How can I get help to my friend?

Annabelle Thorpe was faced with the delicate task of advising Suzanna to see a psychiatrist

Suzanna and I have been friends for years. Real friends, not the type you occasionally go for a drink with after work, or have to remind yourself to ring once every six weeks. We've seen each other through most things over the past decade and our relationship is built on mutual trust and respect, not to mention a good few nights of soul-baring drunkenness. We've supported each other through boyfriend traumas, job rejections, disappointments and frustrations and somehow we've always come up smiling. Until now.

For the last six months, Suzanna has become progressively more depressed. I don't mean the low-lying, day-to-day frustration that we all feel from time to time; this is far beyond that. To Suzanna life seems futile - work is dull, friends let you down, men are hopeless cases. And somehow I have become the only positive point of contact in all this, the one person she still believes in.

But I am ashamed to admit that this responsibility has become more than I can cope with, and I believe Suzanna needs professional help. It's not that I think she's hurtling towards a nervous breakdown, more that her perceptions of life have become distorted - a grey cloud of misery has settled in her mind, totally blocking out anything good. She needs to talk through her thoughts and fears with someone who may be able to help unravel their causes and slowly replace the depression with her old appetite for life.

But how do you go about telling someone that you believe they need to see a psychiatrist? Suzanna is an intelligent woman and I suspect she knows that she isn't well, but she certainly doesn't want to admit it. What right do I have to barge in and inform her that I think she needs help, when it may reaffirm her worst fears and send her into an even deeper depression?

According to the psychologist Patrick McGhee, friends can help in this sort of situation, but the subject must be introduced gently. "You have to be extraordinarily gifted with words not to upset and frighten someone if you simply announce you think they should see a psychiatrist," he says. "For many people mental illness is still practically taboo and the level of understanding is pretty basic; it's black or white - you're either sane or completely mad. The concept of being emotionally bruised or simply needing some support or help is not really understood, and so the idea of referral to a psychiatrist can often induce strong feelings of panic and fear."

This is my main cause for concern: if I do speak up, Suzanna may refuse point-blank to see a counsellor and stop confiding in me as well, in which case I have simply made the situation 100 times worse. If she no longer feels that she can trust me, then she really will be left with no one, and I will be powerless to help her.

"Rather than just announce your opinion, the best thing is gently to question the person about how they feel," explains Patrick McGhee. "If they admit to feeling depressed - or whatever their particular problem is - the next stage is to ask what they think would help them feel better; what action they could envisage taking. The most positive way to help is to encourage them to explore the problem themselves.

"They may have considered counselling but are too scared to admit they need it. This is where friends can help, by confirming that perhaps that kind of help may be necessary, and reassuring them that there is nothing to fear."

A friend, Karena, had a similar problem with a girlfriend of hers, Lisa, who began drinking heavily after discovering that her partner had been having a long-term affair. For weeks Karena worried about how to tackle the subject, understandably squeamish about telling Lisa that her friends were worried that she was becoming an alcoholic.

Eventually, unsure as to the best course of action, she went to an Alcoholics Anonymous meeting for friends and family, and what they said persuaded her to talk to Lisa.

She didn't accuse Lisa or define her as an alcoholic, but gently asked her whether she was aware that her drinking had increased. Because Lisa didn't feel criticised or threatened, she admitted to knowing she was drinking too much, and also admitted that she had thought about counselling. Karena suggested that they go to counselling together and after a little persuasion, Lisa agreed. The endless bottles of wine had been nothing more than a cry for help, and Karena felt dreadful that she hadn't answered it sooner.

The trouble is that whereas alcohol is a tangible problem, depression is far harder to define. It seems that rather than simply informing Suzanna of my opinion, I should encourage her to tell me how she feels and what she thinks could help her get better. Rather than taking the lead, perhaps I should be a little more passive.

"A friend's role is to support and reassure," says Patrick McGhee. "A doctor's role is to diagnose. The best thing a friend can do is to make the person with the problem feel safe. Admitting to needing professional help can be scary; friends can be a force for good by lending a sense of normality."

I know I have to talk to Suzanna, and if the only things stopping me from speaking up are fear that she'll resent me or anxiety that it will make her worse, then I'm simply being selfish. It's not an easy step to take, but then friendship isn't all Saturday afternoon shopping trips and bottles of wine after work. I can't make her see a counsellor, but maybe I can persuade her that it's not such a terrifying idea. After all, if the shoe were on the other foot, it's her I'd want sitting with me in the waiting room. She deserves nothing less from men

Dilemmas returns next week