How to support someone who is struggling — the complete guide
For family and friends. What to say and what not to say, how to sit with someone, when a confidence has to be broken for safety, and ten things you can actually do, with the sentences written out.
If someone you love has changed and you do not know what to say, this page is for you. It explains what helping actually is (not fixing), gives you the sentences that keep the door open and the ones that close it, teaches you how to sit with someone, tells you plainly when a confidence has to be broken for safety, and gives you ten things you can actually do, starting this week.
You are reading this because someone you love has changed, and you do not know what to say. Here are three people in the same place.
Shahnaz, 56, Karachi: her son
Bilal is 28 and has stopped coming out of his room. He used to be the loud one. Now he eats late, alone, and answers in one word. She has tried everything she knows. She has cooked his favourite things. She has told him to pray more, then told him to go out with friends, then told him she is worried, then, on a bad day, told him that other boys his age are supporting families. He got angry. She cried. Her husband says leave him, it is a phase. Her sister says nazar. Shahnaz lies awake wondering what she did wrong as a mother and whether she should take him to a doctor and what the doctor's family would say if it got out. She does not know that Bilal has typed "I am done" into WhatsApp three times and deleted it.
Rida, 21, Lahore: her friend
At 1:14am, Ayesha sent her a voice note, crying, saying she cannot do this any more and everyone would be better off. Rida has never had a message like this. She is terrified of saying the wrong thing, terrified of saying nothing, and terrified of what happens if she tells Ayesha's parents, who are the reason for half of it. She types "you are so strong, you will get through this" and deletes it. She types "should I call someone" and deletes it. It is now 1:31 and Ayesha has gone quiet.
Tariq, 47, Peshawar: his brother
His younger brother Naveed has been drinking. Not openly; nobody in the family drinks openly. But Tariq has found the bottles, and he has seen the way Naveed's hands shake in the morning, and he has noticed that Naveed has not laughed properly since their father died two years ago. Tariq has tried the direct approach ("this is haram, you are destroying yourself") and the angry approach and the silent approach. He does not have a listening approach, because nobody in his family has ever had one. He is afraid that if he says the wrong thing, Naveed will disappear entirely. He is also, though he would not say so, angry that this is his job.
What these three have in common. All three love the person. All three have tried fixing, advising, warning, and praying, and none of it has worked, because none of it is the thing that works first. All three are frightened, and the fright is making them either push harder or go silent. And in all three, the person who is struggling is more likely to be helped by something simpler and harder than advice: being sat with, being asked, and being walked to help. This page teaches those three things, and it teaches the one situation where you have to do more than listen.
You do not need the perfect words. You need to be there, to ask directly, and to know what to do with the answer. Most of what follows is that, in detail, with the sentences written out.
When someone we love is in pain, we reach for what we have: advice, comfort, religion, food, warnings, and, when those fail, anger. All of it comes from love. Almost none of it is what helps first. What helps first is simpler and, for most of us, much harder.
Three jobs, in order. Notice, sit with, connect. Families in a hurry skip the middle one and go straight to the doctor, the imam, or the lecture, and the person digs in. The middle job is the one nobody teaches, it costs nothing, and it is what turns "leave me alone" into "will you come with me".
Noticing
Most people who are struggling do not announce it. They change. The signs are usually visible for months before anyone names them, and families often see them and file them under laziness, a phase, tension, or nazar. Here is what the changes usually mean.
You notice
It might be
Read
Withdrawn for weeks, no interest in anything, sleeping all day or not at all, eating changed, "thak gaya hoon", irritable, tearful or numb, saying they are a burden.
Depression. Especially in men it shows as anger and withdrawal, not tears.
Not fixing. You cannot argue someone out of depression or reason them out of anxiety. If it were that simple, they would have done it.
Not diagnosing. You do not need to know what it is to sit with someone. A professional can name it later.
Not carrying it alone. Your job is to be the bridge to help, not the help. The bridge does not have to hold the whole weight.
Not a one-time conversation. It is a relationship over months: the message that asks nothing, the chai, the sitting in the car outside the clinic.
Not keeping every secret. There is one situation where love means telling someone, and it has its own section.
The basicsWhat to say, and what not to say↑ contents
Every sentence in the left column of this table has been said with love, in millions of Pakistani homes, to someone who then went quiet. Here is why, and what to say instead. The replacements are not magic; they are just sentences that keep the door open.
Do not say
Why it lands badly
Say instead
"Bas positive socho." "Think positive."
Tells them the illness is a thinking error they are too weak to fix.
"I can see this is really heavy. I am here."
"Namaz parho, sab theek ho jayega." "Just pray more."
Tells a believer who is already praying that their illness is a religious failure. Prayer and treatment are not rivals.
"Your faith is yours and it is still there. This is also an illness, and illnesses get treated. Both."
"Aur logon ke masle dekho." "Others have it worse."
Shame on top of pain. Comparison does not lift a mood; it adds guilt about having one.
"It does not matter what anyone else has. This is yours and it is real."
"Kuch nahi hua, tension mat lo." "It is nothing."
Erases what they are feeling and tells them not to tell you again.
"Tell me what it is like. I want to understand."
"Himmat karo, strong bano." "Be strong."
They have been being strong for months. That is why they are here.
"You have been carrying this a long time. You do not have to carry it alone."
"Log kya kahenge?" "What will people say?"
Confirms that their illness is a family shame, so they hide it deeper.
"Nobody needs to know except the people who can help. I will help you find them."
"Ye sab dimaghi hai." "It is all in your head."
Said as dismissal. It is in the head the way a heart attack is in the chest.
"It is real. The tiredness, the body, all of it. It has a name and it can be treated."
"Shaadi kar lo, theek ho jaoge." "Get married, it will fix you."
Prescribes a life event as medicine. It is not, and it ties another person to an untreated illness.
"Let us get you well first. The rest can wait."
"Main samajhta hoon." "I know exactly how you feel."
You probably do not, and it moves the attention to you.
"I do not fully understand, and I want to. Keep talking."
"Tumhe kya kami hai?" "What do you lack? You have everything."
Depression is not caused by lacking things and is not cured by counting them.
"I know from outside it looks fine. Inside it is not, and that is what matters."
Silence, changing the subject, leaving the room
Reads as "this is unbearable to me", so they will not bring it up again.
Stay. "I do not know what to say, and I am not going anywhere."
Swipe the table sideways on a phone.
The specific moments
When they say
Say
Then
"I am fine." (and they are not)
"Okay. I have noticed you seem tired lately, and I am here if that changes. No pressure." Then actually leave it.
Come back in a few days with something that asks nothing: chai, a walk, a message.
"You would not understand."
"You are probably right. I would still like to try. Tell me one thing."
Listen to the one thing without correcting it.
"Everyone would be better off without me."
"That sounds like a lot of pain. Are you having thoughts of ending your life?" Ask the question. Out loud.
The safety section. Do not leave them alone tonight if the answer is yes.
"I do not want to see a doctor. I am not mad."
"Seeing a doctor for this is like seeing one for your stomach. Nobody thinks you are mad. I will come with you, and nobody else has to know."
Book it. Sit in the waiting room. Do not make it a family event.
"Just leave me alone."
"Okay. I am leaving the door open and I am in the next room. I will check on you in an hour."
Check in an hour. Quietly. Then again tomorrow.
"It is nazar / jadoo / a test from God."
"It could be. And it is also something doctors treat. We can do both; there is no rule against it."
Do not argue the belief. Add the doctor to it rather than replacing it.
Anger, shouting, slamming the door
"I am not going to fight with you. I love you and I am worried. I will be here when you are ready."
Leave the room, not the house. Irritability is a symptom, especially in men.
Crying, or a long silence
Nothing. Or "I am here." A hand on the shoulder if that is your relationship.
Wait. Silence is not a gap to fill; it is where the real thing gets said.
Swipe the table sideways on a phone.
If you have already said the left-column things. Everyone has. You can go back: "I said some things last week that were not helpful. I was frightened. I want to do better. Can we try again?" That sentence repairs more than you would think.
"Just listen" is the advice everyone gives and nobody explains. Here is what it actually looks like, mechanically, because the mechanics are what people get wrong.
The listening ladder. Fixing and warning are what frightened love does first, and they close the door. Reassurance is kinder and still closes it ("it will be fine" means "stop telling me it is not"). The three top rungs, asking, reflecting, and simply sitting, are where a person starts to feel less alone, and they use fewer words as they go up.
The mechanics
Side by side, not face to face. In the car, on the roof, walking, making chai together. Eye contact across a table feels like an interview; shoulder to shoulder feels like company. This is especially true for men and for teenagers.
Something for the hands. Chai, peeling something, a walk. Hard things are easier to say when the hands are busy and nobody is watching your face.
Open the door and step back. "You have seemed tired lately. How are you, really?" Then stop. Do not fill the silence. Count to ten inside if you must. The real answer usually comes after the silence, not before.
Ask what it is like, not why. "Why" asks for a cause and produces a defence. "What is it like in the mornings?" asks for a description and produces the truth.
Reflect, do not evaluate. "So you wake up and it is already heavy before anything has happened." Repeat back what you heard, in your own words, without judgement. It tells them you were listening and it often unlocks the next sentence.
Do not solve anything in the first conversation. Your only job today is that they leave the conversation feeling less alone than they entered it. Solutions come later, and mostly from a professional.
Let them cry. Do not hand a tissue too fast (it says "stop"). Do not say "don't cry". Sit.
End with a small next thing. "Can we talk again on Thursday?" "Can I send you something to read?" "Will you let me book the appointment?" One thing. Small.
Then come back. Thursday. The message that asks nothing. The chai. Helping is a rhythm, not an event.
Sitting with a man who does not talk
Many men in our families have never been asked how they feel and would not know how to answer. Do not ask. Do things beside them: the walk, the drive, the repair, the cricket. Say once, plainly, "I have noticed you are not yourself, and I am not going anywhere." Then keep showing up. The talking, when it comes, will come sideways, in the car, about something else. Tariq's brother will not respond to "how are you feeling"; he might respond to being driven somewhere and not lectured.
Going deeperOne level down. Why the loving thing is so often the wrong thing.
When someone we love is in pain, our own alarm fires. Pain in a child, a sibling, a spouse feels like an emergency, and emergencies call for action. Advice is action. Warnings are action. Dragging them to the pir, the doctor, the mosque is action. All of it is the helper's alarm looking for something to do. The person on the receiving end does not experience it as love; they experience it as pressure, and pressure on a depressed or anxious person produces the one thing they still have the energy for, which is withdrawal.
Same fear, two loops. Both helpers are frightened. The difference is what the fear makes them do. Pushing feels like doing something and produces withdrawal, which produces more fear and more pushing; Shahnaz has been in this loop for months. Sitting feels like doing nothing and produces the opening that pushing was trying to force.
Our own fear, and our own shame
Shahnaz's question at night is "what did I do wrong". Tariq's unspoken feeling is anger that this is his job. Rida's is terror of getting it wrong. These are normal and they are the reason helpers push or go silent. It helps to name them, because a helper who knows they are frightened can choose not to act on the fear. It also helps to know that you did not cause this, that you cannot cure it, and that you can still be the most important person in their recovery.
The family as a system
In a joint family, one person's illness is everyone's business, and everyone has an opinion. The father says it is a phase. The aunt says nazar. The uncle says marriage. The grandmother says it never happened in her day. The person at the centre is now managing six opinions in addition to the illness, and hiding from all of them. The research on families and mental illness is unusually clear about which household climates help and which harm.
The family climate
What it sounds like
What the research finds
Criticism
"You are lazy." "You have become useless." "In our family nobody has ever been like this."
Households high in criticism and hostility see markedly more relapse in depression and other conditions; the effect is one of the most replicated in family research.
Emotional over-involvement
Hovering, doing everything for them, crying about them in front of them, "you are killing me with worry".
Also predicts worse outcomes; the person becomes the family’s illness and loses the room to recover.
Warmth with room
"I am here. Take your time. I will come with you. Let me know what you need."
Associated with lower relapse and better recovery. Warmth and low criticism together are the protective pattern.
Silence and secrecy
The topic is never raised. The person is "resting". Relatives are told nothing.
Isolates the person and the carer, delays help, and lets the illness grow in private.
Swipe the table sideways on a phone.
The practical point: a family does not need to understand depression to help. It needs to stop criticising, stop hovering, stay warm, and let one person be the bridge. Getting the household on side is one of the exercises below, because it is often the single most useful thing a helper can do.
Why they refuse help
People refuse for reasons that make sense from inside. Depression itself says nothing will work. Anxiety says the clinic is dangerous. Shame says "I am not mad". Experience says the last doctor gave a tablet in three minutes and called it tension. Fear says the family will find out. Money says it costs too much. None of these are stupid, and arguing with them is useless. What works is removing them one at a time: going with them, choosing the doctor carefully, keeping it private, finding the low-cost option, and, above all, not making the appointment a condition of your love.
SafetyWhen to break a confidence: safety↑ contents
There is one situation where listening is not enough, and it is the one people are most afraid of. If someone you love is talking about death, about being a burden, about everyone being better off without them, you have to do three things that feel wrong: ask directly, not keep it secret, and act. Here is how.
Ask the question. Out loud. Using the words.
People fear that asking about suicide will plant the idea. Decades of research say it does not; asking reduces distress and opens the door. What plants nothing and helps nobody is silence. So ask, plainly, without flinching: "Are you having thoughts of ending your life?" In Urdu: "Kya aap ko khud ko khatam karne ke khayal aa rahe hain?" Not "you are not thinking of doing anything stupid, are you?", which tells them the answer you want. The plain question, in a steady voice, with a face that can hear yes.
If the answer is yes, keep asking, gently: "Have you thought about how?" "Do you have what you would need?" "Have you thought about when?" Each answer tells you where on the ladder they are, and the ladder tells you what to do.
The risk ladder. Risk is not a switch; it is a ladder, and the response climbs with it. At the bottom, the job is to ask the question out loud. Higher up, it is to remove the means, stay physically close, and bring in help the same day. Sudden calm after a long low is not recovery; it can be a decision made, and it is on the top rung.
What to do at each rung
Thoughts only, no plan. Stay close. Talk. Tell them you are glad they told you. Make a plan together for the next bad night (who they will call, what they will do). Tell one other trusted adult so you are not carrying it alone. Book a professional this week. Our helplines page has numbers they can call at any hour.
A plan or a method. All of the above, and remove the means today (below). A professional within days, not weeks. Check in every day.
Means and a time. Do not leave them alone. Not tonight, not tomorrow. Someone with them, awake if necessary. Get them seen today: a psychiatrist, a hospital emergency department, a helpline that can advise. Call 1122 if you cannot get them there.
Preparing, goodbyes, sudden peace. Emergency. 1122 or the nearest hospital, now. Stay with them until help arrives.
Removing the means
This is the least discussed and best evidenced part. Most attempts are impulsive, in a crisis that passes within hours, using whatever is at hand. Making the means harder to reach saves lives; countries that restricted the most lethal pesticides saw suicide rates fall sharply. In Pakistan the means at hand are usually: tablets (paracetamol, sleeping tablets, a relative's blood-pressure or diabetes medicine), pesticides and "wheat pills" in farming households, acid, ropes, and, where present, firearms. Lock them away, give them to a neighbour, keep only a few days' supply of any medicine, and do this quietly, without announcement. You are not insulting them. You are buying time, and time is what a crisis needs.
"But I promised not to tell"
Rida, at 1:31am, is holding this exact problem. Here is the rule: a secret that could end a life is not yours to keep. You can honour the spirit of the promise by telling the smallest number of people who can actually help, by telling the person you are doing it and why, and by not making it a family drama. "I care about you too much to keep this to myself. I am going to tell your khala / my mother / call this number, and I am staying with you while I do." They may be angry. Angry and alive is the outcome you are choosing. Almost everyone, later, is grateful.
What Rida should do at 1:31
Call, do not type. "I got your message. I am here. Are you safe right now? Are you thinking of ending your life?"
If yes: "Where are you? Is anyone with you? Can you go and sit with your mother / sister / anyone, right now, while we talk?"
Stay on the phone. Do not solve anything. "I am not going anywhere tonight."
Get one adult physically to her: a family member Ayesha trusts, or, if there is nobody, a neighbour, or 1122. Rida can call them while Ayesha stays on the other line.
Tomorrow, in daylight: the helplines, a professional, and Rida tells one adult in her own life so she is not carrying it alone.
Tonight. If someone is in danger now: 1122 for emergency services anywhere in Pakistan. The crisis helplines page lists free, confidential lines that can talk to them or to you. Do not leave them alone. Remove what they could use. Stay until help arrives. You do not need to say the right thing; you need to be there and to make the call.
The scienceThe science, kept honest. Skip if you do not want it.
The scienceThe science, stated carefully↑ contents
Social support protects, and its absence harmsAcross decades of studies, people with someone to confide in recover from depression faster and relapse less, and isolation is one of the strongest predictors of poor outcome and of suicide. The effect is not about the number of people; one confidant does most of the work. This is the evidence for "be the one person".
Wang, J. et al. (2018), BMC Psychiatry; Holt-Lunstad, J. et al. (2010), PLoS Medicine.
Family climate predicts relapse"Expressed emotion" (a household’s level of criticism, hostility and emotional over-involvement) is one of the most replicated findings in psychiatry: high-EE households see substantially higher relapse in depression, schizophrenia and eating disorders, and the effect holds across cultures. Interventions that lower criticism and over-involvement reduce relapse.
Butzlaff, R.L., Hooley, J.M. (1998), Archives of General Psychiatry, 55(6), 547–552; Hooley, J.M. (2007), Annual Review of Clinical Psychology.
Asking about suicide does not increase riskA systematic review of studies that asked people about suicidal thoughts, including adolescents and people already at risk, found no increase in suicidal ideation or attempts from being asked, and some reduction in distress. Silence is the risk; asking is safe.
Dazzi, T. et al. (2014), Psychological Medicine, 44(16), 3361–3363.
Restricting the means saves livesSuicidal crises are often brief and impulsive, and method substitution is far from complete. Sri Lanka’s bans on the most toxic pesticides were followed by a roughly halving of suicides; paracetamol pack-size limits in the UK reduced deaths; the pattern repeats wherever a common lethal means is made harder to reach. In Pakistan, pesticides and medicines are the means most often at hand, and locking them away is a real intervention.
Gunnell, D. et al. (2017), The Lancet Global Health; Zalsman, G. et al. (2016), The Lancet Psychiatry.
Family involvement improves treatmentWhen families are given basic education about the condition and simple rules (warmth, low criticism, practical support, not taking over), treatment outcomes improve and carers’ own distress falls. Family accompaniment to appointments increases the chance a person starts and continues treatment, which matters especially where stigma keeps people away.
Sin, J. et al. (2017), Clinical Psychology Review; Rahman, A. et al. (2008), The Lancet (Pakistan, community health workers and family involvement in perinatal depression).
Carers carry a real loadPeople caring for a relative with depression or another mental illness show higher rates of depression and anxiety themselves, and the load is heaviest for those who carry it alone and in secret. Carer support, including peer support, reduces this.
Yesufu-Udechuku, A. et al. (2015), British Journal of Psychiatry.
Motivation is not produced by pressureStudies of how people decide to seek treatment consistently find that confrontation and pressure increase resistance, while empathy, autonomy and small steps increase uptake. This is the evidence behind the listening ladder and "the small ask".
Miller, W.R., Rollnick, S. (2013), Motivational Interviewing (3rd ed.). Guilford.
Comfort in, dump out. A simple rule for families in a crisis: everyone can say anything they need to, as long as they say it to someone further from the centre than they are. The person who is ill should never have to comfort the helper. The helper needs comforting too, and gets it from the next ring out: a friend, a cousin, our team.
One-paragraph version. One person who listens without criticism protects more than any advice. Households high in criticism and hovering see more relapse; warmth with room sees less. Asking about suicide is safe and silence is not; removing the means saves lives; sudden calm is a warning. Families who go with the person to help, and who look after their own load, get better outcomes for both.
Exercises & solutionsThe practical part. Ten cards, same shape each time.
Exercises & solutionsTen things you can actually do↑ contents
The first two are the beginning: opening the door and listening. The third is the question that keeps people alive. Four to seven are the months: small asks, the appointment, the household, the check-ins. Eight is safety. Nine is you. Ten is for the no. Read them all; do the first two this week.
Helping runs in months. Most helpers are intensely present for two weeks and then, exhausted or reassured, drift; the person’s need is still high in month three, which is when they are most alone. The low, steady line is the fix: a message that asks nothing, most days, for months. It costs a minute and it is what most people remember afterwards. Shapes illustrative.
1
Opening the door (how to raise it)
5 min to prepare
What it does
Gets the first conversation started without it becoming a confrontation. Most helpers never get past this step because they wait for the right moment.
Why it works
A gentle, specific, low-pressure opening ("I have noticed X; I am here") is what the research on help-seeking finds most likely to produce an honest answer. Vague openings get "I am fine"; accusatory ones get anger.
Step by step
Choose the setting: side by side, hands busy, no audience. The car, the roof, the kitchen at night.
Name one specific thing you noticed, without judgement. "You have not been coming to Friday cricket." "You seem very tired lately." "Kuch dino se tum apne jaise nahi lag rahe."
Say why you are raising it: "I care about you and I am a bit worried." Then the open question: "How are you, really?"
Stop. Let the silence sit. Count to ten inside.
Whatever comes, do not fix it. Reflect it back. "So it has been like this since Ramzan." Then: "Thank you for telling me."
End with one small next thing and a time. "Can we talk again Thursday?"
Use it when
This week. Not in the middle of a fight, not in front of the family, not at 1am unless it is 1am.
Common mistake
Waiting for the perfect moment, then delivering a speech. The moment is ordinary and the opening is one sentence.
2
The listening hour
30 to 60 min
What it does
Gives the person the one thing that helps first and that almost nobody gives: an hour of being heard without being fixed.
Why it works
Being listened to reduces the isolation that drives depression and anxiety, and it is the precondition for accepting help. The mechanics matter: fixing, reassuring and advising close the door; asking, reflecting and silence open it.
Step by step
Sit side by side. Phone away, both of you.
Ask what it is like, not why. "What are mornings like?" "What does your head do at night?"
For every thing they say, reflect it before you respond to it. "So the worst part is the mornings."
Notice the urge to fix, warn, reassure or compare. Each time, swallow it and ask another question instead.
Let silences run. The real thing comes after the silence.
If tears come, sit. No tissue, no "don't cry".
At the end, say what you heard in two sentences, thank them, and name the next contact.
Use it when
Weekly, for as long as it takes. It gets easier and the hours get shorter.
Common mistake
Treating it as a session at the end of which you deliver your conclusions. There are no conclusions. There is the next chai.
3
Asking the question (about suicide)
2 min
What it does
Finds out whether the person is at risk, which nothing else will tell you, and opens the one door that most needs opening.
Why it works
Asking does not plant the idea; the research is clear. Not asking leaves the person alone with it. The question, asked plainly, is also a message: "I can hear this, and I am not afraid of you."
Step by step
When they say anything about being a burden, not wanting to be here, everyone being better off, or when your gut says so: ask. "Are you having thoughts of ending your life?" Plain words. Steady voice.
If yes: "Thank you for telling me. Have you thought about how? Do you have what you would need? Have you thought about when?"
Do not react with horror, do not lecture about sin or the family, do not promise to keep it secret.
Use the ladder to decide what happens next, tonight.
Tell them what you are going to do and that you are staying with them while you do it.
Use it when
Every time the signs appear. Once a week if they are in a bad stretch. It does not wear out.
Common mistake
"You are not thinking of doing anything stupid, are you?" That is not a question; it is an instruction to say no.
4
The small ask (doing one thing beside them)
10 to 20 min
What it does
Gets a depressed or anxious person to do one tiny thing, with you, which is how recovery actually starts, instead of waiting for them to feel like it.
Why it works
Behavioural activation, the best-evidenced self-help for depression, works by action before motivation, and it works better with company. A helper who does the tiny thing beside the person supplies the motivation the illness has removed.
Step by step
Choose something absurdly small and pleasant or useful: chai on the roof, ten minutes to the shop and back, watering the plants, one voice note to a cousin.
Ask as an invitation, not a prescription. "Come, ten minutes on the roof with me." Not "you need to get out more."
Do it beside them. Do not comment on how well they are doing. Do not make it a milestone.
Tomorrow, the same or another. Same time helps.
Over weeks, slightly bigger. The activity ladder on the depression page is the fuller version; you can build it together.
Use it when
Daily, once the first conversation has happened. Especially for someone who cannot get out of bed.
Common mistake
Making it a test they can fail, or praising it so hard it becomes a performance. It is just chai on the roof.
5
Going with them (the appointment)
half a day
What it does
Turns "I will not see a doctor" into an appointment attended, by removing the reasons one at a time.
Why it works
Most refusals are about specific fears: being seen, being called mad, cost, a bad past experience, not knowing where to go. Each one can be removed by a helper. Accompaniment roughly doubles the chance a person starts treatment in studies from low-income settings.
Step by step
Find the right door. Our directory lists psychiatrists and psychologists by city, including low-cost hospital OPDs. Choose one that is private enough and affordable enough; read how to seek help in Pakistan.
Offer, do not order: "I have found someone. I will book it, come with you, sit in the waiting room, and nobody else needs to know. Just come."
Book it yourself. Pay if you can. Arrange the transport.
On the day: go. Sit with them. Do not go into the room unless they want you to. Do not speak for them unless they ask.
Afterwards: no debrief, no "so what did they say". A chai. "I am glad we went."
Then the follow-up appointment, the same way. The first visit is rarely the whole treatment.
Use it when
After the first conversation, and when they have said any version of "maybe". Do not wait for enthusiasm; it is a symptom that is missing.
Common mistake
Turning it into a family outing, or reporting back to the household. The privacy is what made them agree.
6
Getting the household on side
30 min conversation
What it does
Lowers the criticism and hovering that the research says makes people worse, and makes one person the bridge so the person is not managing six opinions.
Why it works
Family climate predicts relapse more than most things a helper can control. A household does not need to understand depression to help; it needs three rules and one point of contact.
Step by step
Talk to the household without the person present, and with their knowledge: "I am going to speak to Abbu and Ammi about how we can all help. Is there anything you do not want me to say?"
Explain it as illness, briefly. "It is like diabetes of the mood; it is real, it is common, it is treatable, and it is nobody’s fault."
Three rules for everyone: no criticism ("lazy", "useless", "in our family"); no hovering or crying at them; warmth, food, and ordinary conversation about ordinary things.
One bridge. "I will handle the doctor and the conversations. You do not need to ask him about it; just be normal with him."
Handle the nazar/marriage/pir suggestions gently: "It could be. And we are also doing the doctor. Both."
Repeat monthly. Households drift back to criticism under stress.
Use it when
Once the person has agreed you can, and before the appointment if possible.
Common mistake
Holding the meeting with the person in the room, so it becomes a trial with them as the accused.
7
The check-in that asks nothing
1 min, most days
What it does
Keeps the thread alive over the months, without the pressure that makes people go quiet.
Why it works
Recovery takes months, and the helper’s attention usually fades after the first fortnight. A low-pressure, regular signal ("I am still here") does more than an occasional intense conversation, and costs nothing.
Step by step
Most days, one message that needs no reply. A photo of the chai. A meme. "Thought of you." "Bas yaad aayi." Nothing about how they are.
Once a week, an invitation: the roof, a drive, a match. Accepting is not required.
Once a week, if they are open to it, the real question. "How was this week, really?"
If they go quiet for more than a few days: go to the door. Not a message; the door.
Keep it up for months. Set a reminder if you must; the illness does not care that you are busy.
Use it when
From the first conversation until well after they are better.
Common mistake
Checking in only when you are worried, so every message reads as alarm. The ordinary ones are what make the worried ones bearable.
8
Making the home safer
1 hour, once, then maintained
What it does
Reduces the chance that a brief crisis becomes a death, by making the means harder to reach. The best-evidenced thing a family can do for someone at risk.
Why it works
Suicidal crises are usually short and often impulsive; people use what is at hand; and making the means harder to reach saves lives, because most people do not go looking for another method once the moment has passed.
Step by step
Medicines: everyone’s. Paracetamol, sleeping tablets, blood-pressure and diabetes medicines, anything in the house. Locked box, or a neighbour’s house, with a few days’ supply kept out.
Pesticides, wheat pills, rat poison, acid: out of the house entirely. Ask a neighbour or relative to hold them.
Firearms, if any: out of the house, or unloaded and locked with the ammunition elsewhere and the key with someone else.
Ropes, cords, sharp things: harder to be thorough; do what is reasonable, quietly.
Do it without a speech. If they ask: "I am worried and I am keeping things out of reach for now. It is not forever."
Maintain it for as long as they are at risk, and review it with the professional.
Use it when
As soon as anyone in the house has expressed thoughts of ending their life, and before the crisis, not after.
Common mistake
Deciding it is insulting or unnecessary because "he would never actually". The people who "would never" are the ones this saves.
9
Your own tank (looking after the helper)
30 min a week, minimum
What it does
Keeps you able to help for months, which is how long it takes, instead of burning out in the first fortnight and going silent or angry.
Why it works
Carers of people with mental illness have high rates of depression and anxiety themselves, highest when they carry it alone and in secret. The person cannot be your support for this; you need your own, one ring out.
Step by step
Tell one person outside the situation what is happening and how it feels. A friend, a cousin, our team on WhatsApp. "Comfort in, dump out": your fear and frustration go outward, never at the person.
Keep one thing of your own every week that has nothing to do with it. The walk, the match, the class.
Let yourself feel the anger and the exhaustion without acting on them. They are normal. Tariq is allowed to be angry that this is his job; he is not allowed to take it out on Naveed.
Share the load: the household can carry the food and the ordinary conversation while you carry the doctor.
Take the self-check yourself every month or two. Carers slide.
Our burnout page has the fuller version of looking after a carer.
Use it when
From the first week. Before you need it.
Common mistake
Deciding that your exhaustion is disloyal or self-indulgent. A helper who collapses helps nobody.
10
When they refuse help
weeks to months
What it does
Gives you a way to stay useful when the person will not see anyone, without either giving up or forcing it.
Why it works
Pressure produces resistance; the research on motivation is consistent. What moves people is warmth, autonomy, small steps, and the slow removal of specific obstacles. Most people who refuse in month one accept in month three, if the door has been kept open rather than pushed.
Step by step
Stop asking about the doctor. Say once: "The offer is always there. I will not keep pushing." Then keep it.
Find the real reason, gently, over time. Cost? Privacy? The last doctor? Being called mad? Each has an answer you can arrange quietly in the background, so that when they say "maybe", it is ready.
Offer smaller doors: our team on WhatsApp, the two-minute self-check, a page from this site, a helpline. Some people will message a stranger before they will see a doctor.
If they are at risk (the ladder), refusal does not apply; safety comes first, and you act.
If months pass and nothing changes and they are sinking, bring in one more person they respect, once, without ambush.
Use it when
From the first "no".
Common mistake
Giving up after the first refusal, or turning every conversation into the appointment. Both close the door.
A flowchart for where you are, then the situations people actually write to us about.
Have they said anything about death, being a burden, or everyone being better off without them; or has your gut said "risk"?
↓
Yes
Safety firstAsk the question, plainly, now. Then the risk ladder: stay close, remove the means, tell one adult, get a professional this week; higher rungs, tonight. 1122 if in danger now.
No
Have you had one real conversation yet, where they talked and you did not fix?
Keep the door openWhen they refuse: stop pushing, keep everything else, find the real obstacle, offer smaller doors (our team, the self-check). Re-check the safety question weekly.
Common situations
A message at 1am saying they cannot go on→Call, do not type. Ask the question. Get an adult physically to them. Stay on the line. The Rida steps. 1122 if you cannot reach anyone.
Husband or brother drinking, hiding it, not himself since a death→Grief plus something to cope with it. No lectures on haram; he knows. Side by side, doing things. Ask the question. A professional who treats both (directory).
Wife or daughter-in-law after a birth, flat, not sleeping when the baby sleeps, saying she is a bad mother→Postnatal depression, common and serious. Take the night feed. Go with her to a doctor this week. If she mentions harming herself or the baby: 1122, now.
Someone in grief, months on, and you do not know what to say→Say their name. Sit. Bring food. "Tell me about her." Our grief page has a whole card on this.
They say it is nazar or jinn and the family agrees→Do not fight the belief. "And we are also doing the doctor. Both." Book it (go with them).
"Log kya kahenge" is stopping the family from getting help→Nobody at a clinic is looking at who else is there. Household meeting with the illness framed as illness. Private appointment, one bridge, no announcements.
You are exhausted and starting to resent them→Normal. Your own tank: one person outside it, one thing of your own, share the load. Our team is for you too.
No energy to do any of this today→One message that asks nothing. That is a real day of helping.
A week is enough to open the door, sit once, ask the question if it needs asking, make the home safer, and have the appointment ready. It is not enough for them to be better. Helping runs in months; this is the first seven days of it.
In roughly the order they arrive from family and friends.
What if I say the wrong thing and make it worse?
You almost certainly already have, because everyone has, and they are still here. The only things that reliably make it worse are criticism, pressure, and silence; the sentences in the table are the common ones. Everything else is forgivable and repairable: "I said something unhelpful last week. I want to do better." What makes it worse for certain is being so afraid of the wrong thing that you say nothing at all.
They get angry when I ask. Should I stop?
Stop asking the same way; do not stop being there. Anger is a symptom, especially in men and teenagers, and it is often the only feeling that still has energy behind it. Move from face-to-face questions to side-by-side company: the drive, the roof, the repair. Say once, plainly, that you are not going anywhere. The talking, when it comes, comes sideways. If the anger is at everyone and has been for weeks, that is part of the illness, not a verdict on you.
If we take him to a psychiatrist, log kya kahenge?
Almost certainly nothing, because almost certainly nobody will know. Appointments are private, nobody at a hospital OPD is looking at who else is there, and a family that chooses one bridge and makes no announcements keeps it as private as a stomach complaint. What people do say, when someone is left untreated for years, is worse. The household card is about getting a family to agree on privacy and warmth instead of shame.
The family says it is nazar, or jinn, or a test from God. Do I argue?
No. Arguing about the cause delays the treatment and loses you the family. Add rather than replace: "It may be. And it is also something doctors treat, and there is no rule against doing both." Many families do dum and the doctor; the doctor is what changes the sleep and the mood. We are not scholars and do not rule on the unseen; we have simply never met a person for whom treatment was forbidden and a great many for whom it was late.
Should I tell their parents / spouse? They asked me not to.
If there is any risk to their life, yes; a secret that could end a life is not yours to keep, and the safety section says how to do it with the least damage. If there is no risk, respect the confidence and keep working on the obstacles: often the reason they do not want the parents told is the parents, and the right move is a professional they can see privately rather than a family disclosure. You can be the one adult who knows.
Should I hide the medicines and the pesticide? Is that not insulting?
Yes, hide them, and no. Removing the means is the single best-evidenced thing a household can do for someone at risk, because crises are brief and people use what is at hand. Do it quietly and without a speech. If asked: "I am worried and I am keeping things out of reach for now." The people who find it insulting are usually the ones it protects. The card lists what to move in a Pakistani home.
They refuse to see anyone. What now?
Stop pushing, keep everything else (the check-ins, the chai, the listening), find the real obstacle and remove it quietly in the background, and offer smaller doors: our team on WhatsApp, the two-minute self-check, a page from this site, a helpline. Most people who refuse in month one accept in month three if the door has been kept open rather than pushed. If they are at risk, refusal does not apply; safety first. The card.
It is my husband. Can I do this alone, in our culture?
You can start alone, and you should not finish alone. Side-by-side company, the small asks, the check-ins, and going with him to a doctor are all things a wife can do quietly. Where it gets hard is the household: if his mother or brothers are the critics, one of them, or an elder he respects, needs to be brought on side, and that may be a conversation you cannot have without an ally. Our team can help you think through who. And your own tank matters; a wife carrying a depressed husband, three children and a mother-in-law’s opinions is the most common burnt-out carer we hear from.
It is my child, a teenager. Is this normal moodiness?
Teenage moodiness comes and goes, with the mood lifting for friends, games, or food. Depression in a teenager is weeks of withdrawal, sleep reversed, grades falling, no pleasure in the things that used to matter, irritability at everyone, and sometimes talk of being a burden. If it is weeks rather than days, treat it as real: side by side, no lectures about grades, the small asks, and a professional who works with young people. Ask the question about self-harm directly; it is safe to ask, and teenagers are the group most likely to be hiding it.
I am exhausted and I am starting to resent them. Does that make me a bad person?
It makes you a carer. Resentment and exhaustion are the normal price of carrying someone for months, and they are worst for the people who carry it alone and in secret. Tell one person outside the situation. Keep one thing of your own. Share the load with the household. Take the self-check yourself; carers slide into depression at high rates. Our team is for you as much as for them, and the burnout page has the fuller version.
What does it cost to get them seen?
From nearly free upward. Psychiatry OPDs at government teaching hospitals charge a small fee; generic medicines are usually cheap. Private psychiatrists and psychologists charge per visit, with wide variation by city; some university clinics and NGOs offer free or subsidised sessions. Our directory marks low-cost options, and how to seek help in Pakistan walks through the pathways and what registration means.
Is Zara, your WhatsApp companion, someone I can send them to? Or talk to myself?
Both. Our team on WhatsApp is free, private, and there at any hour to talk in English, Urdu or Roman Urdu. It is not therapy, not a diagnosis, and not a crisis line. Some people will message a stranger before they will see a doctor, and that is a real door. And helpers can use it too: to say "I do not know what to do about my brother" to someone who will listen and help you find the next step.
Getting helpWhen it is more than you can carry↑ contents
You are the bridge, not the treatment. Here is when the bridge needs to hand over.
Signs they need a professional now
Any answer of yes to the question about ending their life, at any rung of the ladder.
They cannot eat, wash, get up, work, study, or care for their children most days.
It has been more than a month of the signs, or it has happened before.
They are hearing or seeing things others do not, or convinced of things that frighten the household.
They are using alcohol, sleeping tablets, or other drugs most days.
It is the weeks or months after childbirth.
They are a child or teenager with weeks of the signs.
Signs you need help too
You are not sleeping, or you have started to dread them.
You are keeping it entirely secret.
You have shouted at them, or been silent with them for days, out of exhaustion.
Tonight. If they are in danger now: 1122 anywhere in Pakistan. The crisis helplines page lists free, confidential lines that will talk to them or to you. Do not leave them alone. Remove what they could use. Stay until help arrives. Afterwards, tell one person about what you carried tonight.
Find the right door for themOur directory covers psychiatrists, psychologists and counsellors across Pakistani cities, including low-cost hospital OPDs. How to seek help in Pakistan explains who does what and what it costs. What is therapy describes what will happen in the room, which is often what they are afraid of.
A door they might use before a doctorThe two-minute self-check, this site’s pages, or our team on WhatsApp: free, private, any hour, in English, Urdu or Roman Urdu. Not therapy, not a crisis line; a first step some people will take with a stranger.
For youOur team will also talk to you. "I do not know what to do about my son" is a sentence we hear every day. The burnout page has the carer’s version of looking after yourself.
Peer supportThe HEALING community below is people walking the same road, including families. Not a treatment, not for emergencies; for not being the only one.
Everything factual on this page traces to one of these. Where we were not sure of a number, we did not give one.
Dazzi, T., Gribble, R., Wessely, S., Fear, N.T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361–3363.
Zalsman, G. et al. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3(7), 646–659. Means restriction as the best-evidenced strategy.
Gunnell, D. et al. (2017). Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence. The Lancet Global Health, 5(10), e1026–e1037.
Hawton, K. et al. (2013). Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales. BMJ, 346, f403.
Butzlaff, R.L., Hooley, J.M. (1998). Expressed emotion and psychiatric relapse: a meta-analysis. Archives of General Psychiatry, 55(6), 547–552. Hooley, J.M. (2007). Expressed emotion and relapse of psychopathology. Annual Review of Clinical Psychology, 3, 329–352.
Holt-Lunstad, J., Smith, T.B., Layton, J.B. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS Medicine, 7(7), e1000316.
Wang, J. et al. (2018). Social support moderates stress effects on depression. BMC Psychiatry; and Gariépy, G. et al. (2016). Social support and protection from depression: systematic review. British Journal of Psychiatry, 209(4), 284–293.
Rahman, A., Malik, A., Sikander, S., Roberts, C., Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan (the Thinking Healthy Programme). The Lancet, 372(9642), 902–909.
Sin, J. et al. (2017). Psychoeducation for siblings and family members of people with severe mental illness; and Sin, J. et al. (2017), Clinical Psychology Review, 56, 13–24, on family interventions.
Yesufu-Udechuku, A. et al. (2015). Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. British Journal of Psychiatry, 206(4), 268–274.
Miller, W.R., Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). Guilford.
Silk, S., Goldman, B. (2013). How not to say the wrong thing. Los Angeles Times, 7 April. The "ring theory" of comfort in, dump out.
Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. Reflective listening.
Kitchener, B.A., Jorm, A.F. (2002). Mental health first aid training for the public. BMC Psychiatry, 2, 10. The approach-listen-support-encourage model this page draws on.
Written by the Depression.pk team. Reviewed for safety before publication. Not medical advice: a place to start for family and friends. We are not clinicians; we connect people to independent professionals. If someone is in danger, 1122 comes before this page. Last updated September 2026.
You're not alone in this
Join the HEALING community 💚
A free, kind, judgement-free WhatsApp community for people walking the same road — share when you want, listen when you can, and be reminded you matter. Peer support, not a crisis line.
House rules: privacy first · no judgement · no private messages to members · no medical advice · no selling · no politics or religious debate. Read the rules. If you're in danger right now, please use the helplines below — the group is for support between people, not emergencies. Note: group members can see each other's phone numbers, so share only what you're comfortable with.
You don't have to carry this alone
Talk to our team any time, or find a professional near you.
