As a practising psychologist in Singapore, I often receive calls from distraught family members asking what they can do if they have a family member or friend who they suspect is suffering from depression but who is reluctant to see a mental health professional. The main goal in this situation, is to make sure the person gets an appropriate diagnosis and then start treatment by a mental health professional if he or she does in fact have depression. This article contains a list of suggestions and possible interventions on how you can help the person achieve this goal.

Educate yourself and encourage family members to learn about depression

This includes the person suspected of being depressed. Leave pamphlets about depression for your loved one to read. You want to gradually increase your loved one’s consciousness about what depression is all about. This increased consciousness, sooner or later, will hopefully motivate them to action and to get a diagnosis and treatment. This may take time. The recent study in Singapore conducted by the Institute of Mental Health found that on average depressed individuals wait 4 years before seeking treatment. However your attempt to gradually educate the depressed person may greatly reduce this time period.

Learn to identify the symptoms of Depression

Diagnosis of depression can only be carried out by a qualified mental health professional such as a psychologist, psychiatrist , or clinical social worker. However it is helpful if you are aware of the many possible ways that depression can manifest itself in your loved one’s life. These include:

Change in mood: becomes less cheerful, more sad and unhappy

Reduced self esteem: may feel ashamed/disgusted with self

Becomes increasingly pessimistic; feels hopeless

Crying more

More easily irritated

Feelings of guilt

Feelings of being punished

Can't make decisions as easily as when not depressed

Change in eating habits

Change in sleeping habits

Loss of interest in things that usually they found pleasurable

Increased worry about health problems

Increased sensitivity to pain either emotional or physical

Decreased interest in interacting with other people

When you see your loved one exhibit any of these symptoms just remind yourself that this is depression and not the “true self”. This may help you have the patience and tolerance and understanding necessary to be of help.

Don’t drop bombs and don’t respond to bombs

In other words don’t scold or criticize the depressed person strongly or suddenly. Use moderation in what you say and how you say it. Think carefully before you speak; think about the likely effect of your words on the person who is depressed. Do not accuse the depressed person of faking illness or of laziness.

Follow the SET procedure:

Support the person by saying supportive things such as “I care a great deal about you and want to be of help” Empathize but don’t sympathize. Say for example “I am guessing that right now you are not seeing the future holds great promise for you” Truth statement. Say for example “Research has shown that although it takes effort, experiencing positive things e.g. going or a walk, listening to your favorite music helps people recover from depression”

Prevent withdrawal from activities

Try to persuade the person with depression to continue to do their daily routine, especially doing the things that usually give them pleasure e.g. evening walk outside, going to gym or yoga class. Quiting their usual activities will only increase their sense of isolation and allowing them to wallow in their troubles.

Don’t support, but don’t criticize, what you see as negative coping responses

These can include: sleeping excessively, using alcohol, watching sad movies, over eating especially of high calorie carbohydrates. Instead of criticizing suggest alternative actions that are more positive.

Listen

Do listen to the person in a kind and supportive way. Don’t disagree with or deny what the person says they are feeling; validate their feelings. Most times after venting the negative feelings or even crying in the presence of a kind and supportive listener, the person with depression will feel better to have done so. Very importantly, they may feel so supported that they feel confident enough to think about taking some positive steps to help themselves e.g. to go for a walk, see a professional mental health worker. Reinforce such intentions with as much love and support as you can muster.

Do not try to force solutions

For example, do not push the depressed person to undertake too much too soon. Too many demands can increase feelings of failure.

Taking steps towards recovery requires time and effort

Do not expect him or her "to snap out of it." Eventually, with support and professional treatment, most depressed people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

Remember that depression can interfere with a person's ability to get help because it saps energy and self-esteem and makes a person feel tired, worthless, helpless, and hopeless. So family or friends may need to encourage the depressed person to make an appointment and perhaps offer to accompany the depressed person to the doctor.

Take threats of suicide seriously

Listen carefully and if the person comes to a point where they admit confusion or ambivalence about something, you should emphasize this confusion to them. Remind them that there are things they do value and cherish in their life.

If threat continues and person actually makes some concrete preparations, it may be necessary to call an ambulance and have the person taken to the hospital where they will receive the appropriate medical attention. Many depressed people are grateful for such interventions because it saved their lives.

Concluding remarks

One of the most painful things that can occur in life, is to have a loved one languish in depression. We, like the depressed person, can also begin to feel helpless. However, as the above list makes clear, there is lots that can be done to help the person with depression. Also remember that having a loved one who is depressed in your life is stressful for you the caretaker. Be sure to take extra good care of yourself- physically, mentally and spiritually. You might want to seek out some focussed counselling for yourself. Only if you are in a healthy and resilient state will you be able to actually help the person with depression.

