Supporting someone with anxiety or depression

No matter how long you’ve been supporting a person who’s experiencing a mental health condition, we have some helpful information for all support people and family members – regardless of whether the person you're supporting has just been diagnosed, is recovering, or is in the early stages of anxiety and/or depression.

Some people may not be certain whether the person they’re supporting definitely has a mental health condition. Others will have recognised that something isn’t right and will be taking the first steps to get a medical opinion. Many support people will have been supporting a friend or loved one for some time and will be working towards recovery. Some support people will be looking after someone who has a mental health condition and co-existing physical health problem, disability or chronic illness (e.g. a heart condition, Parkinson’s disease or a cancer diagnosis).

Who do the terms 'support person' or 'supporter' describe?

The terms 'support person' or ‘supporter’ are used to refer to the primary person who is taking care of someone with anxiety and/or depression.

  • A support person could be a husband, wife, child, sibling, partner, flatmate, parent or close friend. 
  • Supporters provide ongoing support which may be in a social, emotional, physical and/or financial capacity. Sometimes, this may be to the detriment of their own employment, relationships, social life, physical and/or mental health.

Other family members and friends can play a major supporting role, too.

Recognising something is not right

For many years, mental health conditions, such as anxiety and depression, were not discussed openly in the community because of fear, ignorance and stigma. Unlike physical illnesses or conditions that have obvious symptoms that can be observed easily and, as a result, talked about frankly, symptoms of mental health conditions may be deliberately covered up or unintentionally hidden.

Signs and symptoms of a mental health condition may remain unrecognised or attributed to being associated with certain life stages, stressful events, hormones or personality traits.

It’s common for people not to discuss mental health conditions with family members or friends. There is even more stigma around mental health in cultures where health issues of any type are not discussed with members of the immediate or extended family and certainly not with friends.

Negative views or stigma about mental health are often due to misunderstandings, cultural beliefs, misconceptions and/or lack of knowledge about mental health conditions and the associated signs and symptoms.

Confirming there is a problem

Initially, it may be difficult to confirm that someone has a mental health problem. While you may sense changes in the behaviour of someone you care about, it’s understandable, when you don’t have much knowledge about mental health conditions, that you may attribute symptoms to other causes.

Alternatively, you may not want to consider the possibility of there being a mental health condition because you’re concerned or frightened about what this could mean for the person and those close to them.

It may also be the case that the person hides, controls or disguises many symptoms. You may no longer notice the symptoms because the associated behaviour has been going on for so long that it now seems normal.

Symptoms may remain undetected for some time because the onset of the condition may be gradual. For these reasons, detection can be difficult and confirming whether there is a mental health condition is often complicated. The best advice is to persevere and trust your instincts if things are not quite right.

What is the problem?

After confirming there is a problem, you need to find out more. Unlike many physical illnesses, there is no test that can provide a diagnosis for a mental health condition. For example, it can be difficult to know whether lack of sleep and weight loss are the result of work-related stress or whether they may be symptoms of anxietydepression or another health condition.

There are a range of physical health conditions with symptoms similar to those of some mental health conditions which may make it difficult to diagnose the problem. For this reason, it’s important to get a thorough assessment of the person’s physical and mental health.

It may be helpful to familiarise yourself with the signs and symptoms of anxiety and depression. If possible, ask the person you are concerned about to complete an online checklist which is quick and anonymous and will show if the person has symptoms in common with anxiety or depression – and will indicate if the person should see a health professional. This checklist is not intended to replace a diagnosis by a health professional, but is a good starting point.


“We both knew something was wrong… he didn’t feel right, he didn’t feel safe, but we couldn’t put our finger on what it was.”


Taking the first step to helping someone with anxiety and/or depression

It’s important to remember, when you take the first step in dealing with anxiety or depression, you are not alone – support is available for you, too.

Mental health conditions are more common than you realise

Mental health conditions are common.

In fact, one in 5 Australians experience a mental health condition in a given year and almost one in 2 will experience a mental health condition at some point in their lifetime1 – the most common of these being anxiety and depression. It’s not only the person with the condition who’s affected. It can also affect family members and friends.

Realising that there may be a problem and then doing something about it can be easier said than done, particularly if you feel that you’re tackling the problem on your own. If you haven’t dealt with a mental health problem before, it can be daunting and knowing how to help someone can be challenging.

Keep in mind that the person you’re supporting can be helped if they access the right treatment.

Have the conversation

A conversation can make a difference in helping someone feel less alone and more supported in recovering from anxiety and depression. Don’t underestimate the importance of just ‘being there’.

Raising the subject with the person you care about may take some planning and thought. Consider the following:

  • When is the person most likely to be attentive?
  • Where is he or she most comfortable and at ease?
  • Where is there a place you both feel safe and will not be interrupted?

For more information on having the conversation with someone you are concerned about, see Talking to someone you are worried about

Acknowledging the impact of anxiety and depression

Often mental health conditions lead to people becoming very introspective, making it hard for them to be aware of the impact their behaviour is having on other people. If the person is unwilling to talk about things, you could let them know how their behaviour is affecting other family members or friends. This may be a way to encourage the person to try to do something about the situation.

Encouraging the person to seek support is another key step. Suggest that you seek support together. For example, you could make an appointment for you both to see the person’s GP for a check-up. The person may not see this as a threatening or intrusive option.

Unfortunately, sometimes the person may be reluctant or may even refuse to get help. People may give a range of reasons as to why:

  • “I’m not ready.”
  • “I’m just going through a phase.”
  • “It may just be stress.”

It’s common for people with anxiety and/or depression to not recognise they need support, so you may find it difficult. Again, it may be useful to consider highlighting the broader impact the person’s behaviour is having on others. You could also talk about the positive effects of getting support. If the person won’t listen to you, think about asking someone else to talk to them.

A trusted friend or family member may be able to get through to the person and raise some issues without posing a threat or creating apprehension. In
more extreme circumstances, where you are very concerned, you may consider contacting your GP to see if they can become involved or make a home visit.

Your ultimate goal is to support the person, so try to keep this in mind even when they may be cross or agitated with you.


“They have to admit they have a problem before you can get them any help."


Supporting someone to see a health professional

It may be that the conversation about seeking some professional support wasn’t easy and actually going to see a health professional may not be easy either… but you’ve taken the first step and it’s important to keep up the momentum.

Working towards recovery

Recovery can mean different things to different people. For some, it’s no longer taking medication, while for others it’s managing the condition on a long-term basis. It’s also important to remember that when dealing with mental health conditions such as anxiety and depression, the path to recovery is not always straightforward, and there are likely to be times when things seem to slip backwards.

The importance of support networks

Ongoing support will play a major role in the person’s recovery and this support may come from many sources, including friends and family members, health professionals and perhaps support groups.

“It’s a really lonely life when you’re dealing with this on your own.”


It’s important to ensure that people with mental health conditions develop skills to support themselves and do not become totally dependent on the person supporting them as the sole providers of support.

Boundaries and goals

At home, having structure and a routine can help set boundaries and bring some order to a life that may seem out of control. A daily or weekly plan that is visible and clear encourages positive behaviour, involvement in the household routine and looking to the future, even if only until the end of the day or week.

You can encourage the person to include the following in the plan:

  • treatment plans
  • medical appointments
  • stress-reducing activities such as walking, meditation, music, craft.
It’s a good idea to have realistic expectations about these plans and about what can be achieved. Acknowledge that some things may not get done. Don’t become discouraged if some of the set tasks aren’t achieved.
 
When working towards recovery, it’s also a good idea to set goals that are small and achievable. You may help the person to recognise any achievements and acknowledge the progress they have made, no matter how big or small. This can help create a positive sense of accomplishment and these successes may provide an incentive for ongoing efforts.

Sharing the load

People who support friend and family with mental health conditions often describe feeling totally overwhelmed and responsible for the person. In response to this, many support people have found it helpful to get support from other family members and friends.
 
As a support person, you may wish to discuss with the person you support your need to look after yourself too and together identify people who may be able to help if needed. Support from others can take many forms depending on your situation. For example, some supporters talk about the importance of having a close friend with whom they can go out for a coffee and chat. Others may need more practical support such as assistance with shopping or cooking meals. Whatever support you receive, recognise that it can be very helpful especially when you feel overwhelmed.

The key to managing your own role in the person’s recovery is to try to incorporate the support role into your life and try not to let it become your whole life.


It’s important for you and other support people to be aware of the signs that may indicate the person with the mental health condition is becoming distressed. Over time, you can learn what triggers anxiety, irritability, fear and panic in the person, just as you may recognise the warning signs of an asthma attack or migraine.

Knowing what to look for helps to reduce your stress and the person’s stress, and can be a helpful coping strategy for everyone.


Try to reflect on the situation sometimes. This may give you a fresh perspective on how things are going and what is working well for you and the person you support.


Overcoming setbacks

It’s common for support people and people with anxiety and/or depression to say they have ups and downs, with frequent periods when they felt they were taking one step forward and two steps back. Dealing with setbacks can be frustrating and disappointing for both the supporter and the person with the condition. It may be useful to remember that life in general has its ups and downs – and while living with anxiety and/or depression is likely to increase your stress levels, not all problems that arise will be due to the condition itself.

Does a person with anxiety and/or depression go through various stages?

Mental health conditions such as anxiety and depression may not always run a particular course where there is a clear beginning, middle and end. This however, can occur with some physical health problems – a diagnosis, treatment such as surgery or medication and then recovery.

Following diagnosis, recovery from anxiety and depression can involve progressing through various stages. It may include trialling different medications, treatments or health professionals. This is all part of learning what works for the person and what doesn’t. This can take time, persistence and patience.

Medication

In the treatment of anxiety and depression there are many medications that are safe, effective and non-addictive. It may take time to find the medication or combination of medications that work in the best way possible for the person with the mental health condition. It’s not unusual for people to be on medication for several weeks and then have the medication adjusted or changed to suit the individual’s needs. If the person is taking medication for other chronic illnesses, health professionals will be careful to monitor combinations, dosages and side-effects. It may take weeks to months to find the best treatment for the person.

Therefore, it’s very important to tell the doctor if any other medication is being taken, including herbal remedies or tablets that may interact and/or interfere with the medications that have been prescribed. Managing the side-effects of medications can be challenging. It’s important to ensure that the prescribed medication is taken regularly, at the same time each day, correctly, following the prescribed dose and consistently. If the person you support can’t tolerate the side-effects of the prescribed medication and wants to stop taking it, urge them to discuss this with the doctor before doing so. The person you support may feel well and consider the medication unnecessary. Again, discuss this with the doctor or encourage the person to do so.

For example, a person with high blood pressure takes medication to help manage the condition and would become unwell without it.


Taking medication for a mental health condition is no different from taking medication for a physical illness.


Relapse

Some people may experience only one episode of anxiety or depression during their lives where psychological treatment or medication or a combination of treatments is effective. The episode may last for months or years, but no repeat episodes occur.

For other people, there may be recurrent episodes of anxiety and/or depression or the symptoms related to their mental health condition may re-occur for a variety of reasons:

  • the occurrence of a specific event, such as a job loss, relationship breakdown or bereavement
  • biological or physiological changes in their body chemistry
  • physical illness
  • sleep difficulties
  • employment stress
  • stopping or starting medication
  • no apparent reason.
​To avoid setbacks, it may be helpful for you and the person you support to think about and identify the triggers and symptoms that were present before the person was diagnosed. This may help you both to recognise these warning signs in the future. You may feel as though you always have to be vigilant, but as time goes by, you will understand that drug and alcohol use, lack of sleep and stress are common triggers leading to relapse of anxiety and/or depression.

“When she started the treatment and was well again, I thought that was the end of it. I didn’t think it would come back.”


Moving forward

Remember, there are ways of moving through an episode or relapse. You may have already been through this once or twice before – and you managed. Although you may fear it happening again, you’re a step ahead now because you know more about where to go, what to do and who to contact, and importantly, how to help.

Write down past achievements in the person’s recovery and focus on these. Put the notes in a prominent place, so they’ll be a positive reminder. You and the person you support can refer to them when necessary.

Emergency and crisis situations

Sometimes, when a person has severe mental health problems or the person’s condition deteriorates rapidly, they may consider attempting suicide or harming themselves.

This isn’t necessarily the case for everyone with anxiety or depression, but it’s important to be aware that for some people their condition may become so severe that they may feel these actions are their only option. It’s always better to be prepared. Talk to the person about the issue of suicide when they aren't highly distressed and support them to develop a safety plan that can be used to cope should they be triggered and start heading into a suicidal crisis. 

Sometimes we need to undertake some training/education to feel more competent in supporting a suicidal friend or family member. Training like the LivingWorks ASIST program can help increase your knowledge and skills.

Suicide and self-harm

Hearing or reading about suicide or self-harm for the first time can be confronting and may create feelings of discomfort and apprehension. These challenging subjects are unfortunately still stigmatised and therefore not easy to discuss.

Some people worry that by raising the topic, it may make someone consider suicide who had previously never thought about it. This belief is just a myth and not true. When you support someone with depression, there may be times when you face emergency or crisis situations, such as a suicide attempt or incidents of self-harm and it’s important to be aware and prepared. Self-harm can occur in many ways. It’s not just cutting or physical self-harm. Self-harm may include risk-taking behaviour such as driving fast and recklessly in a motor vehicle, being careless on public transport, high rates of alcohol use, drug use and sexual promiscuity. This behaviour can also put the those supporting this person, or family and friends at risk. Although it may be difficult, make sure to put your own safety first. For example, if the person you support starts driving dangerously, demand to be let out of the car or refuse to get into the car with them.

It’s frightening and distressing when someone you care about wants to harm themselves. It’s important to remember that for many people this is part of the condition. However, learning about suicide and self-harm may help you to recognise when a person is at risk and you’ll be better prepared should an emergency occur.

Misconceptions about suicide or self-harm

Some of the misconceptions about suicide or self-harm may prevent a support person recognising when someone is actually at risk. Many people think that these actions are about ‘crying wolf’ or being manipulative. Instead, when people talk about suicide and their attempts, they’re looking for help – they attempt suicide because they either want to stop the pain they’re experiencing or they want to release the pain somehow, by harming themselves.

Discussions about suicide or self-harm should be taken seriously so that you can understand their distress and pain and comprehend what is happening to the person and can support them by getting the appropriate help. Listening to the person shows your concern and can help to make them feel less isolated. Asking a person if they thinking about suicide or self-harm isn’t an invitation for them to go ahead with either act, but a way for you to show your concern and find out more about what the person is thinking, and to provide help and support.

Warning signs

If a person is thinking about suicide, there may be some warning signs. Sometimes however, these signs may be well hidden, particularly if the person is withdrawing from you, other family members and friends.

Strong indicators are previous attempts, current or recent thoughts of suicide along with talking or joking about suicide and death or making a suicide plan. The person may talk about feelings of hopelessness and helplessness, feeling like they don’t belong anywhere, feeling trapped, feeling like they are a burden on others or express thoughts about death through drawings, stories, poetry or song. The following behaviours could also be warning signs that may alert you to a problem:

  • stopping activities that they previously found worthwhile
  • giving away possessions
  • increasing or commencing use of alcohol or drugs
  • exhibiting risky behaviour.

If you have concerns, it’s a good idea to check with other family members, friends and teachers. Trust your instincts if you have noticed something different and concerning in the person’s behaviour; it is important to get help and support for the person at risk and for yourself.

Safety planning

Consider developing a safety plan collaboratively with the person you are supporting to use when they are well. Together, list strategies to cope and details about what actions will be taken if they start thinking about suicide or self-harm or previous plans. Specify who the person will let know when they are feeling this way so that they get help immediately. A safety plan is the best way to provide structure to what often seems like an uncontrollable and frightening situation.

If the person is thinking about suicide or self-harm, you will need to undertake the agreed plan of action for their own safety, reiterating that you need to follow through because you care. You also need to assure the person that they can trust you and you trust them.

These resources can help with safety planning:


“There are times when action is non-negotiable.”


Remember, if the person you're supporting is feeling suicidal, they are not able to think clearly or rationally, so you, as the support person, may need to take control of the situation.

Occasionally, the person you support may need to go to hospital for treatment if their symptoms become more severe, if their medication is a problem, if they need specific treatment or if they are at risk of self-harm or suicide. If the person is not willing to get help, then it’s a good idea to talk to a health professional for advice about appropriate follow up.

Urgent assistance

If the situation is urgent and you’re concerned that the person is in immediate danger, do not leave the person alone, unless you are concerned for your own safety.

Call the person’s doctor, a mental health crisis service or dial 000 and say that the person’s life is at risk. If the person agrees, you could go together to the local hospital emergency department for assessment.

It is important to keep these emergency numbers handy.