Expert answers from the psychologists

My boyfriend is suicidal. He attempted to take his life before over a year ago. He's currently taking mood stabilisers and undergoing therapy, but nothing seem to be helping. What steps should I take next? I'm petrified of what he might do.

We are very sorry to hear about your boyfriend’s current mood. Severe episodes of a depressed mood can include having overwhelming thoughts of hopelessness about one’s future and the capacity for things to improve, plus helplessness that they, themselves, can effect change. From your letter, it would seem that your boyfriend is currently receiving input from services in terms of medication and, we assume, some psychological therapy. Given your reports, it is important that his suicidal thinking is shared with his therapist and that his GP is also aware of the current risk you describe.  

In terms of the next steps that you could take, can you check whether your boyfriend has told the staff members working with him about his suicidal beliefs? Can you explain to your partner that you are worried about him and are keen to ensure that he receives additional support to help him through this difficult period? Does he have their contact number to hand and if so can you ask him to call them to let them know how he is feeling? If he feels unable to do this, will he let you contact them on his behalf and explain how things have been for him? Another thing you might try is to ask your boyfriend to let you know when he is feeling suicidal, with the agreement that he will not act ‘just yet’, but will talk to you, or to someone else that he trusts. This advice to try to talk to someone and not act comes from the studentsagainstdepression.org website, that your boyfriend and yourself may also want to look at, whether or not he is a student. The Samaritans also have 24-hour phone lines which he can call and which can be very helpful, particularly if he is having suicidal thoughts late at night.

We know that it can be very difficult supporting a relative who has suicidal thoughts. It can put a lot of pressure on you, which your boyfriend may be trying to protect you from. It may also make you feel angry and frustrated at times, particularly if he is not able to discuss how he feels with you. This can put you in the position of seeing how upset he is, but him not letting you do anything about it. It can be helpful to spread this load. Has he got friends and family you can get involved? When someone is depressed, their thinking typically narrows and becomes distorted – they may feel that no one can really care about them, and may withdraw from social contacts. Can you ask other friends to phone or call round? Are there members of his family who would be able to offer practical help, and again be in phone or Skype contact? Finding out that you do have friends and family who do not put pressure on you, but are happy to have a chat every day can be very useful, and rebut the idea that you cannot be ‘likeable’.

Finally, if you have immediate concerns about your partner’s safety and he is at imminent risk of self harm, you should ring 999 and request the relevant emergency service, such as an ambulance, or the police. At any other time, if your boyfriend is amenable, you can always attend your nearest accident and emergency department where your partner will be seen, assessed and offered the appropriate help.

It is understandable that you feel petrified about what might happen. Try not to let this stop you from getting help when you need to, both for yourself and for your boyfriend. Although there is still stigma about depression and suicidal thinking, it is not uncommon. Try to remind yourself that you are doing what you can, and being very caring trying to help your boyfriend through this difficult time. Do you have someone that you can talk to and discuss the impact this is having on you? It is important to remember that you are not alone in this situation, and that some of your friends and family would be likely to want to help as well. You can also look at the following mental health websites from Rethink Mental Illness or Mind for the details of support groups in your area.

My husband recently told me he believes he is ill as he has been hearing voices and feels people are always looking at him when he is out and about with our little girl, and also he recently lost his job and says he feels depressed. What can I do to help him?

Losing a job can be a major stressful life event for many people and research evidence and our clinical experience confirms that stress can negatively affect an individual’s mental health in several ways. For example, under stress, some individuals will experience mood difficulties including feelings of anxiety, depression and irritability. Sleep and appetite disturbances are also commonly reported. In addition, episodes of stress can cause some individuals to experience unusual perceptual experiences such as hearing voices. It is encouraging that your husband has been able to share these experiences with you, as many people in similar situations can feel embarrassed and worried about their experiences, and subsequently isolate themselves from others, which can make things much worse.

As a first step, it might be helpful to find a time to talk with your husband about how he has been feeling recently and explore whether he has any ideas about what he might like to do to make himself feel better. It would be helpful to reassure your husband that he has been through a stressful event and this will be impacting on his thoughts and feelings about himself and others. You can ask your husband whether there is anything that you could do that would make him feel a little better. For instance he might need you to reassure him that you still love and value him – people often feel they have let their loved ones down, when they lose a job and cannot ‘provide for the family’ in the same way. Letting him know that you understand this, but he is still helping you with things such as childcare – taking your little girl out – or whatever, might be useful.

In addition, your husband would benefit from visiting his GP to explain how things have been for him recently and to consider different options for support. Similar to many other people, your husband may be reluctant to visit his GP out of fear of wasting their time, or not knowing what to say or where to start. By way of offering additional support, can you offer to attend an appointment at the GP with him? You both may find it helpful to jot down the areas you wish to raise with the GP in advance of your appointment. The GP will be in an ideal position to signpost and/or refer your husband to additional services, if required. For example, your husband may benefit from talking to a trained therapist about the impact of losing his job, his mood and the effect on other areas of his functioning.

We don’t know the circumstances of the recent job loss. It is common for people in this kind of situation to feel they are to blame in some way and that others think less of them. These are the kinds of thoughts that can lead to feeling down and depressed and this low mood can trigger unusual experiences such as the voices your husband describes. This will typically happen when new stresses arise – such as being out in the street, meeting strangers, when you cannot check out what they are thinking, and there is a tendency to assume that others think badly of them, when this is very unlikely to be the case. 

This is clearly a challenging time for you and your family. Thus, it is important that you try your best to make sure that you are also being supported. Do you have a trusted friend or relative that you can talk to? Of course, you may prefer to keep the details private between you and your husband, but it is important that you also make time to think about your own support needs. 

My flat mate has told me in confidence that she is hearing a voice that is saying nasty things to her every day, and that she has become very frightened of it. We are both students. Last week, she woke me up in the night. She spoke to me in an aggressive way and said the voice had said I was going to hurt her and had told her to hurt me first. She had a knife in her hand and was pointing it at me. Then she was sobbing and talking to herself and saying I was her friend and she didn't want to hurt me, and then suddenly she screamed at me to go. I went to my friend's flat and then went home to stay with my mum for the weekend. I'm suddenly frightened of my flatmate but do realise she needs help. My mum suggested I talk to her family but I don't know them so can't contact them. When she told me about the voice, I suggested she go to see the GP on the campus, but she said they would think she was mad. I'm now frightened to be alone with her so will be moving out, even though I feel bad to abandon her.

The content of voices can be pleasant for some people, but for many others the content can be negative, highly distressing and commanding. For example, some people may hear voices that make derogatory comments about their appearance and attributes. The voices may swear and issue threats towards the voice hearer, or imply that some harm may come to their friends and loved ones. In other circumstances, a voice or voices may provide a running commentary on the individual’s everyday actions or issue commands to the voice hearer to behave in a certain way. This may include engaging in acts of self-harm or harm towards others. The actual voice may consist of single words or full sentences and they may talk directly to the voice hearer and/or about the voice hearer. The voice hearer is likely to find these comments impossible to ignore and very distressing. Further, the voice(s) may be perceived as very powerful and knowledgeable – someone who needs to be listened to and obeyed. Consequently, the voice hearer may feel compelled to comply with the command of the voice or try to mitigate the threat posed by the command and engage in other behaviours that may be harmful to themselves or others. We know that hearing voices is one of the most common symptoms of psychosis, but we also know that there are many people living in the community who can report having such experiences who are not in contact with or in need of any specialist mental health services.  However, it is often the case that people in contact with services are more distressed by their experiences, have difficulties coping with their experiences and/or engage in behaviors that are likely to be harmful to themselves or others.

It is understandable that you have concerns and fears about your friend given her recent behaviour. Your decision to move out is also understandable and sensible if your friend is saying that at times she finds you a threat to her. It is not clear from your report whether you attend the same college. Assuming that you do, are you able to contact the GP service and/or student welfare service and/or your flatmate’s personal tutor to explain your concerns and recent events? It can be helpful to summarise what exactly happened and when, in a letter. It is clear that your friend is in need of more immediate help and her reluctance to visit the GP is likely to delay her access to treatment. While making contact with any of the people mentioned may leave you feeling that you are going behind your flatmate’s back, it is the case that you were for a short while in a risky situation, and this is what you need to make clear – that you are concerned that your former flatmate is not in a safe situation. 

It is also worth noting that your flatmate is obviously working very hard to resist acting on the commands of the voices. This was fortunate, and many people do try hard to resist such commands, as you describe. However, your friend, on at least one occasion, has come close to obeying the voice. This is not a stable situation, and it is important that your flatmate is able to access help as soon as she can.

Letting her family know about your concerns is an option you could consider. Although you do not know them, they will want to know that she is having difficulties, and may be able to get help for her more quickly. Can you ask your flatmate, by phone or text, if you can you phone one of them for her? If she agrees, just tell them briefly that you are worried about her and why. Try to keep the account factual, as you have done in your question, and ask them to get some help for her as soon as they can. Many family members feel that if they had only known about difficulties earlier, they could have accessed help more effectively. If this is not going to work, you must tell someone that your friend is not safe in the flat. Letting the GP know by letter as we suggested above would be the next step.

You may also find it helpful to visit the Hearing Voices Network (HVN) website for information and resources on voice hearing. The HVN also provides a network of self-help, coping and support groups and regular newsletters. You can perhaps download some general information and leave these with the website address in a letter for your flatmate.

Finally, if there are any more occasions prior to your moving out of the flat that your flatmate becomes aggressive to you or indeed herself, we advise you to call 999 and request the relevant emergency service, such as the police or ambulance service. Though it can be a difficult decision and not an ideal method for your friend to access the support they need, it will ensure that she remains safe and at reduced risk of harming herself or others.

I was given a diagnosis of schizophrenia many, many years ago and have never been well enough to work but mostly manage to lead an independent life. (There is a warden in my flats and I am on benefits). I have a brother and a sister. I don't see them very often as they work and have children. My mother is in her late 80s and recently was admitted to hospital after a fall. She will need help at home when she comes out. I think my brother and sister don't think I am capable of helping her as they are making arrangements without talking to me. I want to be involved because I love my mother and get on quite well with her. But I am also worried that I might find looking after her too stressful and it might make me relapse.

Thank you for your letter and we are sorry to hear about the developments in the health of your mother. It is probably worth noting that the issues you highlight are very common and increasingly faced by many people with elderly and infirm relatives. It is important that in considering what is best for your mother, you are also considering what personal resources you have available.

It would appear that your relationship and contact with your mother is very important to you and you have a good understanding of what things are also likely to negatively affect your mental health. Given this, we wonder if it would be helpful to contact your brother and sister, thank them for taking care of the arrangements so far, but also say that you would like to do what you can, and you would also like to be involved in the decision-making about your mother’s care. Your siblings are probably trying to do what seems best, without involving you because of a wish to reduce any stress that you may feel. In your discussions with your siblings, you should aim to talk openly about what you can all reasonably and realistically offer in terms of caring for your mother, in the context of your resources. Having some professional help organised will not stop whatever you wish to add to this from being appreciated.

Providing care and support to an infirm relative can be done in different ways; some people may be able to offer help financially, whilst others can offer emotional support on the phone or face-to-face, or practical support in terms of completing specific tasks and duties.

There are no universal rules about care-giving except that it is important to do only what you feel able to and to remember that what you are doing is good enough.

Care-giving can be long term, and so it is important if you do commit to some of it, that you are realistic about what will be manageable for you. Your mother would not want to you to make yourself unwell again after all. It may be that you can offer some small amount of support that is feasible for you, and see how it goes. If it is too much, then offer it less often, or via a phone call or whatever. There is no right amount, and we expect your mother and siblings will be pleased with whatever you can manage.  It is encouraging that you are thinking ahead of what will be good for you and your mother and we wish her the best in her aftercare.