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What do you do if someone confides in you about a mental health problem?

I don’t mean someone talking to you about their diagnosis. I mean someone who is struggling with something–self harm, drugs, suicidal thoughts, an eating disorder, any mental health problem–and this person tells you about a problem they are having, and they are not receiving any help.

When we were in high school and college there were things we could do. A system in place where we were supposed to tell a counselor or a teacher, or the friends’ parents. We may not always have done that (and from what I’ve observed at high school and college I’m kind of glad we didn’t) but nevertheless the option was still there. And I remember in high school talking about whether to tell X’s parents about a problem that we couldn’t help her with and we were extremely worried.

The point is that there are safeguards in place when we are in school. A friend doesn’t have to worry about how to help their suicidal friend, there is a system in place that provides help, and that furthermore manages to do so without potentially damaging the person’s reputation.

Out in the “real world” what do you do if a friend tells you they’re suicidal? There’s no school counselor to talk to, no parents to go to, it’s just you and your friend. You will be glad that your friend reached out and asked for help but then what? You’re left with a really big burden. If something happens to your friend you will always feel responsible, but if you can’t talk your friend into going to get help what are you supposed to do?

As far as I can tell all the options that are available in the “real world” are potentially damaging. If your friend has a drug problem you can get the police involved. If your friend is suicidal you can (sometimes) get them held on a psychiatric ward for a certain amount of time. But these things both can indelibly mar a persons’ record. They can break that friend’s trust with you forever, and potentially make the situation a whole lot worse.

So what can you do? What would you do? Is it even your place to say anything?

I know that in high school I didn’t “tell on” my friends when there were these sorts of problems because I didn’t think it was my place to. The only situation I can think where I would have told some third party would have been if a friend told me she was going to commit suicide. In all other cases it felt like it would have been a breach of trust to say anything. I tried to get them to tell someone, but I never did it myself. Even so, the knowledge that I wasn’t the only person who could help was comforting. I never felt overburdened with another persons’ problem because I knew if I got too worried I could tell an “adult”.

But what now? What if a friend comes and tells me they have drug problem, an eating disorder, depression? What can I do if I feel like their life is in danger that wouldn’t risk harming their future (being sectioned is not particularly good in medical records and can still affect certain jobs).

Mental health problems don’t end when we leave college, but it seems like most of the safeguards do.