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Lockdown will be hard for many of us, but even more so for those with existing mental health issues, particularly those who live alone.

As friends, we want to offer support and help where we can, but now that face-to-face meetings are out of the equation, how can we best support those who are more vulnerable to the news cycle and the heightened precautions we’re all being asked to take? And how often should we be checking in with them?

“It’s especially important to reach out to others if we know that they might be struggling,” says Rosie Weatherley, information manager at Mind. “Friends who have a pre-existing mental health problem may be feeling worse due to current measures being put in place, such as self-isolation and social distancing.

“Whether or not our loved ones have a diagnosed mental health problem, it’s still worth letting them know that you’re there for them. Even if they don’t want to talk right now, they know that they can turn to you if and when they do.”

So, how is best to reach out?

There are lots of ways to keep in touch in lieu of physical interaction – you could agree to do a phone call, FaceTime, Zoom session or something else. There are no strict rules, it’s more about finding what works best for the person you care about. You might also want to schedule calls into your diaries so that you don’t forget or get sidetracked on the day. And remember, it doesn’t have to be a long call. Short check ins can be just as effective. 

Regular chats can help to get a sense of how someone is really doing. When it comes to how often you should call, Marjorie Wallace, chief executive of the mental health charity SANE, says: “It is far better to have too much contact than not enough.”

If you aren’t sure what’s best for someone vulnerable – whether that’s a friend, colleague, neighbour or family member – then ask them how they’d like to keep in touch, and how often, suggests Emma Carrington, advice and information service manager at Rethink Mental Illness.

“It might also be helpful to ask what they would like you to do if you don’t hear from them as planned,” she adds. “This will also give you reassurance and help you to avoid any unnecessary worry – it may just be that they can’t make that video call because the wifi isn’t working.”

Whatever you choose to do though, don’t be weird about it. “There is no need to act differently. As things change daily, the stability of your friendship in the form it has always taken could be of utmost importance,” says therapist Yvette Addo. “Act as you usually do together. Behaving differently can make someone feel more isolated.”

What to ask someone who’s vulnerable

Kickstart the conversation with something neutral, so talking about something you’re both interested in, or you could just dive straight in and ask a few questions about how they are feeling, suggests Deidre Kehoe, director of training and services at charity YoungMinds.

Asking them how they are – twice – can help your friend to open up about how they’re feeling, especially because for most of us, the default response to ‘how are you?’ is often a standard ‘yeah, not bad thanks’.

If that doesn’t work, Sue Peart, a volunteer at Samaritans, which has launched an emergency appeal to cope with demand during the outbreak, recommends tweaking the question slightly and asking: how are you feeling today? “If they say they’re fine, and you know them well enough to know that might not be the case, ask them how they’re coping with the current situation,” she suggests. 

If they don’t want to talk

Don’t be put off if they’re not ready to open up yet, says Kehoe. “Just being there for someone can make a huge difference and it might take a while before they feel able to talk about what’s going on. Don’t give up and think about trying again another time.”

And in the meantime, why not suggest playing a game online – or swapping photos of things you’ve seen or are doing (hobbies, cat pics, trees in blossom) – to keep each other company?

It’s a delicate balance – therapist Yvette Addo warns against actually forcing someone to talk. “This could be counter effective and could lead to them feeling pressured, with less autonomy, causing the feeling that they are unable to speak for themselves,” she says.

If they’re willing to talk

A positive first step if they do decide to open up, says Addo, can be in just acknowledging the difficulty for them in sharing how they’re coping and assure them you want to help. “Let them know that you care, that you are available and most importantly that you want to help in any way possible,” she says.

If they do open up about their mental health and the fact they’re struggling at the moment, the most important thing you can do is listen. Let them talk, ask open-ended questions about the situation and acknowledge that it’s a really challenging time.

“If they’re ready to talk, give them your full attention. Focus on the other person, hear them out, and allow them to speak without judgement or interruption,” Kehoe advises. “It’s ok if you don’t have all the answers or don’t know what to say. Often people aren’t searching for advice, all you need to do is listen and make the other person feel heard.”

If someones says they’re feeling worried, gently explore this, says Peart. “Tell me more” is a really useful phrase to use to allow someone to express what it is that might be troubling them.

It’s also good to remind them of their strategies. “If they say they’re having difficulty sleeping, for example, you might ask them if they have any strategies they use – such as listening to music, reading, or walking around the bedroom breathing deeply – to calm their feelings of anxiety,” she says. “Hearing themselves say their strategies out loud serves to remind them of what comforts them; techniques they can call on should they have difficulty sleeping another night.”

Help with the practical stuff

There are more practical things you could be discussing, too. If someone has spoken to you about their mental illness before and you know they’ve had treatment, Carrington suggests that it might be helpful to check that they have spoken to their doctor about arrangements for any medication.

You might be able to help collect this for them if they are unable to go out, and the same can be said for groceries and essentials that they need.

If you don’t live nearby, search online for a community support group (like Covid Mutual Aid UK). These groups can help people to manage essential tasks like shopping and collecting prescriptions if you’re not able to, and can also check in with the person you care about to help them feel less isolated.

You might also want to check in on how they’re eating or ask if they’re managing to get outside once a day – especially as getting out in nature and exercising, even if it’s just a walk, has been found to benefit mental health.

Kindness counts

Random acts of kindness or thoughtful gestures can make a huge difference to those struggling with their mental health, as it shows they’re being thought of and that you care. If you can’t help with the practical stuff, can you send them a lovely letter or card, or perhaps some letterbox flowers to cheer them?

If it’s someone’s birthday or a special occasion, can you be creative about how you celebrate it during the lockdown?

Alternatively, just helping your friend plan out their days can be beneficial – and it’s something you can do at the same time. “It can be helpful to have a good sense of routine at the moment,” Carrington explains. “You could contact them and work together on a plan for the day, and send it through so they have it in writing.”

As time goes by you could work with them to find out what is helping and adapt the plan accordingly. “Sharing tips and advice about how to cope with life in lockdown can be really positive and helpful,” she adds, “but remember that different things work for different people.”

If someone is really struggling

If someone’s thoughts seem increasingly focused on unhelpful, negative ideas or images, you can help them to challenge this thinking, says Carrington. If they have access to the internet you might want to point them towards one of the NHS-recommended apps for maintaining good mental health, the Every Mind Matters support page, or the signposts at the bottom of this article.

“Sometimes people may become anxious when you’re talking to them,” she adds. “If this happens then keep your voice calm and get them to ‘ground’ themselves” – they can do this by sitting down and concentrating on the feeling of the chair beneath them and the ground below their feet. ‘Box breathing’ can also be helpful, where you breathe in for four counts, hold for four counts, breathe out for four counts, and hold for four counts.

If someone is really struggling with their mental health, you can suggest that they speak to their GP or mental health team – many are offering virtual services during the lockdown and some are still running face-to-face sessions where it’s considered the best option.

And remember to look after yourself, too. “You can play a really valuable role in supporting someone you care about through the pandemic, but remember you’re not solely responsible for fixing things or offering advice,” says Carrington. “The most important thing you can do is to listen to them, show them that you care and that you’re taking their concerns seriously.”

Useful signposting

• Mind’s website has a range of information and tips to boost physical and mental wellbeing. Their helpline is open Monday to Friday, 9am-6pm on 0300 123 3393.
• YoungMinds (which supports people under 25) provides a free 24/7 crisis text messenger service. If someone is in mental health crisis, they can text YM to 85258 for support.
• Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI – this number is FREE to call and will not appear on your phone bill.)
• The Mix is a free support service for people under 25. Call 0808 808 4994 or email: help@themix.org.uk
• Rethink Mental Illness offers practical help through its advice line which can be reached on 0300 5000 927 (open Monday to Friday 10am-4pm). More info can be found on www.rethink.org
• Sane can provide support through its website. The charity has a messaging system in place with trained professionals.