.

I'm sorry you have to take on this burden but I can assure you whatever guilt you may feel about walking away from the situation is a mere drop in the ocean compared to the guilt you will feel if it all goes really badly.    

[thecyclist]

Best would be a psychiatrist, but a general physician (visitation only about 200 Pesos) can get him started on medication as fast as possible :A combination of an SSRI and a sedative :The anti-depressant drugs take time to work (a couple of weeks usually), and often make things worse, with insomnia and anxiety, before it gets better :Once the SSRI kick in the sedatives are slowly tapered off. These are controlled drugs in the Philippines, so he will need a prescription. 

[xtrnuno41]

You cant do anything but being supportive. HE is the one who can, he should make a switch in his mind. Thats why you have mental helpers, they are standing away. You are close by.

You will never know what is in his mind and at one dark point he maybe will commit suicide. Medicines are sometimes a solution, but not always.

 

I know a nephew of my Thai gf. He is 14. At school in class the teacher asked what they wanted to be in the future. He answered: he was dead then ! 14 yo ! Even his classmates laughed then for his answer, but he meant it serious. Then you think jeepers what is going on, a young boy just saying out loud, he wants to be dead !!

I had some younger college, he got in a divorce, his (good) job was troubled, but made him commit suicide. I never would have expected that, as i saw him as a balanced kind of guy.  

You just cant tell what is in the mind and what does it do at certain times.

What today is normal or what is not normal. How do you cope with the situations before it can bring you down.

[Ebumbu]

You can't help someone who doesn't want your help. He certainly seems to be headed for a crash. If you're wealthy and can afford to pay his rent and other expenses, you may find yourself in a long-term situation. Make sure he has no "dirt" on you in any way, because desperate people can do desperate things out of desperation. Protect yourself. 

[RuamRudy]

Thank you all for your input - I appreciate it very much. What is clear is that, while he acknowledges that he is ill, the decision to seek treatment is his. I will continue to offer supportive friendship and help, but I realise from many comments here that I cannot take responsibility for him or what may or may not happen in the future. 

 

There were several suggestions that I should contact his family and explain the situation, however (1) his circumstances are very uncommon and, as he explained it to me, I understand his reluctance to engage with them further; (2) I have no idea how I would contact his family or where in the US they actually are - he doesn't share their family name and I don't know what it is. 

[malagateddy]

R/r..I know you will consider everything..then you will do your best.
Best of British from your Unionist mucker[emoji6]

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