How friends and family can help | Dr Kevin Pankhurst

It can be extremely distressing watching a close friend or relative struggling with what may be a mental health problem, but the main thing is that you can do something to help. Not knowing what to do can be even more stressful, and what path you choose will depend on what you think the problem is and what your relationship is with them. So, where do you start? Be careful not to jump to conclusions, but take the time to watch your friend or relative's behaviour.

Signs and symptoms can be many and varied. Of course, seek immediate help if you think they may be in danger of harming themselves or others. The next thing to do is talk. It is one of the hardest steps to take, but you might find they have been trying to discuss their difficulties with you too. Listen to what they have to say, don't judge, offer support, and direct them towards resources. If you are reading this, you are already looking for the right tools to help. If your friend or relative is agreeable to seeking professional help, the next step is to look at setting up that first appointment.

You are more than welcome to attend the appointment with your friend or relative, should they want that. Sometimes it helps to support them in this first step, and often you will not need to attend follow-up appointments with them — but of course it is important you continue to offer your support. They may ask you to attend part or all of the appointment, or simply wait outside for the duration.

The first appointment will usually be 60 minutes long, during which time I will want to build a full picture of the problems that have brought them to me, compile a detailed medical and psychiatric history — if this has not already been obtained through the referral — and ask some general health questions. I may also carry out a number of physical health checks. If you are present at the appointment, or if you have provided information ahead of it, your perspective forms an important part of the assessment. As someone close to the patient, you may have noticed changes in their behaviour, mood, sleep, or daily functioning that they themselves are not fully aware of, or that they find difficult to articulate. Knowing how long these changes have been going on, whether there have been any significant life events, and how things look from the outside can all help me build a clearer and more complete picture. You are not there to speak for them, but your observations genuinely matter.
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‍How to Start the Conversation
One of the most daunting aspects of supporting someone with a potential mental health problem is simply knowing how to raise it. There is rarely a perfect moment, but some moments are better than others. Choose a time when things are calm — not in the middle of an argument or a stressful situation, and not when either of you is rushed or distracted. A quiet, private setting where you are unlikely to be interrupted makes a real difference.

How you open the conversation matters too. Rather than saying "you need to get help" or "you have been acting strangely", try expressing what you have noticed from your own perspective: "I have been feeling worried about you lately" or "I've noticed you don't seem yourself and I just wanted to check in." This approach is less likely to put them on the defensive and makes it clear that you are coming from a place of love and concern, not judgment.

Be prepared for the conversation not to go as you hope. They may deny that anything is wrong, become upset, or push you away. This is not a failure on your part. People who are struggling often find it deeply uncomfortable to have their difficulties named, and a reaction of denial or frustration is entirely normal. Try not to take it personally, and do not feel you need to resolve everything in a single conversation. Often, the most important thing is simply to plant a seed — to let them know that you have noticed, that you care, and that support is there whenever they are ready.

If the first conversation does not land, try again. Sometimes it takes several gentle approaches before someone feels ready to open up. Persistence, when coupled with patience and kindness rather than pressure, is not a sign that you are pushing too hard — it is a sign that you are not giving up on them.

What If They Refuse to Get Help?
This is one of the hardest situations a family member or friend can face, and it is important to acknowledge how painful it is to watch someone you love struggle while feeling powerless to help. You cannot force someone to seek professional support, and attempts to do so can sometimes push them further away. What you can do is keep the door open.

Continue to express your care without attaching conditions or ultimatums to it. Make sure they know, in whatever way feels natural to your relationship, that professional help is available whenever they are ready — and that you will support them in taking that step. Sometimes people need time before they are able to accept help, and knowing that the option is there, without pressure, can make it easier to reach for when the moment comes.

In the meantime, please look after yourself. Supporting someone who is not yet ready to be supported is exhausting, and your own wellbeing matters too. There is more on this in the section below.

In situations where you are seriously concerned about someone's immediate safety, do not hesitate to contact the emergency services by calling 999, or 111 for urgent situations that are not immediately life-threatening. You are not betraying them by seeking help on their behalf when their life may be at risk — you are doing exactly what a caring person should do.

Looking after yourself:
Being a support person is genuinely hard work, and it takes a real toll — emotionally, physically, and sometimes practically. If you are spending significant time and energy caring about someone else's mental health, it is very easy to forget to attend to your own. That is understandable, but it is also unsustainable. You cannot pour from an empty cup, and the support you give will be more effective and more consistent when you are also looking after yourself.

Please do not be afraid to seek your own support. Your GP is a good starting point if you are finding things difficult. You might also consider speaking to a therapist or counsellor in your own right — you do not need to be in crisis to benefit from that kind of space to talk. If you are a carer or have taken on a significant caring role, organisations such as Carers UK offer information, advice, and community. Mind and Rethink Mental Illness both provide resources for people supporting loved ones with mental health difficulties, as well as for those experiencing difficulties themselves. And if you ever feel overwhelmed and need someone to talk to, the Samaritans are available around the clock on 116 123 — free, confidential, and always there.

Your wellbeing is not a secondary concern. It matters in its own right.

What to Do in a Crisis:
If you believe someone is in immediate danger, call 999. This is always the right thing to do when there is a risk to life, and the emergency services are trained to respond with care as well as urgency.For situations that are urgent but not immediately life-threatening, call 111 or attend your nearest A&E department. The Samaritans are available 24 hours a day, seven days a week, on 116 123 — a free call that connects you with a trained listener, whether the call is for you or you are seeking guidance about someone else.

If the person you are concerned about is already a patient at my practice, please do not hesitate to contact me directly. I will always do my best to respond as promptly as possible to concerns raised by patients or their families and friends but please be aware that I do not offer a crisis service.

Whatever the situation, please remember: you are not alone in this, and reaching out for help — including on behalf of someone else — is always the right thing to do.

After the First Appointment — How to Keep Supporting Them:
Once your loved one has taken the step of seeking professional help, your role does not end — but it does change. One of the most important things to understand is that the content of their appointments is confidential. I will not routinely share what was discussed with you, even with the best intentions, unless the patient has explicitly asked me to do so. This is not a barrier — it is a protection, and it applies equally to all my patients whether I see them at my clinic in Esher, in Guildford, in Maidenhead, or virtually. Please try to respect this boundary even if you find it difficult, and reassure them that their privacy is safe.

When they come home from an appointment, resist the urge to ask for a detailed debrief. A simple "how are you feeling?" is often far better received than "what did you talk about?" Let them share what they want to share, in their own time, without feeling interrogated. Small moments of genuine interest and care tend to mean far more than grand gestures.

It also helps to celebrate small progress, even when it feels incremental. Recovery from a mental health difficulty is rarely linear. There will be setbacks, and there will be times when it seems as though nothing has changed or things have got worse before they get better. This is a normal part of the process, and patience — alongside your willingness to stay the course — is one of the most valuable things you can offer.

At the same time, it is important to maintain your own boundaries. It is entirely reasonable to recognise when you need to step back, to limit how much emotional weight you are carrying, or to ask for help yourself. Supporting someone does not mean losing yourself in the process. Taking care of your own mental health, as noted above, is not selfish — it is essential.

Get in Touch:
If you are concerned about someone you care about and would like to discuss whether a private psychiatric assessment might help, please do not hesitate to get in touch. I am always happy to offer advice to family members and friends who are looking for guidance. Whether you are seeking a private psychiatrist in Surrey, mental health support in Berkshire, or a psychiatric assessment in Surrey for someone you care about, I am here to help. My clinics are based in Esher (Surrey), Guildford, and Maidenhead (Berkshire), and virtual appointments are also available.

Frequest Questions
‍Can I contact the practice on behalf of someone else? Yes, absolutely. You do not need to wait for your loved one to make contact themselves. I am always happy to speak with concerned family members or friends, and you are welcome to get in touch to ask questions, seek guidance, or make an initial enquiry about a private psychiatric assessment.

‍Can I attend the appointment with them? Yes, if your loved one would like you to be there, you are very welcome to attend. You may be asked to join for part or all of the appointment, or you may prefer to wait nearby if that is what they find most comfortable. I always encourage patients to think carefully about what level of support they would like from those close to them, and there is no right or wrong answer.

‍Will I be told what was discussed in the appointment? Appointments are confidential, and I will not routinely share the content of discussions with family members or friends without the patient's permission. This applies whether I am seeing someone at my Esher clinic, in Guildford, in Maidenhead, or virtually. If the patient wishes you to be involved in their care — for example, by attending part of an appointment or receiving information directly — I can arrange that with their consent.

‍How do I encourage someone to seek help if they are resistant? Gently and patiently. Try not to frame it as an ultimatum or a demand, but rather as an expression of care — "I'm worried about you and I think it might help to speak to someone." Be prepared for the conversation to take time, and for it to need repeating. Planting a seed is often more effective than pushing hard. The fact that you are here, looking for guidance, is already a meaningful step.

‍What if the situation becomes an emergency? If you believe someone is in immediate danger, call 999 without hesitation. For urgent situations that are not immediately life-threatening, call 111 or go to your nearest A&E. The Samaritans are available 24 hours a day, seven days a week, on 116 123.

‍How can I look after my own mental health while supporting someone else?This is an important question, and I am glad you are asking it. Make sure you have your own sources of support — whether that is your GP, a therapist, trusted friends, or an organisation such as Carers UK, Mind, or Rethink Mental Illness. The Samaritans (116 123) are also available if you simply need someone to talk to. Looking after yourself is not a luxury — it is a necessity, and it will help you to be a better support to the person you care about.

‍Can Dr Pankhurst see the person I am worried about without a GP referral?Yes. A GP referral is not required to arrange a private psychiatric assessment. You or your loved one can contact the practice directly to book an appointment. I see patients at my clinics in Esher (Surrey), Guildford, and Maidenhead (Berkshire), and virtual appointments are also available for those who prefer not to travel or who live further afield.

‍What happens after the first appointment? Following the initial assessment — which typically lasts 60 minutes — I will discuss my findings and recommendations with the patient. This may include a diagnosis, a management plan, recommendations for therapy, medication if appropriate, or a combination of approaches. Follow-up appointments are arranged according to individual need. Family members and friends are sometimes involved in the ongoing care if the patient wishes, but this is always led by the patient's own preferences and consent.

Whatever stage you are at — whether you are just beginning to notice something is wrong, or have been worried for a long time — please know that reaching out is the right thing to do. You are not alone, and neither is the person you care about. I am here to help.