Mark Brown hears from individuals supporting others while struggling themselves.

We do not, as a rule, like to see ourselves as uncharitable or judgemental people. Most us would like to think we would do everything we can to help someone we know through their mental health difficulties. In an ideal world, everyone would get what they need and everyone would be ok. But we don't live in an ideal world. In the real world, existing mental health services draw a line between who they will and won’t support. If you’re unlucky, you may find that there is no support at all. That’s an awful thing to experience that forces you to rely upon those around you.

"Often, it’s those of us who have experienced mental health difficulties who find ourselves trying to help or support others when they’re going through hard times because we get it, right? But what happens when you just can’t do it anymore?"

While studying in the US, Alex supported a friend with a severe eating disorder. Aged 20, she had recently survived trauma, moved halfway around the world and was battling her own mental health difficulties. "There was no option for specialist mental health input for her, or me. Her dad ended up re-mortgaging his house to get her into an eating disorder programme but it wasn’t enough. No one saw through my strong supporter mask and supported me."

Withdrawing, Alex told me, was a necessity. “After her second hospital stay she was a bit more stable and I was essentially suicidal. I’m not sure she ever really trusted me again. I think the reality for most people now is it’s a constant state of fire fighting, crisis management, advocating with NHS or voluntary sector organisations and trying not to feel overwhelmed. There’s very little, if any, space or time for healthy models of support and dependency and boundary establishment.”

Time up?

Contrary to the messages of anti-stigma campaigns such as Time to Change, the challenge was not listening to someone’s difficulties; the challenge was where to draw the line when doing more than that. Modern anti-stigma campaigns assume unchallenged or outmoded attitudes around mental illness lead people to conclude the personal cost of speaking to, or becoming close to, those experiencing mental health difficulties is higher than it is. They encourage people to reach out and others to listen. 'See,' the campaigns seem to benignly say, 'it was just a conversation. It didn't inconvenience you at all.' As with many things related to mental ill-health, the reality is more complicated.

Experience of mental health difficulty often creates situations where we feel in need. Having had similar experiences themselves often gives people greater empathy and compassion for someone else’s situation. The most difficult decision is when to ‘put your own oxygen mask on first’ to preserve your own mental health. This is uncomfortable territory because many of us may have been the person drawing the line. Or we may have been the ones, in desperation or ill-health, overstepping the line that someone else has drawn to keep themselves well. Neither makes for a restful conscience. And that, in the words of one of the people I spoke to for this article, is where things get ‘tangly’.

Emily became friends with a colleague at work who had been having problems with bullying. When this colleague transferred to Emily’s team, which was when Emily felt she couldn't support her anymore. "She tried to get me to back up her claims that our supervisor was bullying her and when I tried to explain that I really didn't think this was the case our relationship suffered. Things then got particularly messy, she was signed off sick from stress and falsely accused members of my team, including myself, of all kinds of things. She never returned to work with us. I still feel guilty to this day that I wasn't able to help her more, especially when she was signed off work."

"I have had a lot of friends that have experienced mental health issues," Emily told me, "but she is the only person I have ever cut off. Ultimately she was in a place where she didn't want my help, she wanted me to blindly enable her behaviour. I felt a lot of guilt. I still feel guilty despite knowing that in that situation there was very little else I could have done. I was in my mid twenties at the time and not a trained mental health professional, I was just a young person trying to be there for a friend. In hindsight I probably enabled her behaviour somewhat but looking back everyone she chose to get close to did. This may not have been a conscious choice but I do wonder whether we would have become friends if I didn't."

Nearly everyone I spoke to mentioned boundaries as vital and nearly everyone talked about the way that mental health difficulty can make it hard to establish or observe them. Reflecting on times when she had given too much to someone else who was experiencing mental distress, Aisha told me: "After my line has been crossed I feel mentally exhausted and sometimes I will need a break from the world and time and space in order to have anything to give to anyone else. It feels overwhelming and like I'm trying to maintain a calm and helpful exterior whilst paddling frantically below the surface just to maintain control of myself. The ability to truly empathise and see yourself in their shoes can make it particularly difficult to put your own wellbeing first. I think sometimes people often give too much and allow their boundaries to be crossed for that reason."

Aisha stressed that boundaries are vital. "It's been a learning process for me but the realisation that friendships that revolve solely around poor mental health aren't healthy for either person has been significant. There's a movement toward peer support and social prescribing. This is potentially a great thing and could be really beneficial. With this in mind I feel it is very important to open a discussion about healthy boundaries because relationships that arise from peer support can also be extremely toxic and damaging."

Shelagh has many friends who also experience mental health difficulty. "When our mental health is very bad, or worse than usual, our needs are different. I understand that in those times people do need more, understanding that sometimes in those times the way we ask might not be respectful. Sometimes our needs are so intense we can’t consider the other. It’s not something I judge but of course I do have to have limits, and that can be scary when I have lost people to suicide and people I love are often suicidal."

One person, who is no longer a friend, over-stepped Shelagh’s limits. "She needed more from me that I think I have ever experienced from anyone," Shelagh remembered. "I started to feel like I couldn’t breathe, couldn’t think, could barely move. She became very abusive when I started asserting my own boundaries and stopped accommodating her every wish. I just became a person for her to hate and rage at. It was actually her who cut contact but I guess on both sides we were figuring out boundaries."

Different conversations

In future, a combination of reduced options for support will make more of us unofficial carers and supporters of others and potentially people who need that care and support ourselves. If there is a mental health community, it’s built on people who’ve been there supporting others who are having difficulties. Which makes it all the more important to have these difficult conversations and to be prepared for them; both for future periods when we are in need and for times when others need us. "I think the key is that your support will never be enough to substitute for proper care, so you have to make a judgement call of the best way to use that resource,” says Alex, reflecting on her own experience.

Yes, reaching out is important, and yes, so is being there for others. But beyond that, there is a world of difficult conversations we need to have with each other. Professional support makes a job of providing stable and consistent support. If in future none of us can rely on the presence of professional support, then all we’ll have is one another. And if all we have is one another, then working out how to make sure we can all be there for each other in the long term is a conversation we need to keep having.