My friend who struggles with mental health can’t afford to get support, what can I do?

1) Dear Alice! 

I have a close friend who has a number of rather difficult issues. One of the most important is a long history of abuse (largely psychological) from her mother during her childhood. (She is now 19.) It is incredibly difficult to talk to her about any of these things. I would like her to see Psych Services, but I am worried about the fact that there are only a limited number of sessions available — that is actually one of the reasons she has offered to me as to why it would be a waste of time to go. Unfortunately, the only medical coverage she has is through her mother's medical insurance, she has no real money outside of her parent's control — it would be extremely difficult for her to pay for counseling, in other words, without alerting her parents. What can she do? What can I do?

2) Dear Alice,

I am actually asking for a friend of mine since this situation is getting worse, and I don't know how to help. The problem is that my friend is very depressed, and has very, very low self-esteem. While sometimes able to be cheerful and "happy," he claims to rarely feel that way and mostly just hates himself. He has mentioned suicide, although I think this is more an expression of the extreme self-hatred he feels than anything. I comfort him and often tell him how wonderful he is — what a good person, good qualities, etc., but I suspect he does not believe me at all. This has been going on for a long time now, and I think it stems from a somewhat unhappy childhood and adolescence. I don't know how to help him and I don't know what to do. I feel like being strong for him is just not enough, and I can't quite convince him that counseling may do some good. It seems to me that, recently, he has been feeling even worse about himself, to the point where nothing will comfort him. He cannot afford counseling, and he has no health insurance. Is there anything you can suggest for me to tell him or suggest to him? Any help will be greatly appreciated, because I just don't how to help him. Thank you so much.

— A friend on-the-line

Dear Reader and A friend on-the-line, 

You’ve both done a lot to show you care for your friends who you’ve noticed are struggling. Even if they’re currently unreceptive to help, being there for them can go a long way in helping them work through challenges and feel supported. Since both of your friends experienced struggles as children, it’s possible that adverse childhood experiences (ACEs) are related to the poor mental health or depressive symptoms they’re experiencing now. Reader, you mentioned your friend being on her mother’s insurance, and A friend on-the-line, you mentioned your friend not having insurance at all. No matter their current coverage status, there may be free, sliding scale, or reduced cost options for mental health support should your friends choose to seek help from a mental health professional. 

In addition to ACEs, some possible causes of poor mental health are traumatic events, genetic factors, family history of mental health challenges, and substance use, though this list isn’t exhaustive. It’s important to note that people who are experiencing mental health challenges often find it difficult to recognize and admit to themselves or others that they’re struggling. Signs of a mental health struggle can vary from person to person, but in the case of depressive symptoms, common patterns include: 

  • Losing interest in activities they once enjoyed 
  • Unexplainable physical pain 
  • Feeling worthless or guilty and fixating on past mistakes 
  • Problems with concentration 
  • Suicidal ideation or mentioning not wanting to be alive 

Many people experience negative feelings, however, when these feelings become extreme, prolonged, or disrupt functions of daily life, it could be an indication that a more serious problem is going on. You both seem to have noticed similar situations with your friends and maybe aren’t sure how to bring it up with them. If there’s an immediate emergency, it might be helpful to contact a crisis hotline. In other cases, some conversation starters to try might include: 

  • I've been worried about you. Would you feel comfortable talking to me about what you’re experiencing? If not, is there someone else you’d feel more comfortable talking to? 
  • I’m someone who cares and wants to listen. Is there some way I can support you through these feelings? 
  • It seems like you’re going through a difficult time. How can I help you to find help or support? 
  • Sometimes speaking with someone who shares or has dealt with a similar experience helps. Do you know of others who have experienced these types of problems who you can talk with? 
  • I'm concerned about your safety. Have you thought about harming yourself or others? 
  • I’m here to listen if ever want to talk. 

List adapted from the Substance Abuse and Mental Health Services Administration 

While these prompts may help to open the door to a conversation, it’s also possible they may not want to talk about it. In which case, it’s best not to push them as it may cause them to isolate further. Other things you may choose to try are inviting and including them in activities (even if they decline), helping them with their tasks, and treating them with compassion. There are also Mental Health First Aid courses you may choose to look into to help educate yourself about mental health more broadly. Doing these things may help to show your friends that you’ll support them no matter what they’re going through. 

If these friends do become interested in seeking help from a mental health professional, there are options for people with and without health insurance, and services that are willing to work with a client's income level. For free or pay-what-you-can services, you might suggest that your friends reach out to a federally funded health center or use the treatment facility locator from the Substance Abuse and Mental Health Services Administration as a starting point. Free hotlines like the 988 Suicide and Crisis Lifeline or National Helpline (1-800-662-HELP) are confidential numbers they may call for help or treatment information. For services with sliding-scale costs, the Anxiety and Depression Association of America has a resource to link people to nearby therapists to avoid a potentially long wait time or limited number of sessions. If your friends are students, their college campus may also have free or low-cost therapy, in either individual or group sessions. There are also mental health apps to guide people through their thoughts and emotions. 

It’s great that you’re thinking of your friends in their trying times. Whether they can’t afford services or aren’t ready to seek help from a mental health professional, being there for them is also a form of support. Staying educated on mental health challenges and knowing what resources are available shows that you’re receptive to their struggles and ready to help them if they want it in the future. 

Last updated Dec 01, 2023
Originally published Jun 04, 2004