Content warning: This week’s episode discusses issues around mental health and suicide. If you or someone you know is struggling with suicidal thoughts, anxiety or depression, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text the Crisis Text Line at 741741. Here’s how to find help outside the U.S.

When Daleena Abraham was in college, her friendship with Priya Balagopal felt really special. The kind where you survive breakups together, celebrate together and are just constantly by each other’s side.

“We were inseparable, and we fully embraced that,” Abraham said. “I was like, ‘Yeah, I’m your soulmate!'”

But despite the laughing fits, the sleepovers and the mixtapes they made each other, Abraham knew Balagopal struggled at times. Balagopal told Abraham she had made two suicide attempts and that depression, anxiety and borderline personality disorder were constant parts of her life.

One day, Abraham returned home from class and found Balagopal lying on her bedroom floor. Unconscious. A suicide attempt.

“That was, like, this moment of panic and fear,” Abraham said. “All of the, like, possible outcomes, like just racing through my head.”

She thought, I need to call 911, I need to call an ambulance. And then this other thought bubbled up — something else Balagopal told her that plagued her, on top of the depression.

“All of the things that she had told me about, like previous attempts, like when she was in high school, and like earlier in college, and this financial burden on her parents. Like, they’re still paying off some of those hospital bills,” Abraham said. “All of that rushed to my head. And I was like, ‘I can’t call an ambulance, they’re going to have more bills.'”

Despite this moment of panic and fear when her best friend’s life was on the line, Abraham felt like she had to think about the money. The cost of the ambulance and hospital bills. It was a factor she calculated because she knew that her best friend did too.

For some people, mental illness is wrapped up in shame and secrecy, but it can have as big an impact as physical illness, if not bigger. And as with a lot of other illnesses, it can be incredibly expensive to treat. It can feel like a vicious cycle: costly hospital stays or treatment, debt that becomes a stressor exacerbating mental illness, leading to more costs and more debt. Millions of people are trapped in it.

On this week’s show, Reema travels to North Carolina to talk with Balagopal’s mother and best friend about the high cost of mental illness and the toll it can take.

If you or a loved one is in crisis, please, please reach out to the Crisis Text Line (Text TALK to 741741) or the National Suicide Prevention Lifeline (1-800-273-TALK).

If you know someone who’s struggling, consider talking to him or her. Research shows that talking about suicide will not push anyone to kill themselves. Often the person may even feel relieved that someone cares enough to ask. The American Foundation for Suicide Prevention has a lot of great resources, including local support groups for people who have lost someone to suicide.

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“This Is Uncomfortable” is Reema Khrais, Megan Detrie, Hayley Hershman, Peter Balonon-Rosen, Camila Kerwin and Marque Greene.