Supporting People with Depression: A Guide for NDIS Support Workers
This guide brings together current research and the practical experience we have gained supporting people with depression across South East Queensland. Our hope is that by sharing what we have learned, more individuals, families and support workers can benefit from support that is respectful, person-centred and evidence-informed.
Registered NDIS Provider · Gold Coast, Logan, Ipswich & Brisbane
Depression is not sadness, and it is not laziness. Effective support is not about cheering someone up or pushing them to "just get moving." It is about understanding how depression affects a person's energy, motivation and sense of self, reducing unnecessary friction in daily life, building a genuinely trusted relationship, and creating conditions in which they can keep working toward the goals that matter to them, even at a slower pace than the world expects.
At Hearts In Action, these principles guide the way we support people every day. This guide combines evidence from current depression research with practical insights from our work alongside people with depression and their families. We hope it encourages thoughtful, compassionate support that helps people build on their strengths, regain momentum and live life on their own terms.
A note before you read on
Every person is unique, including every person who experiences depression. The patterns in this guide come from research, but no two people experience depression the same way, and no single approach here will suit everyone.
Use this guide as a way to build understanding while remaining open, curious and responsive to the person you are supporting. Their experiences, preferences, strengths and pace should always guide the support they receive.
The Relationship Is the Intervention
If there is one finding that cuts across major studies of depression support, it is this: the quality of the relationship often matters as much as any specific technique. A qualitative study of peer supporters working with older adults living with depression found that the strongest, most durable relationships were often built not around a shared diagnosis but around shared, ordinary experience, one peer supporter described connecting with someone over physical aches and pains before anything about mood was ever discussed. Peer supporters described forming genuine emotional bonds with the people they supported, bonds strong enough that program endings brought real separation anxiety for the supporters themselves (Tang et al., 2022). It's the same everyday consistency our personal care and daily living support is built around.
It's worth remembering
Be someone they can rely on. Keep your word, arrive when you say you will, and follow up when you say you will. You don't need to fix someone's depression to be genuinely useful to them; a steady, ordinary, trustworthy presence is doing real work on its own.
Understand What Depression Actually Is
Depression is not simply feeling down. Clinically, major depressive disorder involves a persistent, pervasive drop in mood, interest and energy strong enough to interfere with everyday functioning, relationships, health care and work, and it frequently outlasts whatever triggered it. A mixed-methods study of adults living with major and treatment-resistant depression in England found that tiredness, lack of energy and motivation were among the most dominant themes in how participants described the condition's impact on their daily activities, socialising and career goals, alongside poor concentration and decision-making (Kerr et al., 2023). The study's authors concluded that standard clinical assessment tools likely underestimate how much depression genuinely affects a person's day-to-day functioning.
It's worth remembering
Depression is physiological, not moral. When someone struggles to get out of bed, cancels plans, or can't seem to start a simple task, that is not a lack of willpower. Treat the person as someone managing a genuine drop in energy and functioning, not as someone who just needs to try harder.
Embrace Person-Centred, Autonomy-First Thinking
Research on depression care consistently shows that people do better when they are active participants in their own support. A study of shared decision-making in depression treatment among an underserved patient population found that people wanted genuine collaboration when information was being weighed up, but also wanted to retain control over the final decision about their own care, and that trust in the person supporting them was described as a critical precondition for that collaboration to work at all (Matthews et al., 2021). The same study found that stigma around depression itself often shaped how willing people were to engage with treatment and support in the first place.
Support that respects autonomy does not mean leaving someone to manage everything alone. It means making plans together, explaining why a strategy might help, and adjusting based on feedback rather than insisting that a manual knows best.
It's worth remembering
Ask what the person wants from the session before you decide what to do. Offer options rather than a single fixed plan, and don't take it personally if today's answer is "not much." Trust is what makes collaboration possible, and trust is built slowly.
Recognise the Hidden Costs: Withdrawal, Low Energy and Masking
Many people with depression spend real energy managing how they appear to others, showing up to a shift, answering "I'm fine" on autopilot, or pushing through a visit while privately running on empty. From the outside, they may look functional; on the inside, the basics of the day may already be using up everything they have.
Withdrawal from activities and relationships is one of the most common and most misunderstood features of depression. It is rarely a lack of care for the people or things being withdrawn from. More often it reflects a genuine, functional drop in the energy and motivation needed to sustain them, the same drop in energy, motivation and concentration documented in research into how depression actually affects daily functioning (Kerr et al., 2023).
It's worth remembering
Don't assume that someone who seems to be coping is coping easily, or that cancelling plans means they don't want your support. Create an environment where the person doesn't feel they have to perform: accept low-energy days, honest "I can't today" statements and small steps rather than pushing for big leaps.
Fatigue and Cognitive Fog Are Core, Not Character Flaws
For many people, the most disabling part of depression is not sadness at all, it is exhaustion and mental fog. Research into the lived experience of major and treatment-resistant depression found that tiredness and lack of energy directly impacted participants' daily activities, socialising and career goals, and that poor concentration and difficulty making decisions were prominent enough to explain reduced work performance (Kerr et al., 2023). From the outside, a person moving slowly through a simple task, or struggling to decide something small, can look like disinterest or indecisiveness. It is more often a real, measurable drop in cognitive and physical capacity.
It's worth remembering
Don't mistake slowness for a lack of effort. Build in extra time for decisions and tasks, offer fewer choices rather than more, and be patient with a pace that may look different from what you'd expect. What looks like low effort is often someone working hard with a fraction of their usual capacity.
Structure and Small Activity Are Supports, Not Pressure
Structure can make a genuine difference for people living with depression, not because it forces someone to "snap out of it," but because rebuilding small amounts of activity and routine is itself one of the most evidence-based ways depression improves. A meta-analysis of 22 randomised controlled trials of individual behavioural activation, a structured approach built around scheduling small, achievable, meaningful activities, found a large effect on depression symptoms compared with control conditions, with benefits broadly comparable to other established therapies such as cognitive behavioural therapy and interpersonal psychotherapy (Cuijpers et al., 2023). That same approach, small achievable steps planned together, is what our capacity building support is built around.
The key is that this structure is built with the person, not imposed on them. A single small, achievable activity chosen and scheduled together, a short walk, one phone call, ten minutes of a hobby, does more than a long list of "shoulds" handed down from someone else.
It's worth remembering
Help the person build their own system, not yours. Start smaller than feels necessary, celebrate the small win, and resist the urge to add more once something is working. A single activity done consistently beats an ambitious plan abandoned after day two.
Evidence-Based Strategies You Can Support
You are not a therapist, but you can support the use of evidence-based strategies in everyday life. Research gives us approaches that are both effective and adaptable to NDIS support work.
Behavioural activation. A meta-analysis of individual behavioural activation for adult depression found a large effect (Hedges' g = 0.85) compared with waitlist or usual care, and the effect remained significant even when restricted to the lowest-bias studies (Cuijpers et al., 2023). In practice, this looks like identifying activities the person values or used to enjoy, breaking them down into small achievable steps, and scheduling them consistently, then reviewing and adjusting together. Support workers are often perfectly placed to help this actually happen, showing up, providing the transport or company that turns an intention into something real, the same everyday participation our community access support is built around.
Digital and app-based support. A systematic review and meta-analysis of 17 randomised controlled trials of digital behavioural activation interventions found significant reductions in depressive symptoms at two, three and six months, with quality of life also improving significantly at the three- and six-month marks, though these benefits did not persist at twelve months without ongoing use (Jia et al., 2025). This suggests digital tools work best as an active, ongoing part of someone's routine rather than a one-off download. Support workers can help by scheduling time to use a program, troubleshooting access, and checking in on whether it still feels useful.
It's worth remembering
Your role is to make it easier for people to use the strategies they already have or are learning, not to diagnose or prescribe. Ask what tools they've been given by therapists, clinicians or apps, and explore together how those can be woven into ordinary days.
Support Identity, Not Just Symptoms
People are not their depression. A qualitative study of personal and societal recovery in depression described personal recovery as an intrapersonal, retrospective process of self-discovery and self-management, and societal recovery as a separate, interpersonal process centred on rebuilding belonging through meaningful participation (van Geffen et al., 2026). The researchers noted that people often move through a low-demand phase of small, manageable activities before they are ready for roles that align with their values, and that the kind of support someone needs shifts over that journey, from empathetic support in the harder early stages toward more practical, pragmatic support as things improve.
It's worth remembering
Notice what stage of recovery someone seems to be in and adjust your support accordingly. Early on, that might mean simply being present without expecting much. Later, it might mean practical help getting back toward roles and activities that reflect who they are. Neither stage is a step backward.
Address the Training Gap
Inadequate training around depression, and the stigma that so often accompanies it, is a structural issue that directly limits support quality. A systematic review and meta-analysis of interventions to reduce mental health stigma among healthcare professionals in primary care found that contact-based and multicomponent training, approaches that combine education with direct engagement from people with lived experience, produced stronger and more lasting improvements in attitudes than education alone. Purely educational programs showed gains that were often short-lived, tending to decline within three to six months without reinforcement (Zhamaliyeva et al., 2025).
This matters directly for support work. A single training module is a starting point, not a finish line. Ongoing exposure to real people's experiences of depression does more to shift how you actually show up than a one-off session ever will.
It's worth remembering
Seek out depression-specific training and, where possible, learn directly from people with lived experience, not just textbook material. Revisit it regularly rather than treating it as a box ticked once. The more clearly you understand what someone is actually managing, the more naturally your support adapts to what they need.
Families and Networks Are Partners, Not Peripheral
For many people with depression, family members and close friends carry a substantial informal support load. A mixed-methods study of carers supporting people with treatment-resistant depression found that carers of someone currently unwell showed significantly lower quality of life than carers of someone in remission, and that the psychological distress of caregiving frequently cascaded into carers' own physical health, concentration and day-to-day functioning. Notably, when the person they supported achieved treatment success, carers themselves experienced reduced anxiety and regained a sense of autonomy (Denee et al., 2023).
This cuts both ways: families are often carrying more strain than they let on, and effective support for the person you're working with can genuinely ease pressure on the whole household, not just the individual.
It's worth remembering
Where appropriate and with the participant's consent, keep families informed about what's going well and any changes you've noticed. A brief, clear update can reduce household tension and help everyone provide support that fits together. You are not working in isolation, and neither is the family.
References
- Cuijpers, P., Karyotaki, E., Harrer, M., & Stikkelbroek, Y. (2023). Individual behavioral activation in the treatment of depression: A meta analysis. Psychotherapy Research, 33(7), 886–897. https://doi.org/10.1080/10503307.2023.2197630
- Denee, T., Kerr, C., Eva, J., Vincent, S. A., Young, A. H., Jacobsen, N., Desai, M., Baldock, L., & Rathod, S. (2023). The impact of treatment-resistant depression on the lives of carers: A mixed-methods study. Journal of Affective Disorders, 325, 194–205. https://doi.org/10.1016/j.jad.2022.12.135
- Jia, E., Macon, J., Doering, M., & Abraham, J. (2025). Effectiveness of digital behavioral activation interventions for depression and anxiety: Systematic review and meta-analysis. Journal of Medical Internet Research, 27(1), e68054. https://doi.org/10.2196/68054
- Kerr, C., Denee, T., Vincent, S. A., Bailey, K. M., Young, A. H., Rathod, S., Desai, M., Baldock, L., & Jacobsen, N. (2023). The lived experience of major and treatment-resistant depression in England: A mixed-methods study. Acta Psychologica, 240, 104035. https://doi.org/10.1016/j.actpsy.2023.104035
- Matthews, E. B., Savoy, M., Paranjape, A., Washington, D., Hackney, T., Galis, D., & Zisman-Ilani, Y. (2021). Shared decision making in primary care based depression treatment: Communication and decision-making preferences among an underserved patient population. Frontiers in Psychiatry, 12, Article 681165. https://doi.org/10.3389/fpsyt.2021.681165
- Tang, J. P. S., Liu, T., Lu, S., Sing, C. Y., Sze, L. C. Y., Lum, T. Y. S., & Tse, S. (2022). "It was the deepest level of companionship": Peer-to-peer experience of supporting community-dwelling older people with depression, a qualitative study. BMC Geriatrics, 22, Article 443. https://doi.org/10.1186/s12877-022-03121-4
- van Geffen, A., Smit, D., Vrijsen, J. N., & Spijker, J. (2026). Personal and societal recovery in depression: A qualitative study. International Journal of Mental Health Nursing, 35(2), Article e70247. https://doi.org/10.1111/inm.70247
- Zhamaliyeva, L., Ablakimova, N., Batyrova, A., Veklenko, G., Grjibovski, A. M., Kudaibergenova, S., & Seksenbayev, N. (2025). Interventions to reduce mental health stigma among health care professionals in primary health care: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 22(9), Article 1441. https://doi.org/10.3390/ijerph22091441