How can I help a friend get professional help if she doesn't know she has a problem

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I'm fully expecting a lot of posters to come down on me for posting bits of this. I'm floundering with an old friend and don't know how to help her. I've probably got lots wrong. I'm stuck for what to do best. I am now suspecting she has a mental health issue ...all her friends have been putting the behaviour down to reaction to life events but increasingly we are all concerned

Work is an underlying issue. She can be very good at her job...but her behaviour, lack of organisation, lack of decision making and refusal to accept advice (when she has sought it!?!) means she is almost paralysed. She is always behind at work which has a huge impact on both staff and clients. If her workload is reduced she is exactly the same. I don't think its a shortage of time issue...it's more like she cannot conclude her task regardless of how long she is given.

She seeks advice on decisions repeatedly. She is given very good clear advice and goes and chews it over.....before going and finding someone else to ask....same advice.......goes and chews it over.....endlessly (similar pattern in personal life as well). It doesn't matter what the advice is. It can completely concur with her thoughts or be completely at odd. She will always say 'yes that's right, that's what I need to do' and go and stress over doing it....before starting exactly the same conversation about it.

Relationship wise she has bounced from one bad relationship to another. I think many of us have assumed that her behaviour is due to trauma of bad relationships affecting her. I'm now wondering if in actual fact it's a mental health issue which is impacting on relationships.

Work colleagues have started to allude to concerns over specifically bipolar disorder. I'm uncomfortable but....I know exactly what they are referring to. She can at times be very very 'wired' constantly moving and constantly talking jumping from subject to subject. It's exhausting just being in her presence. You feel like a whirlwind passed over you. She can also sit with her whole body tense and tightly coiled and staring into the floor lost in thought for lengths of time (in a social gathering/meeting) She is usually oblivious to others around her when like this, when otherwise she can be a very social person.

Her relationship experiences would fill the board on here. She doesn't seem to discriminate but takes on any new man who expresses interest in her and usually she bombards them with attention at first hint they've noticed her. She's lovely but quite forceful in this respect. She never ends it, they usually do after a prolonged break down where she falls apart. Obviously losing lots of weight, all of the above worrying behaviour, driving erratically, not sleeping... All normal for a breakdown but always a little bit more than is normal. Waking up neighbours at 4am because she is doing DIY, impulsive financial decisions, impulsive travel decisions....I'll go to Istannbul on my own for a week. Booked ten minutes later. I'll decorate my bathroom...starts the job immediately but then realises she can't finish it so it stays like that for months upsetting her.

All of above on their own could be understandable because it's reactionary to either work stress or home stress...except we've all realised that supporting her to cope with the fallout of bad decisions and get back on her feet doesn't work because she just launches into another.

It's also all getting a little bit more worrying. I realise written down it possibly sounds like nothing or easily dismissed or excused. All I can say is that almost everyone that knows her would read this and nod sadly. We are all worried. It isn't a recent development. The behaviour has been similar but lower intensity for 15 yrs? The last four years have got much worse and I'm quite worried about her.

She went to counselling at friends suggestion about 3 yrs ago. She said it didn't help at all and won't go back.

What can I do. I really am worried for her

Why did she go for counselling if she doesn't think she has a problem?

Sorry, posted too soon by mistake.

From your description she does sound like she might benefit from making some changes.

Did she see a gp before? If she has bipolar she will need mood stabilisers otherwise the counselling will be of limited use.

What do you think she would say if you suggest to her that she seems to be suffer erring from anxiety?

She went for counselling because of strong suggestions from concerned friends. At the time she was almost unable to function professionally so she had a few weeks off work.

She hasn't seen a GP for ages and has no diagnosis. It is not something I feel I can or should diagnose obviously and I'm even concerned about suggesting it on a forum. However I think there is more to this than 'just' stress or anxiety

I think she definitely needs to change this cycle of distressing chaos in her life.

I have gently suggested anxiety before now...she reacts quite badly to even a hint that the problems might stem from her. I feel she is quite fragile and I'm reluctant to do anything which might tip her but have come to a point that I feel something will happen anyway. I'd rather we (her friends) intervened sooner but I'm not sure if that's the wrong thing

To have a situation where it feels like everyone but her recognises an issue ...and they are all talking about albeit in kind manner rather than a malicious way feels awful, daft and pointless.

She does have 'not friends' who also are aware and whilst I don't chat with them so don't know what they are saying I am aware of a general dismissive and unsupportive tone from them. I know she is a nightmare to work with so appreciate that people who are not friends will express their frustration. It still worries me because I think she is aware of this feeling.

I guess I'm concerned about validating the opinion of people who don't care about her, to her .I think it would break her.

I don't really think you can do anything sadly. Your friend sounds alot like me, i suffer from anxiety and what you describes sounds very much like i am. Always looking for validation, reassurance that im doing the right thing, lacking the confidence to start even the simplest of tasks. I try to cover this up by being a bit OTT. I most definately do not have Bi-polar and it is very dangerous to be even suggesting such a diagnosis. Your colleagues sound like a bunch of gossips if im honest and i suspect you feel the same.

I understand your concerns, but all you really can do is suggest she seeks help, maybe focus on improving her confidence and self esteem issues that she has.

I have had counselling, lots of it, to be honest, it hasn't worked for me. Medication works, to a degree. If it were my friend i would try and point her in the direction of CBT counselling as this will challenge her self esteem and confidence issues and help her break her cycle of behaviour.

At the end of the day (sorry to sound like jeremy kyle) your friend needs to seek help for herself and all you can do is be there for her. Is she being supported at work by management? Is she being told she is doing a good job when she is? Is she being given sufficient information and background to do her job? I was in a job where i didn't receive this, so with my anxiety disorder it precipitated a nervous breakdown from which i haven't yet recovered. I hold my employers responsible for this as they failed on their part in providing me with the support to do my job properly. A non anxious person would have told them to stick their job where the sun don't shine but it broke me.

They are not a bunch of gossips. Very little is said tbh. It gets given a mention usually in terms of something that has happened and people say Why?????? and another person will say well it was and everyone falls silent and asks no more questions. The comments regarding her behaviour being manic (used not in the medical sense) are also not constant whisperings. I've known her for 30 yrs and it's just lately that concern has been expressed. People have come to me as a close friend and expressed concern and I am aware of a trend of expressions of real worry for her lately bizarre behaviour.

I don't think anyone is planning to suggest bipolar to her. It feels like people are now concerned that we are all ignoring behaviour which is becoming more dangerous than confronting it.

A lot of self esteem building is done. She does have a circle of very caring and perceptive friends. It feels like an impossible task; like trying to fill a rapidly leaking bucket with water

Work management is shite. I think this is a massive issue. I have suggested she explore alternatives to her work location because it's very unhealthy and I don't see a change happening there.

CBT is a great suggestion. She might accept that as she does know she has some issues. That would fit with her idea of what issues she has.

It's very hard but unless your friend wants help or puts herself or others in danger, there is nothing you can do. If she does have bipolar, the window for realising that her actions are 'manic' is really small and even people who have lived with a BP diagnosis for years and accept it, find it really very hard to recognise that they are entering a manic phase. The depressive phase can be literally paralysing.

My mum has BP and when she wasn't diagnosed she did all sorts of stuff that she can't even remember. Things like calling the police on my father because he had a gun (he didn't and doesn't own one, but was plucking pheasants that had been given to them), coming to my college and telling me to change my appearance because he would run me down, took my sister to another county and enrolled her at a new school, etc. The Friends she stayed with only realised that she was unwell when she started making them a roast dinner at 5 am, etc.

I think the likelihood is that work will implode first (it did for Mum. They asked her to visit the doctor and told her she couldn't work because she was seeing all sorts of 'problems' and trying to fix them instead of doing her job). Then she may be forced to see the issues.

Is she being told she is doing a good job when she is. The sad truth is that she is rarely doing it. I think work is a mixture of shoddy management and the fact that now she is a pretty poor performer in the workplace. That's grim to say, but factual. Colleagues are covering for her.

She is capable of doing a good job. Her 'issues' meant her work slipped (this is going back 10 yrs) Management was good but frustrated as the cycle of poor work....working with her....poor work....working with her ...poor work.... was constant. Nonetheless they were supportive. Management changed and also her relationship breakdowns increased and I feel we have a perfect storm building for her

X posted lougle. I suspect you are right re work. I feel like I'm standing by and watching her crash. It's painful watching. Fuck knows what it is like bing that person.

I forgot to say that mum has been stable for years now (meds) but has a very limited world. She finds new situations very difficult and will only do familiar tasks. I love her so much, though. She's wonderful.

That's a lovely thing to hear Lougle. I want to see my friend well.

GP's and therapists across the board are reluctant to work with a person who will not admit to having difficulties in their life and your friend would not benefit from therapy unless she is motivated to change things.

Sadly, therapy is not about being helped but rather helping yourself with good direction.

I hope the situation improves for your friend.

FF firstly can I say that your OP struck me as being very sincere and clearly written by someone with was very sensitive and empathetic about a friend having problems. I certainly didn't think your colleagues were gossiping, quite the reverse really, so I think Lem was a bit hard on you there (hi Lem x) but I think it might have triggered something for her, as she explained.

It certainly does sound like your friend has MH problems, though exactly what it's not possible to say really, as her specific problems need to be diagnosed and treated by a psychiatrist. GPs are ok at diagnosing depression and anxiety but for more complex MH problems it needs diagnosis by a consultant psychiatrist.

Can I ask do you work together - I assume you do, but I just wondered. Is it a high powered job? You describe management as "shoddy" and I think that's certainly true. Why wouldn't they be picking up on her poor performance and inability to make decisions and colleagues covering for her. All this is helping to keep the problems (whatever they are) underground, and is not helping your friend.

You mention in your OP that your friend "falls apart" following the break down of a relationship. What exactly happens when she "falls apart" - does she become depressed/take time off work or become more manic in the way that you describe.

I was a bit puzzled by these "not friends" - do you mean FB friends?

You don't say how old she is, or whether she has a DH or DP or children, or lives alone. I get the impression she lives alone as you talk of her jumping into relationships. Does she have a supportive family at all? I wonder do you know very much about her early life, as far back as childhood and whether she suffered any particular trauma in childhood. I mention this because this can (and often does) lead to a variety of MH issues in adult life that are complex and enduring.

I'm not surprised the counselling didn't help and I'm not sure about CBT either. I'm going to disagree with others who say you can't do anything to help. As you seem to be her closest and long standing friend I think you should talk to her, and tell her you are worried about her, and see if you can get her to agree to see the GP and offer to go along with her - I think this is essential anyway in the circumstances. You can see her GP yourself and tell him/her your concerns, though they won't obviously be able to discuss anything about your friend with you, because of patient confidentiality. He/she may have some idea of how best you can help your friend - maybe you can talk to someone from the Community Mental Health Team - I think (though am not sure) that you could ask for an assessment. It might be worth contacting MIND to see if they have any helpful advice.

Normally it is of course always up to the individual to take responsibility for themselves, but I don't think this is necessarily the case with MH issues because by its very nature, sometimes people don't realise that their behaviour is bizarre or that they could be in danger, and so it becomes imperative that those who can see what is happening do their best to get the person some help and support. This is especially true in psychotic illness (where the patient is out of touch with reality) although that doesn't seem to be the case with your friend. Nonetheless she seems to be free wheeling towards some kind of disaster as you have noticed things getting worse............SO do what you can to get her assessed, and hopefully a diagnosis and treatment could follow. Having said that MH services nationwide are severely limited because of all the ridiculous amounts of cuts the govt is demanding that all public services make. Added to that a tiny percentage of the NHS spend is on mental health as opposed to physical health, despite Cameron trumpeting that mental health has to have parity with physical health.

Sometimes the diagnosis can be a bit of a "catch all" - and called "Borderline Personality Disorder" - though recently re-named something like "Emotionally unstable/Intensive Disorder" as that is thought less stigmatising. And of course the stigma in MH is alive and well and that's another big problem.............

Sorry I've asked a lot of Qs and don't feel you have to answer........just trying to clarify a few things. I am no medic by the way, but I suffer from intermittent depression and anxiety which can be severe at times, hence my interest in mental health issues and why I post a lot on the MH threads.

You sound a lovely friend to have and I really hope you can get some help/support for your friend...........

I didn't mean that the OP was a gossip, far from it, and not the friends , just some of the colleagues. OP sounds like a really good friend, like most of us, faced with the fact that support for mental health issues is pretty much zero both in the work place and elsewhere.

Can I ask do you work together - I assume you do. Not any more but we have joint friends and I'm still very much in contact with her working life.

Is it a high powered job?. High intensity and professional.
Why wouldn't they be picking up on her poor performance and inability to make decisions and colleagues covering for her. They have picked up but are not dealing with it either sensitively or properly. She gets poor feedback inappropriately and no support.

You mention in your OP that your friend "falls apart" following the break down of a relationship. What exactly happens when she "falls apart" - does she become depressed/take time off work or become more manic in the way that you describe. Continues to work but decision making gets far worse. Very depressed and withdrawn. The manic phase usually precedes the breakup (she sees it coming). That can last months...

I was a bit puzzled by these "not friends" - do you mean FB friends? just colleagues who are not friends really

I wonder do you know very much about her early life, as far back as childhood and whether she suffered any particular trauma in childhood. I'm pretty sure not. She lives alone with all family many miles away but seems close and talks on the phone a lot. She had a very traumatic relationship which I can't go into because it's too identifying but I don't think she has ever healed from that. It was with the father of her child.

I don't know who she is registered with GP wise but I will chat to her. MIND is a great idea..

Lem It's fine. I anticipated that sort of query. Honestly she is surrounded by friends who are at times exasperated and frustrated but all care.