Updates
VOLUME 2 ISSUE 16
“Is Anybody There?” A Survey of Friendship and Mental Health
“Is Anybody There?”
SUMMARY The Mental Health Foundation carried out a survey investigating friendship and mental health. This formed part of a campaign for Mental Health Action Week, April 2001. This paper summarises some of the main findings. BACKGROUND Friendship was recognised as an important part of people’s coping strategies in the Foundation’s user-led research ‘Strategies for Living’i. In addition, a Foundation report ‘Pull Yourself Together’ showed that although people are keen to tell their friends and families about their mental distress, they are also likely to face discriminationii. THE RESEARCH A questionnaire was designed using open and closed-ended questions. The survey was distributed via the Foundation’s mailing lists and those of Mind Cymru. People were also encouraged to pass the survey onto other individuals and organisations. The survey was divided into two main parts:
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Part One asked people to describe what it is like being friends with someone who has experienced mental distress. Part Two asked people who themselves had experienced mental distress to describe their friendships. 543 questionnaires were analysed: 70% of respondents were female; all the age ranges were represented (from 18 to 65+); the majority of respondents were aged between 25 and 54 years of age; 82% of respondents were White British.1 32% of respondents completed part one only, i.e. a third of all respondents were describing their experience of being friends with someone experiencing mental distress. 23% of respondents described their own experience of mental distress and friendships at that time. 45% of respondents completed both sections, i.e. they had personal experience of mental distress as well as being a friend to somebody experiencing mental distress.
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The respondents
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THE FINDINGS 2 PART ONE: Being a friend of someone who is experiencing mental distress3 Finding out about a friend’s mental distress 1 in 4 people did not find out about their friend’s mental distress until they went into hospital. 5% found out about their friend’s mental distress following their suicide attempt.
1 Further research focusing on the needs of people from black and minority ethnic communities is required. 2 It is important to note that all percentages reflect the number of respondents who mentioned a certain theme as a percentage of the number of respondents who answered that particular question. Therefore totalling the percentages across a whole question will give an inaccurate figure since some respondents mentioned more than one theme per question. All quotations are anonymous to protect the identity of the respondents. 3 Completed by 421 respondents.
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MENTAL HEALTH
Reactions to mental distress When asked how they had responded, 1 in 3 friends talked about wanting to help their friend (33%), and feeling concern for them (25%). 1 in 5 said they felt shocked or frightened for their friend (21%). “Shocked and worried. Appalled at the state of the hospital. Felt as if my friend had died and was grieving for them.” Nearly 1 in 10 people reported feeling powerless and helpless (7%). The immediate impact on relationships 68% of respondents who answered this question felt that there had been an impact on their friendship. Of this group, nearly half felt that their relationship had improved (42%). “Positive - forging a stronger bond of friendship.” 87% of people responding to this question felt that their friendship had become strained or difficult to maintain. Respondents gave various reasons for this such as feeling stressed by the relationship, excessive demands, difficulties talking to each other and not knowing how to help. “Due to erratic behaviour, subsequent rows and excessive demands (emotional and physical) together with continual apprehension as to what other scenes and rows, could and would occur, the friendship became very tenuous.” “Felt helpless not knowing how to cope with the effects.” The longer term impact In the longer term, friends similarly described relationships becoming stronger (40%). Others described the long-term strain of being a friend to someone who is experiencing mental distress (36%). Even those friends who described their friendships as becoming stronger also described experiencing some difficulties due to the emotional impact. “This is hard to define as each friendship we have is different, but there are times when the impact of the illness and the memories on my friend can be exhausting mentally and emotionally to me as I listen. But we also have many times in which we enjoy things together.” Providing support 90% of people stated that they could sometimes provide support for their friend. This support was provided in a number of ways:
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52% provided support by talking and listening to their friends. 41% simply gave time or let their friend know they were there for them. 29% provided support through acceptance. 23% offered information and advice. 22% provided practical support such as helping with housework, helping with transport to appointments and financial help.
Difficulties in providing support 78% of people who gave support, said that they sometimes found this difficult. 43% felt that the emotional strain simply became too much; it was distressing, exhausting and demanding particularly when the respondent’s own mental health was vulnerable. “Emotional and distressing. Wanting to do the best for her, but not sure how. Apprehensive about suggesting to get help. Time pressures.”
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Support for ‘carers’ 58% of people providing support to their friends felt that they also needed to be supported in this. People who received help found support mainly amongst their family and friends, (72%). However almost a third of those friends who needed support did not get any support. Respondents were asked what kind of support would have helped them to support their friend experiencing mental distress.
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39% of respondents mentioned talking to a professional. 27% wanted more information. 23% felt the need to be kept informed about their friends care. 21% needed ‘time out’ from their friend.
PART TWO:The experience of friendship by people with personal experience of mental distress 367 people responded to this part of the survey. Disclosure of mental distress Respondents were asked if they were able to tell their friends about their mental distress or mental health problems. “My close friends know but I don’t go shouting about it.” 48% of respondents were only able to tell certain friends. People said that they often felt worried about telling their friends for fear of being discriminated against or becoming a burden to their friend, (39%). More than 1 in 3 respondents said they could only tell a few friends or could not tell any of their friends (34%). Response of friends following disclosure 49% of people reported that their friends had offered to provide support. Almost half of respondents were able to say that all or most of their friends were understanding (47%). However some respondents did report negative responses from their friends:
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1 in 3 found very little understanding from some of their friends. 1 in 10 people reported that their friends were prejudiced. A further 1 in 10 reported losing all or most of their friends after telling them about their mental distress or mental health problems.
Support from friends Although people reported negative responses from friends, it is still clear that many people have friends that support and care for them. “After asking ‘how are you?’ and being told ‘fine’ they come after me and said ‘you’re not fine really - how are you? This showed interest acceptance, and basic human love.” 80% of respondents that described receiving support from their friends spoke of emotional support; their friends were understanding, accepting, and listened and talked to them. 46% of respondents reported that their friends provided practical support such as help with household chores, transport to appointments and sometimes financial support. The effect on friendships More than half of the respondents who had received support said that their friendships had become stronger, (54%). Whilst 41% of respondents reported that they felt the stigma of mental ill-health had had an impact on their friendships. A further 21% described other strains caused to their friendship.
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IMPLICATIONS AND RECOMMENDATIONS This research illustrates the importance of friendships. People want to support their friends who are experiencing mental distress, and yet often feel out of their depth and require support themselves. Recommendations for Government and policy makers
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There is an ongoing need to challenge the stigma and discrimination faced by people who experience mental distress. The Government’s ‘Mind Out’ initiative is to be welcomed, but it is important to ensure that this type of work continues, and that it does so at a local as well as a national level. The National Carers’ Strategy needs to recognise the role of friends as informal carers and to ensure that support is available on a local level. The new Disability Rights Commission should give priority to addressing discrimination in relation to people with mental health needs. There is a need for more positive images of people with mental health problems in the media and a greater recognition that using negative language encourages discrimination. Awareness raising campaigns must begin in schools where children from an early age are given the skills and knowledge to understand mental health and mental health problems. This could link into the new Citizenship curriculum in schools. Mental health professionals need to recognise the role of informal carers in people’s lives. There needs to be greater access to information, services which operate out-of-hours, alternatives to acute psychiatric hospitals and greater access to talking treatments. All GPs should have on-going training to develop their understanding of mental health problems and regarding ways of helping people and their informal carers to develop their own strategies for coping with mental distress, and to locate alternative sources of help. There needs to be more and longer-term funding available for local support groups and users groups.
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Recommendations for media and educational campaigns
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Recommendations for mental health professionals
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Recommendations for funders
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This Update was written by Sarah Wright of the Research & Policy Unit at the Mental Health Foundation.
Series editor: Lisa Bird The full report is available from the Mental Health Foundation on 020 7535 7441/7455. For more information about this research, please contact the Research & Policy Unit on 020 7535 7444 or swright@mhf.org.uk For information on subscribing to Updates, please call 020 7535 7441
The Mental Health Foundation 20-21 Cornwall Terrace, London NW1 4QL Tel: 020 7535 7400 Fax: 020 7535 7474 The Mental Health Foundation Scotland 5th Floor, Merchants House, 30 George Square, Glasgow G2 1EG Tel: 0141 572 0125 Fax: 0141 572 0246
E-mail: mhf@mhf.org.uk Website: www.mentalhealth.org.uk Registered Charity No. 801130 i Faulkner, A. & Layzell, S. (2000) Strategies for Living. A report of user-led research into people’s Strategies for Living with Mental Distress. The Mental Health Foundation: London. ii De Ponte, P. (2000).Pull Yourself Together: A survey of the stigma and discrimination faced by people who experience mental distress. The Mental Health Foundation: London. © The Mental Health Foundation April 2001