How to Tell a Friend They Need Help

It's important to lead with empathy.

My high school health class used to watch episodes of the TV show “Intervention.”

Set to ominous music, a person struggling with addiction enters a room to find their family and friends have “staged an intervention.” They tell the person that they need professional help.

That’s the scene I always picture when I have a friend going through tough stuff. It might not be drug addiction, but I can see they’re struggling. I want to help them out.

Maybe they just had a death in the family. Maybe they had a really hard breakup. Maybe it’s depression or anxiety. Or maybe it’s something I don’t even know about.

Whatever it is, sometimes it’s bad enough that I can tell they’re not functioning well and might need professional help.

I want to tell them that. But it’s hard knowing where to start.

There’s no ominous music to help me, and a dramatic confrontation doesn’t always seem like the best option. I’m not always sure it’s my place to say anything at all.

Licensed marriage and family therapist Gwendolyn Nelson-Terry says it’s definitely OK to speak up. You’re not crossing a line.

“As a trusted person in your friend’s life, you are in the position to express care and concern in a way that they can best hear,” she said.

a sad woman with depression. REWIRE PBS love helpCredit: Adobe
Instead of telling your friend what you think they’re struggling with, you might find it more helpful to ask them how they’re doing.

Lead with empathy

The way you approach it is key. And you probably shouldn’t look to “Intervention” as your guide.

Instead of confronting the person in a way that blames them, it’s important to lead with empathy, says psychologist and anxiety specialist Tamar Chansky.

That’s because the person who is struggling probably already feels pretty bad about themselves.

“The songs of anxiety and depression are played in the key of self-criticism, so you need to proceed with caution and lead with your empathy that we’re all in the same boat in the big picture,” Chansky said. “That is, that one day it’s her struggles, another day it’s yours and it’s up to each of us to help each other out.”

Emphasize that you’re only speaking out because you care about the person. You want the kind of friendship where you support each other, no matter how tough.

Phrase your words with sensitivity

Instead of telling your friend what you think they’re struggling with, you might find it more helpful to ask them how they’re doing.

You don’t want to misdiagnose your friend, and you don’t want to be insensitive.

“Most of the time when you are present and listening, people will open up,” said Justin Baksh, a licensed mental health counselor. “It’s almost an automatic reaction. The less you say, the more they will.”

Baksh recommends saying something like, “How are you? I’ve noticed you’ve been distant,” or “I’ve noticed that you’ve been more stressed than normal. Is everything OK?”

Since mental health still has a stigma, it’s possible they won’t respond well or might feel anxious talking about it.

If so, you can also approach the issue from the other side, asking questions that might lead to a discussion about it.

You might do this by telling your friend how you’ve missed them at social gatherings lately. Or by sharing how you relate to what they’ve been going through and what’s helped you. Or, offer your support and point out some behaviors you might have noticed that are spurring the conversation.

[ICYMI: How to Know If Your Therapist is a Good Fit]

Validate their feelings

Don’t start out by suggesting therapy. Even though it’s a helpful tool for mental health, and might be what you want from the conversation, some folks and cultures might see that as an accusation that something is wrong with them.

Your discussion should make the person feel like you see and hear them. Make them feel validated.

You can frame your concern by talking about how it’s affecting their day-to-day life.

“This helps frame the situation as a problem separate from the person,” said licensed mental health counselor Chalice Mathioudakis.

“The person is not the problem, the problem is the problem.”

For instance, you can say that their depression is affecting the amount of time they spend with their family.

It’s possible they’re already trying to work on this. Maybe they’re trying to eat healthily or exercise to get their mood up, but it’s still not enough.

You can point out their hard work and acknowledge that there’s more they can try.

Ask open-ended questions

Since many folks don’t like being told what to do, it might be more useful to ask your friend their thoughts on treatment instead of telling them that they should seek it.

“Ask if they have researched types of treatment or specific clinicians,” said psychiatrist Jared Heathman. “You could then tell a story about how another peer met a specific excellent doctor or counselor that made a big difference. Ask what has kept them from seeking care.”

These sorts of questions might help your friend be more open to thinking about mental health treatment as an option instead of fighting it on their own.

Mathioudakis said it’s also good to normalize the fact that mental health treatment like therapy has an end game, and that’s getting better. They won’t have to go to therapy their entire lives.

Having this conversation with your friend might be scary. But it’s worth it to talk about it.

Baksh said that, in general, people like to talk if you give them an opening to do so.

“They are open to solutions when they are struggling and can trust the person they are talking with,” he said.

The key is to get talking.

Gretchen Brown

Gretchen is an editor for Rewire. With past stints in public radio and at a rural daily newspaper, she’s passionate about public media as a public service. She’s also into music and really good coffee. Follow her on Twitter @gretch_brown.