What do I do if I think a friend or family member has mental illness?

I’ve had many people ask me: What should I do if I think my friend or family member has mental illness?

Mental illness is a touchy subject. There is a lot of stigma surrounding mental health conditions, as well as a great deal of misunderstanding. I think we are all afraid of bringing up something, in case we might anger or offend the person. But if you really are concerned, here is my suggestion for how to proceed.

Step 1: Know and Recognize the Signs
Drawing from the American Psychiatric Association, Everyday Health, and Mental Health America, here are common warning signs of mental illness in adults as concisely as I can put it:

•    Thoughts of suicide and death, or attempts (IMMEDIATE RED FLAG)**
•    Delusions or hallucinations
•    Differences in usual behavior or decline in functioning
•    Prolonged sadness, irritability
•    Excessive fears, worries and anxiety
•    Rapid or dramatic shifts in feelings or “mood swings.”
•    Increase in risky behavior, which is unusual for the person, such as spending extravagant amounts of money or becoming hypersexual
•    Substance abuse
•    Dramatic changes in sleeping, eating, and self-maintenance

Additional signs are (quoting the above sources directly):
•    Confused thinking
•    Feelings of extreme highs and lows
•    Social withdrawal
•    Strong feelings of anger
•    Growing inability to cope with daily problems and activities
•    Denial of obvious problems
•    Numerous unexplained physical ailments
•    Recent social withdrawal and loss of interest in others.
•    An unusual drop in functioning, especially at school or work, such as quitting sports, failing in school, or difficulty  performing familiar tasks
•    Problems with concentration, memory, or logical thought and speech that are hard to explain
•    Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations
•    Loss of initiative or desire to participate in any activity; apathy
•    A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality.
•    Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult.
•    Fear or suspiciousness of others or a strong nervous feeling.
•    Uncharacteristic, peculiar behavior.
•    Dramatic sleep and appetite changes or deterioration in personal hygiene.

Step 2: Look at the circumstances
•    Does mental illness run in the person’s family?
•    Does/Did this person abuse substances?
•    Did this person undergo any major life changes, such as going to college, starting a new job, experiencing the death of a loved one, or divorce?
•    Did this person undergo any traumatic event recently or in the past?
(Partially drawn from WebMD)

Step 3: Decide whether to bring it up to the person directly, or tell someone close to that person
First, don’t throw in the mental health card right away. I also encourage you to avoid the word “illness” during the conversation because it is so stigmatized. Talk to the person and bring up the signs you’ve noticed gently and gradually. Try to understand why they are behaving, thinking, or feeling the way they are.

Express that you are concerned and you want to help. Listen to them empathetically.

For example:

“Hi Hufsa. Are you alright? … I just wanted to let you know that I’m concerned about you because of a few things I’ve noticed. Is it alright if I point them out to you? … Well, I noticed that you haven’t been going to class lately and just stay in your room. This worries me because you don’t normally do that. I’ve also heard you cry in your room at night. Have you noticed these things?”

Step 4: Address the stigma and bring up the mental health issue
It’s a fact that people don’t understand mental illness and that mental health is as real as physical health. Bring up that you care about the person, and also relate it to a physical illness like the diabetes. Again, I don’t recommend saying the word “illness” because that is charged and stigmatized (at this time).

“Hufsa, I care about you, and I’m only telling you this because I want you to be better. If I noticed that you were eating a lot of sugar, getting dizzy, and having blurry vision, I would let you know that I think you have diabetes and encourage you to seek help. I’m doing the same thing right now by telling you I think you’re not well mentally and physically.”

Step 5: Let the person know they’re not alone and offer your help
It is important that the person knows that they are not alone. I cannot stress this enough. Let them know that there is help available and that you will (or have someone else) go with them to their first appointment. Help them make a call to their local NAMI for information and resources and where to seek help.  Give them information from the NAMI website on mental illness to educate them and normalize what they are going through.

“I know this might be a lot to take in. But I want you to know that you are not alone. I will be there to help you through this process of getting help if that’s what you want to do…here is information I found about mental health and there’s an organization called NAMI that can help you too. I can call them with you…”

Step 6: Follow up and help the person build a support system
Be sure to check in with the person after. Taking in the concept of having a mental health condition can be frightening, confusing, and overwhelming. It is frequently a long process and the person needs people by their side.

Again, these are just suggestions for what to do. I have consulted with several individuals with mental illness about how they would like to be approached by someone else about their illness, and this is what I’ve come up. By all means, if you have something to add, please do so in the comments!

** IF SOMEONE HAS VOICED SUICIDAL THOUGHTS, call 1 (800) 273-8255 with the person, the Suicide Lifeline IMMEDIATELY.**