Dear Annalisa

I have an old friend who I moved away from about six years ago. When I left he was a lovely, jolly chap who was friends with everyone. He was positive, optimistic, a real comedian and a joy to be around. He had recently married and he and his wife were expecting their first child. 

The child they had, a boy, was autistic. Shortly before their son’s birth his wife had become estranged from her previously close family. The stress that this caused drove him and his wife apart, and she moved out about two years ago. She cannot spend any time alone with their son as he constantly hits her. They have no family support. She has decided to not work, and instead volunteers at the special school that their son attends. Both are devoted parents; however, their relationship is in tatters. They are stressed, sleep deprived and I think my friend is deeply depressed. 

Every time I have visited, he has seemed worse and worse, and now I’m worried he will consider killing himself. He financially supports himself and his wife, and struggles to pay the bills. He seems to feel deserted by his parents. His son’s behaviour is getting worse and he cannot have a night off because his son will not go to anyone else. He seems imprisoned by his situation and cannot see a way out. 

He lives quite a distance away and I only manage to make it back once a year, but the lovely, friendly, bubbly person I knew is gone. I want to offer support but I’m not sure how. I’m terribly worried for him.  

I was confused by the living arrangements. It sounds as if your friend’s son lives with him but his ex-wife, the boy’s mother, lives nearby? This is the assumption I’ve made, anyway.

Well done for wanting to help and being concerned, and not just turning a blind eye to what sounds like a very stressful situation for all concerned. I would like your friend to contact the National Autistic Society (autism.org.uk, helpline 0808 800 4101). I spoke to them on your behalf and one of the first questions they asked is when did the behaviour in the little boy start and are there/were there any triggers?

I also spoke to Andrew Kinder, who is a counselling psychologist (bacp.co.uk). He said that your friend shouldn’t hesitate to contact the Samaritans (call 08457 909090, or email jo@samaritans.org) in the most immediate instance. In the more long term, I wonder if you could persuade him to visit his GP for advice? Again, I know the support varies but some GPs are wonderful for mental health problems. Sleep deprivation affects emotional wellbeing and is not to be underestimated. I wonder if there is anything that could be done here to help him?

Kinder also said that it sounded as if your friend and his ex are immersed in quite separate, but connected, worlds. “There seems to be a lack of sharing about what it’s like in the other’s camp,” Kinder pointed out. “I wondered if they could get a greater appreciation [of each other’s lives and stresses] and build a joint strategy. Jointly build up support for, and with, each other.” Kinder said it sounded as if your friend is very “head down” about earning money, quite understandably, but wonders if he is tending to his emotions about it all. Men can, to generalise wildly, fixate on making things better practically rather than emotionally. You describe your friend as a “comedian” and that immediately made me wonder if, even before this, he tended to suppress more negative emotions?

Does the boy’s school have any practical guidance on how to help too?

I know you live far away but you can call or email to keep in touch. Perhaps you could show him this column and ask a question, as Kinder suggested – knowing how hard it can be to reach out for help when you feel so down – “if they don’t get help, what will it be like in a year’s time?”

This first appeared in the Guardian Family section on 10 October 2014.