Can I help an old, distant friend with apparent mental illness?

Several years ago, a long distance friend of mine was experiencing what were fairly obviously paranoid delusions. I knew they had a history of bipolar disorder, and that paranoia featured heavily in some of their worst times. At one point, they had given me their parent's email address for an unrelated reason (though I never contacted them). While they were telling me that people were out to get them, that lawyers had advised them to not leave the house because they might be killed, they also told me that I should not contact their parents (with whom they were living at the time) because they would just worry, and they knew as much about the situation as they needed to. I emailed their parents. They ended up hospitalized until they could be stabilized on medication. Today, several years later, this person is doing far, far better. I felt bad breaking their trust at the time, but now, I have zero regrets. I knew I was not able to provide the help this person needed, and I knew that people closer to them would be more equipped to get them in touch with that help. I'm sorry. This is a really tough situation, and I'll reiterate what everyone else said about taking care of yourself first.

First of all: protect yourself. Protect your personal safety and that of your family, your property, your finances; do not give Chris any more information than you already have --- do not provide your address, your employer, or anything other than the phone number they already have. Do not offer a place to stay or agree to 'lend' money. I'm sorry if this sounds harsh, but the Airline Oxygen Rule applies here: that's the rule where if you're on an airplane in trouble, you put on your own oxygen mask first, then you can try to help someone else --- it doesn't do anyone any good if you pass out too instead of remaining conscious so you can help others. As for Chris: yes, please contact their relative. Realistically, you are dealing with someone you honestly don't even know --- a slight acquaintance from 20 years ago, with a short re-acquaintance 12 years ago, then nothing until now? Chris is basically a total stranger to you. The best thing you can do --- for Chris, for you, for Chris's family --- is to ignore that promise not to do so, and to contact the relative at once.

From an anonymous commenter:Over the next months however it became clear that Chris was developing the belief - or had chosen to start revealing the belief to me - that the abuse had been the beginning of an organized campaign of persecution against them. In some sense, this is not an entirely crazy way to interpret abusive situations. If you read up on it, it is not uncommon for other people to have some idea that something is not right, but they look the other way because they don't want to stir up trouble or they aren't sure and thus are unwilling to call the police without anything but vague suspicions and so on. So, if you are in an abusive situation, in some sense, yes, it can feel very, very much like the people around you are colluding against you. Is it a wholly accurate interpretation? Not really. But, on some level, yes, when abusive things happen, in some sense, it happens because everyone fails to stop it. Many well meaning people can kind of dismiss the idea that it is as bad as it really is. The people who are abusing you may well be people in a position to prevent others from helping you. I attended a wedding and I did not wish to sit with someone who had raped me and no one cared because at weddings you sit with your relatives, so that is where I was escorted and seated -- near a man who raped me. I got a first boyfriend who was older than me and the two male relatives who had molested me were part of a family conference wherein it was decided behind my back that this guy was too old for me and he was obviously just a rapist and so on. And they forbade me from saying goodbye to him and cut me off from him. He had never had intercourse with me. Unlike my male relatives, he was willing to take "no" for an answer and wait until I was ready. But the age difference made his position indefensible if the law got called in and the law would have agreed that my relatives were merely looking out for my best interest. No one would have believed me if I had told them that my rapists were preventing me from getting a boyfriend, probably out of jealousy and a need to still control me, even though they were no longer molesting me. If police had been called, it would have been a shit show and I likely would have ended up in a psych ward. That is not to say Chris is correct that there is some kind of organized conspiracy. There was no organized conspiracy in my case. I am sure that neither of the men who molested me knew that the other one had done so at the time of the family meeting. I am sure that on some level, they believed they were, in fact, protecting me from a pedophile and rapist -- not because my boyfriend was either of those things, but because they were unable to see that not all men were like them. They were projecting their own tendencies on an innocent third party and there was no way I could have proven to authorities that this decision was evil fruit from an evil seed. My past experience allowed me to actively encourage someone to flee an abusive situation. Their other friends did not think it was really that bad and were encouraging them to stay. After they fled, it became more apparent how truly terrible it was. The abusive relatives had connections and did, in fact, do things like managed to get an arrest warrant issued on trumped up charges. So, given my experiences, I tend to err on the side of believing people if they do not trust a particular relative. If this were my friend, I would not contact the relative. As others are saying, yes, try to make sure you are safe. The reality is that if something really awful is going on in terms of multiple other people being problematic for this person, there may be nothing you can do other than try to do no harm. It may be beyond your ability to provide any kind of real help. The person who took my advice and fled -- they briefly left some of their stuff at a friends house and retrieved it on the way out of town. This friend of theirs got dragged into this shit show and, initially the friend's relatives were mad as hell about it -- until they met the abusers and saw firsthand how sick these people were. They covered for the escaping person, but then told them "Don't contact us again." Which was for the best for all parties. And I tell that to say this: If there really are dangerous people trying to do something bad to this person, which does, in fact, sometimes happen, you trying to help them may in no way protect them and may, in fact, just get you in over your head. So please do not try to insert yourself here. You do not sound qualified to handle it. I knew what I was doing and I had a good idea that I was probably beyond the reach of the relatives in question. I don't regret my actions. But I knew that I was dealing with dangerous people and this was not just someone making stuff up and I had dealt with that kind of thing before. So, while it is possible the person is merely mentally ill, it is also possible they are trying to articulate something that, on some level, is real but they are doing a terrible job of trying to explain it. Or perhaps they are mentally ill because of the abuse and this is causing them to exaggerate or frame things in a particular way which sounds really crazy, but that doesn't mean they do not have genuine reasons to be concerned about you talking with their relatives and giving them information about them. In situations where I am not clear what is really going on, for absolute sure, I try to err on the side of "first, do no harm." If I do not know for sure that someone is trustworthy, I try to say nothing to them. I do not think you know enough about Chris and their life and their relatives to make sound judgment calls about whom to talk to and what to say to them. And it sounds like you don't know enough about dealing with potentially dangerous relatives to navigate that either should there be any truth to it.

Finally I've marked this resolved (my core issue being resolved as much as it's likely to) and marked several answers I found most helpful - but I want to reiterate how much I appreciate all answers, especially those from people sharing their direct experience with family or friends.

I'm sorry. This is so hard. You are not going to be able to fix this on your own, no matter how much you care for this person. I know you understand that, but it's important that you hear it again and really believe it. What you can do is act as a safe ear for your friend. What you say about believing that Chris is genuinely upset, unhappy, scared and cofused is really the heart of this. You can hear that and let Chris know that without buying into the delusional beliefs. You can be ready with resources for Chris to get psychiatric help (a hotline, a psychiatric emergency room near you, things like that). You can call for help if Chris ever seems like a danger to him/herself. Beyond that, there are not many things you can do. It's important that you take care of yourself if you're going to be available for any of this. Setting limits and boundaries is part of that. Think of what you can and cannot provide for this person and give yourself permission to stick to that. http://www.nami.org is a great resource if you have questions or need help with resources.

I just wanted to post a quick follow up. I took the preponderance of advice and did contact the family member who'd originally reached out to me on Chris' behalf. As some suggested was likely it turned out that this was very much a known issue and that the family is doing their best to manage it and get Chris help. I'm not going to get into any more details out of respect for everyone involved. I'm glad I took the advice to reach out, and I believe it was the correct advice, though in this case it turned out to be basically moot. There has been no further response from Chris and I don't know if there will be but if there is I will continue to offer my friendship and emotional support while asserting that I can't and won't engage with the issues of these particular beliefs. Thanks again to everyone who gave advice.

In general, it's also good to keep in mind that unless Chris is in serious immediate danger (which generally means he's actively suicidal, or else so disabled by his mental illness that he's refusing or unable to eat or to avail himself of housing options or that he's so out of it he's putting himself in danger, like wandering into traffic), no one can really force him into treatment (and even then, it's complicated and difficult). I think it's a great idea to make sure people who can help him are aware that he likely needs help, but be aware that that might be all you can do, and that's ok. There's a line that everyone's walking between making sure people in need don't get hurt and making sure no one loses their right to autonomy without really good reason, and a lot of friends and family of people with mental illness can get frustrated or demoralized at the inability to force someone into treatment. It can be really helpful to manage your expectations accordingly -- activating a safety net is a great goal, even if it doesn't result in an immediate change in Chris's functioning. A person with mental illness and an engaged social safety net is in a much better position than a person with mental illness and no social safety net.

I appreciate everyone's advice particularly those drawing from their personal experience. Given the preponderance of advice I'm inclined to do my best to see that someone trustworthy with a more direct and active connection with "Chris" is aware of the situation. I'm considering the best way to go about this. I also appreciate the reminders to take care of myself and to be appropriately circumspect given the unpredictability of Chris' condition.

You're right that diagnoses can't be made over the Internet; the anonymous commenter is correct that sometimes there are abusive, persecutory dynamics within families or groups. What there are absolutely not are strangers on the street being paid to whisper about passersby. It's not a diagnosis to name a symptom, and this is absolutely a paranoid delusion. What that symptom is caused by, what the "diagnosis" is could be a whole range of things. Most of that range of things gets much more unpleasant the longer they go untreated and, for that reason I would not hesitate to contact the family member or a religious leader. If it makes you feel any better, you're not violating your friend's trust in the manner we usually think of...as though they'd sworn you to secrecy about an unrequited love or some such. It's much more analogous to, say, your friend hit his or her head and it's super obvious s/he has a concussion, but impaired judgement from the concussion is keeping him/her from seeking medical care.